States May See Higher Uninsurance Rates Among Children When PHE Ends

The children’s uninsurance rate may escalate after the end of the public health emergency, barring policy changes, according to an article published by Urban Institute.

The researchers used National Health Interview Survey (NHIS) and the Current Population Survey (CPS) Annual Social and Economic Supplement as well as Medicaid and CHIP's enrollment data for children. The studied population included children ranging from infancy to 17 years old.

Using data from 2019 through 2022, the researchers assessed the impact of the first and second rounds of pandemic legislation in March 2020 and March 2021.

The children’s uninsurance rate from early 2021 did not wildly depart from 2019 levels. According to NHIS, the children’s uninsurance rate in 2019 was 4.9 percent and in 2021 it was 4.6 percent, while CPS recorded a 5.9 percent children’s uninsurance rate for both timeframes.

Public coverage for children increased over the course of the pandemic from early 2019 to early 2021, with NHIS recording a nearly five percentage point boost in public coverage during this time period. According to the administrative enrollment data, children’s enrollment in Medicaid and CHIP grew by 4 million beneficiaries in March 2021, compared to March 2019.

In contrast, private coverage dove a little over four percentage points.

CPS data indicated that the opposite trends in public coverage and private coverage could be responsible for maintaining a stable children’s uninsurance rate.

Since early 2021, the Medicaid and CHIP children’s enrollment has steadily increased. After a slight dip followed by a steep growth curve in April 2019, the trend has predominantly continued upward.

“The decline in children’s uninsurance observed on the NHIS is remarkable given the economic downturn, and if it is confirmed by other federal surveys, policymakers will have a better understanding of which policies can successfully mitigate coverage losses during economic downturns,” the researchers explained.

Several policies might have influenced these trends. The Medicaid continuous coverage requirement, American Rescue Plan Act subsidy expansions, and the special enrollment period in 2021 which included heightened outreach efforts all had the potential to impact children’s enrollment in Medicaid and CHIP.

“For children, the continuous coverage requirement was especially important given that the share of children covered by Medicaid/CHIP is much larger than the share with Marketplace coverage,” the researchers noted.

It looks like this upward trend in children’s Medicaid and CHIP enrollment will continue through 2022. The researchers found that 2022 plan selections for children were higher than 2021 plan selections by 300,000 child enrollees.

However, the report warned that various factors could destabilize Medicaid and CHIP enrollment and reverse this trajectory. In particular, when the coronavirus-related flexibilities expire at the end of the public health emergency, policies such as continuous coverage and paused eligibility verifications will end with them.

States can protect Medicaid and CHIP enrollment by enabling automatic renewals, collaborating with stakeholders to engage families whose children are eligible to renew coverage, empowering consumer support, and using more than one mode of communication to engage families.

The Urban Institute researchers projected that ending the continuous coverage flexibility would have a larger impact on children’s healthcare coverage than ending the American Rescue Plan Act expanded subsidies. Still, around 303,000 children could lose their coverage if the subsidies end.

“Pandemic policies’ success in stabilizing and even strengthening children’s insurance coverage is impressive, but without additional efforts, children’s uninsurance could once again increase later in 2022 or in 2023,” the researchers concluded.