In Missouri, children’s enrollment in Medicaid and the Children's Health Insurance Program fell nearly 10% over the last 14 months – the second biggest decline of any state after Idaho, according to a new report.
The report, by Georgetown University’s Center for Children and Families, says neither the strong economy nor an increased number of children with employer-sponsored health coverage is sufficient to explain the decline.
Nationwide, about 828,000 fewer children were enrolled in the Medicaid and CHIP programs at the end of 2018 than in the previous year – a 2.2% drop.
In Missouri, the decline in 2018 was more than quadruple that, 9%. Additional drops in January and February translated to a total decline in Missouri over the last 14 months of 9.6%.
Tricia Brooks, an associate research professor at Georgetown and author of the report, said a variety of factors accounted for the decline nationwide, including the Trump administration’s harsh immigration policies and its reduction of funding for health insurance marketing and outreach.
But in Missouri, she said, the problem was made worse by the state’s recent implementation of a new Medicaid eligibility system. As a result, Missouri postponed or suspended many annual renewals.
“We know that renewal is the most vulnerable time for eligible kids to lose coverage,” Brooks said. “And there are any number of reasons for that. The mail doesn’t catch up with families. They get complicated notices or confusing notices. They don’t exactly know what to do.”
The Missouri Department of Social Services, which administers the Medicaid and CHIP programs, known as MO HealthNet, did not respond to a request for comment.
The department in the past has said that the improved economy is one reason children’s enrollment has fallen. But healthcare advocates say the decline is largely due to the state’s efforts to weed out improperly enrolled residents and to the difficulty of re-enrolling.
“It’s not because of the economy. Missouri’s decline, the last time we looked, was probably about five times the national average. I know no one has claimed our economy is five times better than the national economy,” said Joel Ferber, director of advocacy at Legal Services of Eastern Missouri.
Rather, Ferber said, the steep decline “coincides pretty much directly with the reinstatement of annual reviews in the department’s new computer system.”
“So it’s not that these folks have suddenly struck it rich and have great insurance,” he said. “They’re still eligible, but they fell through the cracks because of the bureaucracy.”
CHIP, which stands for Children’s Health Insurance Program, provides insurance coverage to uninsured, low-income children whose families make too much money to qualify for Medicaid. A family of four in Missouri qualifies for CHIP if its income doesn’t exceed $77,250 per year.
The program is financed jointly by the state and federal government. For every dollar spent on care in CHIP, Missouri contributes less than 3 cents, according to MO HealthNet’s 2018 annual report.
Brooks said that one of the most striking aspects of the decline in Missouri’s child enrollment is that 80% of the children that have lost coverage are under the poverty level.
“That would suggest that those children are not in families where the economic circumstances have improved to the point where they’re no longer eligible for coverage,” she said. “And so that tells me that it’s really about the barriers and the red tape that families face in getting their kids enrolled and keeping them enrolled.”
Dan Margolies is a senior reporter and editor at KCUR. You can reach him on Twitter @DanMargolies.