Officials with the Centers for Medicare & Medicaid Services (CMS) are calling for a nationwide assessment and repair of health care eligibility systems because they said children who should be covered by insurance programs were mistakenly dropped in the unwinding process.
The end of the COVID-19 public health emergency (PHE) meant states could begin disenrolling individuals who no longer are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) or who lost coverage for procedural reasons, such as not returning required paperwork. As part of the unwinding, each state is required to file a data report with CMS on the eighth of every month following its April 1 start date.
Months before the unwinding process began, the AAP launched advocacy and education efforts to ensure children would not lose health care coverage inappropriately or experience disruptions in health care. AAP leaders continue to push state and federal officials to protect children’s health care coverage.
In a letter sent Aug. 30 to all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands, CMS is calling for officials from each jurisdiction to immediately correct problems and reinstate eligible individuals.
“Parents and caregivers should not have to worry about whether their child’s Medicaid coverage is in jeopardy,” said AAP President Sandy L. Chung, M.D., FAAP. “Medicaid coverage means access to care so that children can receive check-ups, get vaccines and be treated when they are sick from illnesses like RSV.”
Resources include an updated “3 Steps to Keep Your Coverage” flyers, available in English and Spanish, as well as guidance for all 50 states and Washington, D.C. The page, which will continue to be updated, also includes information to help practices navigate coverage scenarios.
To keep eligible people enrolled in Medicaid or CHIP coverage, states use an auto-renewal process, which uses information already available through existing reliable data sources to determine whether people are still eligible.
CMS, however, believes several state eligibility systems are programmed incorrectly and conduct automatic renewals at the family-level instead of the individual-level, which may inadvertently disenroll eligible children. Children often have higher eligibility thresholds, making them more likely to be eligible for Medicaid or CHIP coverage even if their parents do not qualify.
The AAP has been pushing policymakers to take action to protect children’s coverage and supports measures to hold states accountable for inappropriate terminations of coverage.
“Pediatricians have been raising the alarm for months about eligible children being inappropriately disenrolled from Medicaid and we are heartened by the announcement as a first step forward to keep children and families connected to the health care coverage they depend on,” Dr. Chung said.