Monday, May 20

Biden Administration Warns 9 Governors About Medicaid Losses Among Children

The Biden administration on Monday warned governors in nine states of unusually high Medicaid coverage losses among children, suggesting officials were failing to protect young, low-income Americans as they vetted the program’s roles.

Xavier Becerra, the secretary of Health and Human Services, wrote letters to leaders of states that had the highest number or percentage of Medicaid coverage losses among children through September, after a federal policy requiring states to maintain people in the program had expired.

The calls to state leaders doubled as a call to expand Medicaid under the Affordable Care Act. Recipients of the letter included Governor Ron DeSantis of Florida, Governor Brian Kemp of Georgia, and Governor Greg Abbott of Texas. All three are Republicans who lead states that have not expanded Medicaid and where hundreds of thousands of children have lost coverage this year.

The nine states accounted for about 60% of the decline in enrollment in Medicaid and the Children’s Health Insurance Program, or CHIP, through September, federal health officials said.

Governors should “ensure that no eligible child loses their health insurance due to red tape,” Becerra said at a news conference Monday morning. She called on state officials to facilitate transfers of children from Medicaid to CHIP; reduce waiting times at the call center; and adopt special rules that allow states to streamline procedures for keeping children enrolled in Medicaid.

The letters, which the Biden administration released Monday with new data on childhood Medicaid losses through September, signal an aggressive new stance during the so-called unwinding of federal Medicaid requirements.

The process was marred by technical problems, bureaucratic errors and delays that caused thousands of poor children to lose health coverage.

Federal officials had been reluctant to target governors or state Medicaid officials as they worked to resolve these bureaucratic problems. Some advocacy groups and public health experts said the administration had not been aggressive enough in calling out, stopping and resolving lawsuits that had led to large numbers of children losing coverage in some states.

In a posted on XGov. Sarah Huckabee Sanders of Arkansas, a Republican to whom Becerra wrote Monday, accused the Biden administration of engaging in a “politically motivated public relations stunt by accusing us of limiting access to Medicaid.”

“This is false. During the liquidation process mandated by federal law, the Biden administration sent letters to some states to suspend their liquidation, but Arkansas was never one of them,” he wrote. “Arkansas respects state and federal laws, while Biden plays politics on Christmas.”

Children’s enrollment in Medicaid has fallen by more than three million this year, according to a separate analysis released Monday by Georgetown University’s Center for Children and Families.

Because of data lags and differences in how states report Medicaid losses, that figure is likely a significant underestimate.

Overall, Medicaid enrollment fell by nearly eight million, according to researchers. According to Georgetown researchers, nearly seven million children may be uninsured at least some of the time due to the settlement, or nearly one in 10 nationwide.

In September, Florida, Texas and Georgia saw the largest declines in childhood enrollment in Medicaid nationwide, according to data shared Monday by federal health officials. Federal health officials noted Monday that the 10 states that did not expand Medicaid under the Affordable Care Act canceled more children than all those that did combined.

Stacey Pogue, senior policy analyst at Every Texan, a research and advocacy group, said Monday that thousands of children in Texas are still waiting for decisions from state Medicaid officials, who face a substantial backlog of applications.

“We didn’t have the necessary staff. We didn’t have the necessary technology,” Ms. Pogue said.

According to KFF, a nonprofit health policy research group, more than 70% of people who lost Medicaid this year did so for procedural reasons, such as when a family failed to return documents to confirm their eligibility .

Children have more generous eligibility limits for Medicaid and CHIP, suggesting that many of those who lost coverage this year should have remained eligible for some form of coverage.

The researchers pointed out that only a small percentage of children transferred to CHIP, a sign that states have not done enough to facilitate such transfers.

Federal officials also presented data Monday showing what they say is a clear correlation between fewer Medicaid losses and the adoption of special waivers by the Centers for Medicare and Medicaid Services; states have requested waivers to facilitate the eligibility screening process.

The Biden administration said Monday that the waivers, of which nearly 400 have been approved so far, will be extended through 2024.

Robin Rudowitz, director of the Program on Medicaid and the Uninsured at KFF, said the waivers have allowed states to use other government benefit programs to automatically verify eligibility for Medicaid and to give managed care organizations the authority to Help program recipients complete application forms.

Some states have sought even more ambitious versions. Kentucky and North Carolina recently extended Medicaid eligibility for children by 12 months.

States “are doing so many things at once that it’s difficult to disaggregate what makes the biggest difference,” Rudowitz said. The data presented Monday by the Biden administration, he added, “was an attempt to try to connect some specific policies to what might happen.”