How COVID-19 Policies Impacted Medicaid Enrollment Among Children

Medicaid enrollment among children surged during the coronavirus pandemic, fueled in certain states by policies in the Families First Coronavirus Response Act (FFCRA) that helped maintain coverage, a Health Affairs data watch found.

When the coronavirus pandemic broke out, states that did not already have a continuous coverage requirement for children had to institute one. The difference between coverage rates before these states implemented continuous coverage and in the year after this policy went into effect could shed light on the impact of continuous coverage on uninsurance rates among children.

“Our findings suggest that policies providing for continuity of coverage may help increase access to and ensure stability in children’s health insurance, particularly when families are faced with challenging economic circumstances,” the researchers concluded.

The researchers observed children’s Medicaid enrollment from March 2019 to March 2021 using CMS enrolment data and leveraged the Census Bureau’s 2019 American Community Survey to estimate enrollment by state.

The data showed that in the months after continuous enrollment policies were implemented, Medicaid coverage among children increased by 4.62 percent in states that had not previously adopted continuous enrollment. Across the 26 states that did not have continuous coverage policies in place before March 2020, over 655,000 children enrolled in the Medicaid program during the study’s timeframe.

Before the pandemic started, states without continuous enrollment had a lower mean participation rate than states that had continuous enrollment policies in place.

After the pandemic started and the continuous enrollment policy became ubiquitous due to FFCRA, states that had not previously had a continuous enrollment policy saw a 14.67 percent surge in children’s Medicaid enrollment in the first year of the policy.

States with pre-existing continuous enrollment policies saw an enrollment increase of 9.03 percent. Only four of these states were among the eleven states with the highest percentage increase in children’s Medicaid enrollment. The remaining seven states had no continuous enrollment policy before FFCRA.

States with new continuous enrollment policies that achieved the highest increase in children’s Medicaid enrollment included Missouri, Texas, Florida, Georgia, Oklahoma, Nevada, and Utah. States with preexisting continuous eligibility that also saw high increases in children’s Medicaid enrollment were Wyoming, Colorado, Kansas, and North Dakota.

These eleven states saw between 15.0 percent and 25.8 percent increases in children’s Medicaid enrollment in the year after FFCRA was enacted.

These results bode well for children’s coverage rates after 2024, at which point all states must have permanent, year-long continuous eligibility policies in place for children. However, the researchers noted that Medicaid enrollment among children might experience a decline in 2023 due to the impact of recertification.

The findings support continuous eligibility in other programs as well, not just children’s enrollment in Medicaid, the researchers suggested. For example, separate research affirms that extending the continuity of Medicaid coverage during the postpartum period could help decrease uninsurance among new parents.

“Although increases in coverage may increase short-term costs for state Medicaid agencies, these policies could decrease administrative costs and ultimately lead to improved access to care and better health outcomes for beneficiaries,” the researchers noted.

“Overall, this study adds to the growing body of evidence showing that policies that reduce administrative burdens associated with access to government benefits may boost enrollment and retention.”