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High Stakes for the Nation’s Children When Medicaid Continuous Coverage Protection Expires

Wednesday, February 15, 2023

Joan Alker, Executive Director Georgetown U. Center for Children and Families & Research Professor, McCourt School of Public Policy

Tricia Brooks, Research Professor, McCourt School of Public Policy

Lisa Costello, M.D., MPH, FAAP

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Consolidated Appropriations Act Ends Medicaid’s Continuous Coverage Protection

  • During the PHE, states got extra federal $ and could not disenroll anyone involuntarily from Medicaid -- including CHIP funded Medicaid
  • States can begin terminations April 1, 2023, but have until May 2024 to complete the renewal process
  • States must submit monthly data to CMS and face an FMAP penalty if they do not
  • Secretary Becerra has new enforcement authority to issue a corrective action plan for states if there are too many procedural disenrollments
  • Congress required 12 months continuous eligibility for all children in Medicaid/CHIP effective January 1, 2024

Source: Alker, J., Brooks, T., Clark, M., Dwyer, A., Park, E., "Consolidated Appropriations Act, 2023: Medicaid and CHIP Provisions Explained," January 2023, Georgetown University Center for Children and Families, accessible here: https://ccf.georgetown.edu/2023/01/05/consolidated-appropriations-act-2023-medicaid-and-chip-provisions-explained/

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Phase-Down of Medicaid/CHIP Federal Funds

Source: Alker, J., Brooks, T., Clark, M., Dwyer, A., Park, E., "Consolidated Appropriations Act, 2023: Medicaid and CHIP Provisions Explained," January 2023, Georgetown University Center for Children and Families, accessible here: https://ccf.georgetown.edu/2023/01/05/consolidated-appropriations-act-2023-medicaid-and-chip-provisions-explained/

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Enrollment Growth in Medicaid and CHIP: Child vs. U.S. Total, February 2020 – August 2022

Source: Alker, J., Osorio, A., Georgetown University Center for Children and Families analysis of Centers for Medicare & Medicaid Services (CMS) State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Data, available here.

Note: Arizona does not report a child enrollment number in the CMS data, so CCF substitutes state administrative data, which Arizona releases quarterly. CCF also substitutes state administrative data for Indiana in August 2022. 

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90,722,539

42,261,973

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States with 60% or More of All Children Enrolled in Medicaid/CHIP

Source: Alker, J., Osorio, A., "Child Uninsured Rate Could Rise Sharply if States Don’t Proceed with Caution," February 2023, Georgetown University Center for Children and Families analysis of Centers for Medicare & Medicaid Services (CMS) State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment.

Note: Arizona does not report a child enrollment number in the CMS data, so CCF substitutes state administrative data, which Arizona releases quarterly. CCF also substitutes state administrative data for Indiana in August 2022. Child population totals from U.S. Census Bureau American Community Survey (ACS) Table HIC-5, Health Insurance Coverage Status and Type of Coverage by State - Children Under 19: 2008 to 2021, Health Insurance Historical Tables 

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Share of All Children Enrolled in Medicaid and CHIP by State

Source: Alker, J., Osorio, A., "Child Uninsured Rate Could Rise Sharply if States Don’t Proceed with Caution," February 2023, Georgetown University Center for Children and Families analysis of Centers for Medicare & Medicaid Services (CMS) State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Data, available here.

Note: Arizona does not report a child enrollment number in the CMS data, so CCF substitutes state administrative data, which Arizona releases quarterly. CCF also substitutes state administrative data for Indiana in August 2022. Child population totals from U.S. Census Bureau American Community Survey (ACS) Table HIC-5, Health Insurance Coverage Status and Type of Coverage by State - Children Under 19: 2008 to 2021, Health Insurance Historical Tables 

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Children’s Public Coverage Eligibility Is Higher Than Adults: Median Medicaid/CHIP Income Eligibility for Children and Adults by Expansion Status, 2022

Source: Tricia Brooks et al., “Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022: Findings from a 50-State Survey” (Georgetown University Center for Children and Families and Kaiser Family Foundation, March 2022), available here.

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“Policymakers should consider the needs of children separately due to the fact that their eligibility levels are higher so they are most likely to remain eligible even if their parent’s income is over the adult eligibility guidelines.”

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Top 10 States with Highest Child Share of Enrollment Growth in Medicaid

Source: Alker, J., Osorio, A., "Child Uninsured Rate Could Rise Sharply if States Don’t Proceed with Caution," February 2023, Georgetown University Center for Children and Families analysis of Centers for Medicare & Medicaid Services (CMS) State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment.

Note: Arizona does not report a child enrollment number in the CMS data, so CCF substitutes state administrative data, which Arizona releases quarterly. CCF also substitutes state administrative data for Indiana in August 2022. Child population totals from U.S. Census Bureau American Community Survey (ACS) Table HIC-5, Health Insurance Coverage Status and Type of Coverage by State - Children Under 19: 2008 to 2021, Health Insurance Historical Tables 

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Top 10 States for Highest Child Enrollment Growth in Medicaid/CHIP

Source: Alker, J., Osorio, A., "Child Uninsured Rate Could Rise Sharply if States Don’t Proceed with Caution," February 2023, Georgetown University Center for Children and Families analysis of Centers for Medicare & Medicaid Services (CMS) State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment.

Note: Arizona does not report a child enrollment number in the CMS data, so CCF substitutes state administrative data, which Arizona releases quarterly. CCF also substitutes state administrative data for Indiana in August 2022. Child population totals from U.S. Census Bureau American Community Survey (ACS) Table HIC-5, Health Insurance Coverage Status and Type of Coverage by State - Children Under 19: 2008 to 2021, Health Insurance Historical Tables 

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