Medicaid Unwinding, CHIP operational changes negatively impacting children’s access to coverage
HARRISBURG (November 16, 2023) — The number of uninsured children in Pennsylvania worsened during the last year of the COVID-19 pandemic, and this year’s unwinding of the Medicaid continuous coverage provision and CHIP eligibility systems transition has also caused children to lose coverage, according to the State of Children’s Health report by Pennsylvania Partnerships for Children.
Between 2021 and 2022, the rate of children in Pennsylvania without health insurance increased significantly from 4.4% to 5.2%, despite Medicaid enrollees having uninterrupted access to health insurance that connects them to doctor visits, immunizations, and well-visits that screen for physical and mental health.
Medicaid is an essential source of coverage for Pennsylvania children with disabilities, those living in low-income families, and those living in and aging out of foster care.
Pennsylvania has the 5th highest number of uninsured children in the nation. The latest Census data shows that the statewide rates for children under age six and for children over age six without health insurance have significantly worsened since the prior year. Additionally, the gap between those statewide rates has grown larger, indicating younger children are increasingly more likely to go without coverage than older children.
“We expected 2022—the last full year of the pandemic and the Medicaid disenrollment freeze that came with it—to reflect at least stable coverage or even gains in connecting kids to health insurance,” said Kari King, President and CEO of Pennsylvania Partnerships for Children. “However, 145,000 Pennsylvania children are without health insurance. They could fill every seat in Penn State’s Beaver Stadium, plus an additional 39,000 kids in the parking lot. And that’s not including children who have lost Medicaid coverage when the state began unwinding the disenrollment freeze and resuming pre-pandemic operations in April.”
Pennsylvania’s uninsured rate is heading in the wrong direction, going against the national trend and a troubling spot to be in ahead of what is expected to show a significant loss in coverage when data for 2023 becomes available next year. Pausing disenrollments during the pandemic significantly impacted the total number of Medicaid enrollees. Child enrollment in Medicaid increased by 22%, peaking at well over 1.4 million children.
Like most states, Pennsylvania is using a year-long process to unwind the disenrollment freeze and resume regular pre-pandemic eligibility and enrollment operations. Pennsylvania is one of 30 states that received a warning from the Centers for Medicare & Medicaid Services (CMS) to assess and fix its eligibility systems so eligible children and their families can remain enrolled in Medicaid.
“The issue is how some states have been conducting automated renewals, also known as ‘ex parte’ renewals, that are causing improper disenrollments for those still eligible, especially children,” King said. “One child without health insurance is too many and we need to fix any system errors causing children to be disconnected from vital health care coverage.”
In addition, during the same month the Medicaid unwinding began, DHS moved forward with an IT eligibility systems transition for the Children’s Health Insurance Program, despite advocates’ concerns about the timing and urging the state to exercise its flexibility to delay. This transition of eligibility processing and determinations from the CHIP managed care organizations (MCOs) to caseworkers in local DHS County Assistance Offices (CAOs) has caused complications, mainly falling on families.
To keep children connected to their health insurance, she said her organization is urging the state Department of Human Services to:
- Immediately restore Medicaid coverage for children who needlessly lost it during the automated “ex parte” renewals error.
- Support multi-year continuous eligibility in Medicaid for children during a critically important developmental period from birth to kindergarten.
According to the report, factors such as race and ethnicity, poverty level and geographic region impact children’s access to health insurance. Demographic highlights include:
- Uninsured rates rose significantly for children under age 6 (4.6% in 2021 to 5.6% in 2022) and school age children (4.4% in 2021 to 5% in 2022).
- By race, Asian children and Hispanic or Latino children saw the biggest improvements in their uninsured rates from 2021 to 2022, while uninsured rates worsened for American Indian and Alaska Native children, Black children, White children, and children of multiple races.
- Children in families of all income levels saw increases in their uninsured rates, although children in lower-income families are more likely to be uninsured. Approximately 7.3% of PA children are financially eligible for Medicaid but not enrolled.
King said accompanying fact sheets for each of the 67 counties show the local uninsured rate, race and ethnicity profiles, and public health insurance enrollment data.
For more information on enrollment for children’s health care coverage, visit:
- CHIP 1-800-986-KIDS (5437) or online
- Medicaid 1-866-550-4355 or online
- Pennie™ 1-844-844-8040 or online
Pennsylvania Partnerships for Children is a strong, effective and trusted voice to improve the health, education and well-being of children and youth in the commonwealth. Since 1992 its public policy victories have helped countless children learn, thrive and succeed, regardless of circumstances. PPC is statewide, independent, non-partisan and non-profit. Learn more at papartnerships.org.
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