Report Confirms the Worst: Thousands of Kids Lost Health Coverage during Medicaid Unwinding

Heather Braum | July 23, 2024

Over the past two years, KAC raised repeated concerns that thousands of still-eligible Kansas children would lose their KanCare coverage during the unwinding period because of paperwork reasons. As the unwinding unfolded, we saw how children were disproportionately losing coverage, even while still remaining eligible for coverage.  

Now, a recent Georgetown Center for Children and Families (CCF) report validates those concerns, as Kansas saw a nearly 57,000 net decline in children enrolled in the state’s Medicaid and CHIP programs (KanCare) between April 2023 and December 2023. However, the report’s time period of analysis doesn’t cover the full unwinding period, which the state announced was complete at the end of May 2024. We expect the net decline of children enrolled in Medicaid and CHIP to be even higher than described in the Georgetown report once all data through May 2024 is compiled.

We should all be concerned when children do not have health insurance coverage, as this leads to poorer health in the short and long term while their families are exposed to high medical costs and medical debt. As Kansas has completed its year of “unwinding” and returns to “normal” annual renewals, it’s clear we must do more to ensure all Kansas kids eligible for KanCare successfully receive that coverage.

Report's Findings

The Georgetown CCF report released in May 2024 looked at trends in child Medicaid and CHIP enrollment since states began the post-pandemic process of redetermining eligibility for everyone enrolled, also known as the “unwinding.” The report showed that nationwide, more than 4 million children had lost Medicaid/CHIP by the end of 2023, even though most of these children are likely still eligible based on their family’s income. More recent data shows that more than 5 million children have lost their Medicaid/CHIP coverage since renewal reviews restarted.

Specific to Kansas, child enrollment in Medicaid/CHIP declined by nearly 57,000 between April 2023 and December 2023, a 17 percent decrease. Kansas ranks 11th nationally for the largest decline (in terms of percentage) of children enrolled in Medicaid and CHIP as of December 2023.

Because income eligibility for children is much higher than adults, most of the children who lost coverage are likely still eligible and must reapply. Kansas children in a family making up to $65,481 per year may still be eligible for Medicaid or CHIP. The income cutoff is even higher for larger household sizes.

Implications

Health insurance coverage and access during childhood can change the trajectory of a child’s life — for better or worse. Even short gaps in coverage cause children to miss vital prescriptions or not be able to see a doctor when they are sick. Children with time-sensitive therapy or treatment appointments could be negatively impacted for life, as their families will be unlikely to pay for these appointments while their child is uninsured.

These data indicate that thousands of Kansas children are likely going without the protection that health coverage provides, potentially leading to poorer health in the short and long term while their families are exposed to high medical costs and resulting debt.

In 2022, Kansas already had a 5.2 percent (or about 38,000) uninsured rate for children. We expect those uninsured rates and numbers to increase once data is measured post-unwinding.

How did these numbers get so high? Children depend on their parents to turn in their renewal paperwork, and many factors can prevent that paperwork from being returned at all or in a timely fashion, some completely out of a family’s control.

The mail system could hiccup (or fail!) on either end, or incomplete paperwork could be returned and families never learn more information is needed. Language and health literacy barriers may exist. The processes to return renewal forms are impacted by humans and paperwork burdens, and who gets caught in the middle? Likely still-eligible children.

Outreach Needed

As the state has indicated that the unwinding process has ended and it returns to the regular cycle of annual renewals, targeted outreach to those who were discontinued due to paperwork reasons is needed. There likely are thousands of Kansas parents and caregivers who thought that because the adults in the household were no longer eligible for coverage, their kids were also no longer eligible – which is not true. And there are likely thousands more families who have no idea their children are eligible for Medicaid or CHIP coverage.

Health, education, and community organizations that work with children should all regularly remind the communities they serve about the potential availability of health insurance for their children. This can include utilizing state outreach tools like social media and videos, directing families toward resources to start the application process, and assisting or connecting with organizations (like CoverKansas and Thrive Allen County) that help with Medicaid and CHIP enrollment where possible, especially when language or health literacy barriers exist.

Policy Solutions

KDHE has worked with advocates over the past 18 months to improve processes and direct outreach efforts to families. Through collaboration and listening to feedback, the state has increased the time period to turn in enrollment forms and improved the state rate of data-driven automatic renewals (ex parte renewals) that reduce paperwork by using other databases the state accesses for matching family income and other data involved in the eligibility and renewal processes.

• However, more improvements are still needed long term as the regular renewal process continues forward, such as:
• More outreach and education to families eligible for Medicaid or CHIP;
• Increasing enrollment assistance;
• Increasing the hours families can reach eligibility staff;
• Identifying and removing unintended barriers that families face when applying or renewing their coverage, like updating the technology systems for eligibility determinations, call systems, and the state’s websites;
• Addressing language and literacy barriers; and
• Investing in additional funding to maintain a stable, experienced workforce of eligibility workers.

Additional policy changes that would increase child enrollment and keep it stable could be pursued, including:

• Permanently fixing a 17-year-old CHIP eligibility error in Kansas law that’s been temporarily fixed through budget provisos the past three years;
• Addressing additional parts of Kansas law out of alignment with current federal rules around lockouts and waiting periods;
• Increasing income eligibility thresholds for CHIP;
• Eliminating CHIP premium payments;
• Allowing multi-year continuous eligibility for young children, which several states have already approved and more are pursuing;
• Covering all kids, regardless of immigration status; and
• Improving outreach by identifying necessary eligibility system changes (including any funding needed) to track and publicly report reasons for procedural disenrollments (paperwork reasons).

The number of Kansas kids who have lost KanCare coverage over the past year but may still be eligible should concern everyone, and Kansans must work together to support policy changes that would remove barriers, improve access to, and even expand child KanCare coverage in the coming years.

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