About 146,000 fewer children in Texas were enrolled in Medicaid and the Children鈥檚 Health Insurance Program between the end of 2017 and the end of 2018, according to by the Georgetown University Center for Children and Families.
Nationwide more than 828,000 fewer children were enrolled in Medicaid and CHIP, combined, at the end of 2018. About 70 percent of those losses took place in seven states, including Texas, the report found.
鈥淲e are extremely concerned about what we are seeing and what it portends for the uninsured numbers these fall,鈥� said Joan Alker, the executive director of the Georgetown University Center for Children and Families. 鈥淔or many years there鈥檚 been a national bipartisan commitment to reduce the number of uninsured children and the effort have borne fruit. Unfortunately, today we do not feel confident that this national commitment still exists.鈥�
Typically, a drop in enrollment for government health programs is tied to an improving economy; more Americans are presumably getting health insurance through their employers. The study's authors say they see little evidence that鈥檚 what鈥檚 happening here.
So far, the authors wrote, 鈥渢here is no clear evidence that there was a sizable increase in employer-sponsored insurance among children in low- and moderate-income families鈥� during the months they reviewed.
鈥淚t鈥檚 far more likely eligible children are falling through the cracks,鈥� said Tricia Brooks, a senior fellow at the Georgetown University Center for Children and Families and lead author of the report.
Census data expected to be released this fall ultimately should provide a clearer picture of whether these losses were offset in any way by private insurance gains.
The study pointed to a series of factors that might help explain the enrollment drop.
Among those factors are ongoing cuts to marketing, outreach and grants aimed at letting families know they are eligible for the programs and how to sign up. Another factor is a lapse in CHIP funding caused by that led to some declines in enrollment for the program.
Researchers also found a 鈥渃hilling effect鈥� caused by anti-immigrant rhetoric and proposed policies.
In particular, there鈥檚 evidence some immigrant families are not enrolling their citizen children in government programs because of a potential change to who can get a legal status, or a green card, in the U.S. In 2018, there were reports the Trump administration began the process of , making it more difficult for people who rely on government services to get green cards.
鈥淩eports of a decline in participation in Medicaid began after draft proposals were leaked to the press and intensified after the proposed rule was released in October 2018,鈥� the study said.
Advocates have said, anecdotally, in services for fear it could hurt their chances of getting a green card.
The report from a Medicaid health plan in Texas that found evidence that leaked versions of changes to the green card rules actually contributed to declining enrollment in the state.
鈥淚t is thought,鈥� the letter said, 鈥渢hat nearly 150,000 fewer individuals currently access Medicaid in Texas in part due to the leaked rule.鈥�
Last, researchers found red tape and bureaucracy has led to a significant slowdown in enrollment of children in Medicaid and CHIP. For example, they say, changes to eligibility systems and verification procedures have made a big impact in certain states, particularly Texas.
鈥淥ne of the more stark examples of the move to conduct more frequent and stricter reviews of eligibility is occurring in Texas,鈥� the authors wrote. 鈥淭he state contracts with a third-party vendor to review children鈥檚 Medicaid eligibility in months 5, 6, 7, and 8 of enrollment, while more moderate-income children enrolled in CHIP get 12-month continuous eligibility.鈥�
According to the report, Texas is disenrolling more than 4,000 children from Medicaid a month. During those monthly check-ins, families are given only 10 days after they are flagged by the state to send in paperwork to prove they meet the income requirements for the program.
鈥淭hat鈥檚 causing significant confusion for families and throughout our health care system,鈥� said Laura Guerra-Cardus, deputy director of the Children鈥檚 Defense Fund of Texas.
Guerra-Cardus said in some cases, children are being kicked out of the program before the letter to send paperwork is even sent to families. Nine out of every 10 children dropped from coverage are dropped because of red tape, she said.
鈥淪o when this month-to-month coverage policy began, the entire child health care community started seeing a significant increase in churn of Medicaid-eligible children,鈥� she said. 鈥淎nd the families had no idea.鈥�
There was an effort to get Texas lawmakers to reverse the policy during this year鈥檚 legislative session, but those efforts failed. House Bill 342 would have allowed children to remain covered by Medicaid for a year at a time once they are deemed eligible. The bill moved slowly through the Legislature, however, and failed to pass.
鈥淥ur lawmakers failed to prioritize this issue and actually left this flawed policy in place,鈥� Guerra-Cardus said, 鈥渨hich means we are going to continue knocking thousands of eligible children off of their health care coverage every month.鈥�
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