By – CHIP and Medicaid enrollment among children decreased by 2.2 percent by the end of 2018, raising serious concerns about the rate of uninsured children, revealed a new study conducted by Georgetown University’s Center for Children and Families (CCF).
Researchers pointed out that the drop in CHIP and Medicaid enrollment from 2017 to 2018 was unusual. The study showed that the rate of enrollment declined in only one year from 2000 to 2016. That year was 2007, and enrollment fell by 1.1 percent. Child enrollment in CHIP and Medicaid remained relatively stable after 2016.
While CHIP and Medicaid enrollment recently experienced significant changes, so did the rate of uninsured patients, researchers added.
The rate of uninsured children reached an all-time low of 4.7 percent in 2016. But by 2017, the rate increased for the first time in about ten years, rising to five percent despite the strong economy, researchers explained.
In an analysis of the first nine months of 2018, Center for Disease Control (CDC) broke down the data behind the uninsured rate. The report specified that uninsured children in poverty remained stable at 6.5 percent and in nearly-impoverished children, the number of uninsured dropped by 1.8 percent, which the CDC characterized as a “statistically insignificant” shift.
With the recent history of stable Medicaid and CHIP numbers, experts are grappling with this surprising departure from the trend.
The CCF’s analysis cited several causes related to the ACA’s implementation and partial repeal. The report stated that despite an increase in coverage for low- to moderate- income families, lower-income families still face eligibility and affordability concerns that may prevent them from accessing healthcare.
Individuals employed in part-time, temporary, or probationary positions often are ineligible for employer-sponsored insurance (ESI), making it impossible to extend ESI coverage to their children.
However, even eligible families who fall in the low- to moderate-income bracket face challenges when fulfilling the take-up rates and their employers’ low contribution to their healthcare plan.
To CCF Senior Fellow and Georgetown University Associate Research Professor Tricia Brooks and the report’s other authors, these statistics demand government action at both the state and federal level, including renewed marketing and outreach to families who may be unaware of their enrollment status and eligibility, improving the technologies, processes, and standards used to review Medicaid and CHIP applications, increasing accessibility to outstations, addressing how to apply “reasonable compatibility” standards during renewals and reviews, and establishing new performance indicators.
However, where Brooks and her colleagues find cause for concern, CMS Administrator Seema Verma, sees the results of “a thriving economy.”
On April 25, 2019, the same day that CMS released the CHIP and Medicaid monthly enrollment report, Verma tweeted, “It’s always been clear that as the economy improves, unemployment drops & incomes grow, people move off of public assistance programs like Medicaid. We’re exploring factors like the economy, as well as systems issues, data quality & reporting, & shifts in population patterns.”
From the same series of tweets on April 25, Verma confirmed that “the improving economy seems to be a consistent factor. Some states saw a downward trend comparable to the drop in unemployment.” This was based on her early analysis of seven states with the highest disenrollment. She also noted that overall enrollment in Medicaid had declined by 3.7 percent.
Observing the strong economy, the decrease in child enrollment, and the recent volatility of the number of uninsured children, experts disagreed about the causes contributing to these numbers.
“At a time when the economy is strong, the critical question is whether these children are moving to private coverage or becoming uninsured—a question that will not be answered definitively until the US Census Bureau’s American Community Survey data become available this fall,” the Georgetown University Health Policy Institute’s report concluded.