Children are once again at the front lines of pandemic-era social service cuts, this time in the form of Medicaid restarting its annual eligibility checks, which has resulted in many eligible children losing their benefits.
Altogether, around half of the children losing Medicaid have done so for administrative reasons, not because they have been proved ineligible. The state must ensure the accuracy of Medicaid enrollments, but it shouldn’t be doing so by carelessly erring on the side of ending benefits for vulnerable people who may well still be eligible.
The state’s “unwinding” of the pandemic rules, which allowed continuous coverage without renewal procedures, has resulted in a messy administrative backlog since the process began nationwide in April. In particular, families who moved during the pandemic, switched jobs or are receiving other government benefits are now getting lost in a bureaucratic maze trying to receive the care they previously had access to.
But other Medicaid recipients — in Pennsylvania, a maximum of 100,000 people may have been affected — have gotten kicked off the rolls because the state’s automatic system doesn’t assess eligibility on an individual basis, but only through households. This led the state, and 30 others, to incorrectly remove coverage from entire families if even just one person in the household is ineligible.
Caseworkers now have to manually collect data to approve each individual case. As of Oct. 23, no one in Pennsylvania affected by the glitch had been re-enrolled.
The hope was that children losing Medicaid might transition to other forms of coverage. There is some evidence this is happening in Pennsylvania, where Children’s Health Insurance Program (CHIP) enrollment has increased by nearly 25,000. Enrollment has stayed flat nationally, however, indicating that many children getting removed from Medicaid remain uninsured, or that their parents are opting for pricier private coverage.
Restoring automatic renewals based on reliable data the government already collects would be the obvious and least labor-intensive solution, at least until a better eligibility assessment system can be built. Right now, only 4% of Pennsylvania’s renewals go through this automatic process, the third-lowest rate in the nation.
Children’s health insurance doesn’t have to be this complicated. In late September, the Biden administration sent a letter to all states ordering 12 months of continuous Medicaid coverage for children, regardless of parents’ fluctuating incomes, starting in January 2024. This will buy time for states to staff up and fix their own Medicaid systems. However, families who have already been removed, or are currently in administrative limbo, won’t find relief until then.
The benefits of health insurance — benefits which help not just the child and family but society — are undermined when coverage is inconsistent. Developing relationships with primary care providers and removing the price burden for routine appointments results in better health outcomes and fewer emergency room visits.
Governor Josh Shapiro has emphasized streamlining government agencies, and the failure in “unwinding” Medicaid is a conspicuous example of the inadequacy of the bureaucracy he inherited. The state must provide support for families who have been erroneously removed from the rolls through the end of the year — while building out a modern, efficient and above all accurate system for determining eligibility moving forward. Children’s well-being depends on it.
Update: This editorial has been updated with new information regarding an increase in CHIP enrollment in Pennsylvania.
First Published: October 25, 2023, 10:00 a.m.
