Biden-Harris Administration Releases New Medicaid and CHIP Renewal Data Showing the Role State Policy Choices Play in Keeping Kids Covered

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Sec. Becerra Calls on Nine States with the Highest Child Disenrollments to Immediately Take Up Proven Federal Flexibilities to Protect Children and Families; Biden-Harris Administration Extends Federal Flexibilities to States Until End of 2024

The U.S. Department of Health and Human Services (HHS) released new data on state Medicaid and Children’s Health Insurance Program (CHIP) enrollment changes among children and youth since full eligibility renewals for these programs restarted earlier this year. The data released today make it clear that state policy choices have real consequences for children and families during Medicaid and CHIP renewals. States that take up proven flexibilities and strategies from the Centers for Medicare & Medicaid Services (CMS) are better able to protect kids’ coverage – especially when the state has also expanded Medicaid.

According to the data:

  • States that have taken up more of the federal strategies provided by CMS and prioritized auto-renewals (ex parte) to reduce red tape for families have helped more eligible children renew Medicaid and CHIP coverage. Many of CMS’ flexibilities make it easier for states to renew eligible children’s coverage by using data the state already has available.
  • Barriers to coverage, such as a failure to expand Medicaid, are leading children and youth to fall through the cracks. For example, the 10 states that have not expanded Medicaid – Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming – have disenrolled more children than those that have expanded combined. In non-expansion states, youth who turned 19 while the continuous enrollment condition was in place are at risk of falling in the coverage gap and becoming uninsured; these youth on average account for 27.6% of disenrollments among children in non-expansion states since March 2023, compared to 12.1% of disenrollments in states that have expanded.
  • More than 88 million people, including nearly 40 million children and youth, were enrolled in Medicaid and CHIP coverage as of September 2023. Before the pandemic, in February 2020, about 71 million people were enrolled in Medicaid and CHIP, including about 35 million children.

In light of this data, CMS released new comprehensive guidance to states on strategies to protect Medicaid and CHIP coverage for children during this return to regular Medicaid and CHIP renewals. The guidance also announced an extension of these federal strategies for states through the end of 2024. 

Secretary Becerra also sent letters  to the governors of nine states with the highest child disenrollment rates by number and percentage, urging them to adopt additional federal strategies and flexibilities to help prevent children and their families from losing coverage due to red tape. Those states include Arkansas – PDF*, Florida – PDF*, Georgia – PDF*, Idaho – PDF*, Montana – PDF*, New Hampshire – PDF*, Ohio – PDF*, South Dakota – PDF*, and Texas – PDF*. These nine states account for about 60% of the decline in children’s Medicaid and CHIP enrollment from March through September 2023, as indicated in the data release – PDFtoday. This is especially important for children and families of color who are likely disproportionately impacted.

“I urge you to ensure that no eligible child in your state loses their health insurance due to ‘red tape’ or other bureaucratic barriers during the Medicaid enrollment process,” said Secretary Becerra.

Because children’s eligibility thresholds are generally higher than those for adults, many children who have been disenrolled may still meet substantive Medicaid or CHIP eligibility requirements – underscoring the need for states to take further action to prevent eligible children from falling through the cracks. In his letter, Secretary Becerra called on these governors to:

  • Adopt the dozens of federal flexibilities and strategies developed to make renewals easier for children and families, including by leveraging guidance and tools published by CMS today;
  • barriers, like CHIP enrollment fees and premiums, that make it harder for children to transition to CHIP coverage if they are no longer eligible for Medicaid;
  • Reach additional families by reducing call center wait times and partnering with pediatric providers, managed care plans, schools, and community organizations; and
  • Expand their Medicaid programs, if states have not done so already, to ensure that young adults over the age of 18 have affordable coverage options and do not fall in the coverage gap.

The actions taken today reflect HHS’ continued commitment to helping people access comprehensive, high-quality health coverage, whether through Medicaid, CHIP, the Health Insurance Marketplaces, Medicare, or an employer. To date, HHS, through CMS, has issued extensive guidance to states on federal Medicaid and CHIP renewal requirements, approved nearly 400 flexibilities for states to make renewals easier for people, made a special enrollment period available on HealthCare.gov to help individuals no longer eligible for Medicaid transition to Marketplace coverage, engaged with stakeholders across the public and private sectors, and conducted extensive outreach and advertising efforts to improve awareness about the return to regular Medicaid and CHIP renewals. HHS will continue to closely monitor states’ renewal efforts to ensure their compliance with federal Medicaid renewal requirements and will not hesitate to take action where it identifies issues of non-compliance.

“CMS is doing everything in our power to protect access to health coverage during the Medicaid and CHIP renewal process, especially for children,” said CMS Administrator Chiquita Brooks-LaSure. “That’s why we’ve put forward dozens of strategies for states to protect children and families’ ability to stay covered. Many states have worked with us to adopt the strategies we’ve put on the table – and we strongly urge all states to do their part to make sure eligible children keep the coverage they need to grow and thrive.”

In addition to this data release – PDF on children and youth, CMS is releasing a CMS Informational Bulletin – PDF that highlights steps states can take to help keep eligible children enrolled in Medicaid and CHIP and announces for the first time that (e)(14) flexibilities will be available at least through the end of 2024, giving states even more opportunity to take up these strategies; new guidance to support transitions – PDF to other forms of coverage, including from Medicaid to CHIP and additional guidance – PDF to help states adopt CMS’ strategies and flexibilities to promote continuity of coverage; and data describing other enrollment trends – PDF during renewals, including trends related to Health Insurance Marketplace® enrollment.

* This content is undergoing Section 508 remediation and people with disabilities may experience issues accessing the content. If you need assistance, contact [email protected].

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