Understanding the Impact of Medicaid Unwinding on Children’s Healthcare Coverage
During the COVID-19 pandemic, states received increased federal Medicaid matching rates on the condition of maintaining continuous coverage for enrollees. However, with the public health emergency winding down, Congress enacted changes under the Consolidated Appropriations Act (CAA), 2023, to transition out of the continuous coverage requirement, termed “Medicaid unwinding.” This process aimed at ensuring smoother renewal for the approximately 94 million Medicaid enrollees at the end of 2022.
Changes in Legislation
Under the CAA, the continuous coverage requirement ended as of April 1, 2023. New provisions were introduced to facilitate a smoother renewal process, including a gradual phase-down of extra federal Medicaid funding throughout 2023 and mandatory reporting of unwinding data to CMS by states. Additionally, Congress mandated that all states provide 12 months of continuous eligibility for children in Medicaid and CHIP from January 1, 2024, albeit applying only after successful renewal or enrollment within the past year.
CHIP Coverage Dynamics
CHIP allows states to cover eligible children through M-CHIP, a separate CHIP program, or a combination of both. Most eligible children are covered through M-CHIP, protected by the Medicaid continuous coverage requirement. Despite the pandemic, some states paused separate CHIP disenrollments voluntarily. However, procedural disenrollments posed challenges, especially for children from marginalized communities, potentially leading to coverage loss despite remaining eligible.
Impact Assessment
Enrollment data reported to CMS reveal a decline of 4.16 million children in Medicaid/CHIP nationwide by the end of 2023 compared to pre-unwinding levels. Contrary to expectations, CHIP enrollment remained relatively stable. State policy choices, including the timing and prioritization of renewals, and variations in administrative renewal capacities, led to significant differences in disenrollment rates across states.
State Disparities and Concerns
Concerns about varying disenrollment rates prompted Health and Human Services Secretary Xavier Becerra to address nine Governors in December 2023. Disparities in disenrollment highlight the importance of understanding state-specific factors influencing the unwinding process and its impact on children’s healthcare coverage.
Conclusion
The Medicaid unwinding process, marked by changes in federal legislation and state-level implementation, has had significant repercussions on children’s healthcare coverage nationwide. Addressing disparities in disenrollment rates and ensuring smoother renewal processes remain critical in safeguarding children’s access to essential healthcare services.
