Biden administration warns nine governors about Medicaid losses among children

The Biden administration on Monday warned the governors of nine states of unusually high losses of Medicaid coverage among children, suggesting that officials were failing to protect young, low-income Americans while shrinking the program’s rolls.

Xavier Becerra, secretary of health and human services, wrote letters to the leaders of the states that had the greatest number or percentage of Medicaid coverage losses among children through September, after a federal policy requiring states to keep people in the program expired.

The appeals to state leaders doubled as a call to expand Medicaid under the Affordable Care Act. Among the recipients of the letter were Governor Ron DeSantis of Florida, Governor Brian Kemp of Georgia and Governor Greg Abbott of Texas. All three are Republicans who lead states that have not expanded Medicaid and where hundreds of thousands of children have lost coverage this year.

The nine states accounted for about 60 percent of the decline in enrollment in Medicaid and the Children’s Health Insurance Program, or CHIP, through September, federal health officials said.

Governors should “ensure that no eligible child loses their health insurance due to bureaucracy,” Becerra said at a news conference Monday morning. He called on state officials to facilitate transfers from Medicaid children to CHIP; reduce call center waiting times; and adopt special rules that allow states to relax their procedures for keeping children enrolled in Medicaid.

The letters, which the Biden administration released Monday with new data on Medicaid child losses through September, signaled a new aggressive stance during the so-called elimination of the federal Medicaid requirement.

The process has been marked by technical problems, bureaucratic errors and delays that have caused thousands of poor children to lose health coverage.

Federal officials had been reluctant to attack governors or state Medicaid officials as they worked to resolve those bureaucratic problems. Some advocacy groups and public health experts have said the administration has not been aggressive enough in reporting, stopping and resolving processes that had led to large numbers of children losing coverage in some states.

in a publish in XGov. Sarah Huckabee Sanders of Arkansas, a Republican to whom Becerra wrote on Monday, accused the Biden administration of having undertaken a “politically motivated public relations stunt, accusing us of restricting access to Medicaid.”

“That is false. During the liquidation process required by federal law, the Biden administration sent letters to certain states to suspend their liquidation, but Arkansas was never one of them,” he wrote. “Arkansas follows state and federal laws, while Biden plays politics on Christmas.”

Child Medicaid enrollment has dropped by more than three million this year, according to a separate analysis published Monday by Georgetown University’s Center for Children and Families.

Because of data lags and differences in how states report Medicaid losses, that figure is likely a significant undercount.

Overall, Medicaid enrollment has decreased by nearly eight million, according to researchers. According to Georgetown researchers, nearly seven million children could be left uninsured for at least some time as a result of the reduction, representing nearly one in 10 nationwide.

Through September, Florida, Texas and Georgia had the largest drops in children’s Medicaid enrollment nationwide, according to data shared by federal health officials on Monday. Federal health officials noted Monday that the 10 states that have not expanded Medicaid under the Affordable Care Act had discharged more children than all those that have done so combined.

Stacey Pogue, senior policy analyst at Every Texan, a research and advocacy group, said Monday that thousands of children in Texas were still waiting for decisions from state Medicaid officials, who face a significant backlog of applications.

“We didn’t have the staff that was needed. We didn’t have the technology,” Ms. Pogue said.

According to KFFa nonprofit health policy research group, more than 70 percent of people who lost Medicaid this year did so for procedural reasons, such as when a family did not return paperwork to confirm their eligibility.

Children have more generous eligibility limits for Medicaid and CHIP, suggesting that many of those who lost coverage this year should have remained eligible for some type of coverage.

Researchers have pointed out that only a small percentage of children have been moving to CHIP, a sign that states have not done enough to facilitate those transfers.

Federal officials on Monday also presented figures showing what they said was a clear correlation between fewer Medicaid losses and the adoption of special exemptions from the Centers for Medicare and Medicaid Services; States have requested the waivers to facilitate the eligibility verification process.

The Biden administration said Monday that the waivers, nearly 400 of which have been approved so farwould extend until 2024.

Robin Rudowitz, director of KFF’s Medicaid and Uninsured Program, said the waivers had allowed states to use other government benefit programs to automatically verify Medicaid eligibility and give managed care organizations authority to help program beneficiaries to complete the application forms.

Some states have sought even more ambitious versions. Kentucky and North Carolina recently expanded Medicaid eligibility for children by 12 months.

States are “doing so many things at once that it’s hard to break down what makes the biggest difference,” Rudowitz said. The data the Biden administration presented Monday, he added, “was an attempt to tie some of the specific policies to what might be happening.”