Journal Article

Child Enrollment in States With and Without Continuous Coverage in Medicaid and CHIP During COVID-19

Nelson, Daniel B., Singer, Phillip M., Mandle, Jessie

2021

Overview

COVID-19 threatens the health of children, yet it is important to recognize that children's health is at risk not only by the disease itself but by the policies that have been adopted before and during the pandemic. As unemployment has increased during the pandemic, so has the risk of uninsur-ance.1 Loss of insurance coverage is particularly harmful for children because of the long-term health, education, and financial benefits of nsurance.2 Levels of health insurance coverage for children were decreasing even before COVID-19, outpacing similar negative trends in adult insurance coverage3 In an effort to improve children's coverage, 25 states adopted policies that extended continuous eligibility in the Children's Health Insurance Program (CHIP) and 23 states adopted continuous eligibility for Medicaid, allowing children to remain enrolled for a 12-month period even if temporary income changes would have made them ineligible for the program.4 Since the pandemic began, the federal government mirrored these state actions to stabilize Medicaid coverage through the Families First Coronavirus Response Act. The act provided enhanced funding for Medicaid, but it required states to not restrict eligibility standards and to provide continuous coverage without eligibility redetermination for enrollees through the remainder of the public health emergency. Although CHIP has been a policy success, its smaller enrollment and budget compared with Medicaid, recent lapses in federal funding, and fraying bipartisan support has resulted in a program that can be overlooked by policymakers.5 This is what happened when Congress did not require CHIP to provide enrollment protections for enrollees through Families First. During the pandemic, a handful of states have adopted enrollment protections for their CHIP programs, but this has been a patchwork approach. Ultimately, the contrasting treatment of continuous eligibility regulations, combined with the fragmented insurance landscape across programs, complicates and threatens the health of enrollees.We analyzed variation in Medicaid and CHIP enrollment changes across states that had implemented continuous eligibility policies prior to the COVID-19 pandemic. We aggregated data from the federal government's standardized monthly reports of Medicaid and CHIP enrollment figures across all the states. All states are required to report a range of data to the Centers for Medicare & Medicaid Services (CMS), including application, eligibility, and enrollment figures. We collected reported data from March to October 2020, when finalized reports by the CMS were last made available. We measured changes in child enrollment in two different ways-on a per capita basis and as a percentage change in enrollment over the time period of the study.

• Publisher: American Public Health Association
• Subject: Aggregate data / Changes / Child / Children / Children's Health Insurance Program - statistics & numerical data / Childrens health / Childrens health insurance programs / Coronaviruses / Correspondence / COVID-19 / COVID-19 - epidemiology / Eligibility / Eligibility Determination - statistics & numerical data / Enrollments / Families & family life / Federal government / Funding / Government / Government programs / Health care industry / Health care policy / Health education / Health insurance / Health Policy / Humans / Insurance / Insurance coverage / Insurance Coverage - statistics & numerical data / Legislatures / Medicaid / Medicaid - statistics & numerical data / Medicare / Opinions, Ideas, & Practice / Other Child and Adolescent Health / Pandemics / Policy making / Public health / Regulation / SARS-CoV-2 / Trends / Unemployment / United States - epidemiology / Viral diseases / Welfare recipients