MCH Advocates are Alarmed About the Rapid Loss of Child and Family Coverage in the Medicaid Redetermination Process
September 19, 2023

Medicaid has proven to be a critical safety net for families and children during the COVID-19 pandemic. As a result of the continuous coverage provision enacted in March 2020, there are now an estimated 95 million adults and children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), an increase of nearly 25 million above pre-pandemic levels. The continuous coverage requirement ended on March 31, 2023, and states are now conducting eligibility redeterminations of all Medicaid/CHIP enrollees, including children.  Effective April 1, 2023, states have been permitted to resume Medicaid coverage terminations. 

The Medicaid eligibility renewal process is off to a troubled start. According to the Kaiser Family Foundation’s Medicaid Enrollment and Unwinding Tracker, as of September 15th, over 6.5 million Medicaid/CHIP enrollees nationwide have lost their coverage. Across all states with available data, nearly 74% of people were disenrolled for procedural reasons. Procedural terminations can result from errors in state income verification processes, confusing communication from the state Medicaid agency or incomplete renewal paperwork, among other reasons.  Medicaid enrollees needing assistance with their applications are often experiencing excessive call center wait times, and Medicaid enrollment staff with insufficient knowledge of the Medicaid renewal process.  Many who have lost coverage for procedural reasons may still be eligible for coverage and are often not clearly informed about their appeal rights. In the 15 states reporting age breakouts, children accounted for over four in ten (43%) Medicaid disenrollments. The rate of coverage loss is outpacing predictions by policy experts.  

The disenrollment numbers are not going unnoticed. The Centers for Medicare and Medicaid Services (CMS) recently sent letters to all states, reviewing their respective data on procedural terminations, call center wait times and renewal application processing time. The agency also reminded states of their responsibilities to ensure appropriate access to renewal resources for people of color, people with limited English proficiency, and people with disabilities. 

CMS has offered states a robust list of strategies to minimize procedural disenrollments. At least 10 states are using strategy #14: Delay procedural terminations for beneficiaries for one month while the state conducts targeted renewal outreach. CMS is also intervening in states that are in violation of federal rules and requiring that redeterminations be halted while problems are being addressed.   

CMS has called for an all-hands-on-deck approach to ensuring continuity of coverage and a fair redetermination process. The agency has developed a host of resources on the Medicaid/CHIP renewal process, including a communications toolkit, training presentations for advocates (“What is Happening With Medicaid and the Children’s Health Insurance Program (CHIP) Right Now?”), and targeted outreach material (“Reaching Children and Families in School-Based and Early Education and Care Settings”).  AMCHP and its partners – Family Voices and the Catalyst Center at Boston University – have produced a consumer brochure explaining options for families experiencing Medicaid coverage loss. Thoughtful and strategic communication is critical in the continuing months. 

Title V Maternal and Child Health (MCH) programs are strongly encouraged to work with local grantees, community health centers, state health policy organizations, and others to educate families about the renewal process, provide direct assistance to them when possible, and advocate on their behalf.  The urgency of this situation is an opportunity for MCH programs to connect with non-traditional partners that are equally concerned about keeping children and families insured.  Minimizing coverage loss is an issue that all organizations can rally behind.  

AMCHP will continue to monitor this issue, sharing updates through social media, Member briefs, Pulse, regional calls, monthly town halls, and special events and resources. We encourage you to look at our resources on this topic on AMCHP’s website under the Promoting Coverage for MCH topic.