Medicaid coverage of kids close to pre-pandemic levels

Over 150,000 Mississippians have lost health care coverage in the year after the Medicaid “unwinding” process began. 

Many are kids, who account for about half of the state’s total Medicaid recipients. In June of 2023, the number of covered children peaked at 456,314. By May, the rolls fell by more than 110,000 to 344,517. 

The state began the process of reviewing each Medicaid recipient’s eligibility in April of 2023 as pandemic provisions requiring states not to terminate people’s health care coverage ended after three years. 

Though this represents a significant decline in children covered, it’s more than were covered before continuous enrollment began. In March 2020, 342,043 children were covered by Medicaid – 2,000 fewer than in May 2024. 

“When state Medicaid programs are directed to return to pre-pandemic enrollment rules, it’s not surprising to see Mississippi’s Medicaid enrollment returning to around pre-pandemic enrollment levels,” Matt Westerfield, spokesperson for the Mississippi Division of Medicaid, said in an email to Mississippi Today.

He said 45,000 of the people disenrolled were children when the pandemic began but have since aged out of the program, which covers individuals up to 19 years old. 

Khaylah Scott, program manager for the Mississippi Health Advocacy Program, noted that because children are often healthy, changes in coverage have caught some families as a surprise. The Mississippi Health Advocacy Program works to improve health policies and practices in the state for underserved and poor communities. 

“When it’s time to get a back-to-school visit or vaccination or physical exam, they may show up to the doctor and that’s when they’ll find out that they no longer have their health care coverage,” she said. 

Scott said the ramifications of children missing out on visits to the pediatrician are broad. “We know that when kids don’t have the care that they need they sometimes miss out on the services that support healthy development,” she said.

The state has seen an increase in enrollment in the Children’s Health Insurance Program (CHIP), a program that provides free or low-cost health insurance to children that are not eligible for Medicaid but have an annual income under $31,200 for a family of four. CHIP enrollment in Mississippi has grown from about 42,000 children at the start of the unwinding process a year ago to over 50,000 in May. 

This change – 8,000 additional children covered – makes only a small dent in the 110,000 young people who lost Medicaid coverage in the past year. 

When children are deemed ineligible for Medicaid coverage in Mississippi, they are automatically enrolled in CHIP when they meet eligibility requirements. 

Adults, too, are impacted

To date, about 74.5% of completed reviews for adults have resulted in a renewal.

Most were completed by recipients filling out a renewal form. The other 31% were ex parte renewals, or automated decisions the agency made using existing information.

Of Mississippians who have lost coverage during the unwinding process, 26.2% were deemed ineligible. The remaining 73.8% were dropped for procedural reasons, or for reasons other than being determined ineligible. This may mean they did not return, complete or receive required paperwork.

The state does not report how many procedural disenrollments were children. 

At the start of the unwinding process, the rate of procedural disenrollments neared 80% for enrollees who lost coverage. In April, procedural reasons accounted for 72.4% of terminations. 

This is slightly higher than the nation’s average of 69% for procedural disenrollments, according to KFF.

Scott said she is concerned by the state’s high rates of procedural disenrollment. 

“We’re seeing [them] go down over time, but they’re not where we would like them to be,” she noted. “… We don’t want kids to be caught up in the red tape issues of this unwinding process.”

The Centers for Medicare and Medicaid Services (CMS) introduced waivers, or opportunities for increased flexibility in making determinations, to states last year in response to high procedural disenrollment rates and to ensure that eligible people nationwide maintained coverage. 

Mississippi has since adopted six waivers to increase ex parte renewal rates, support enrollees with renewal form submissions and ensure the department has access to accurate contact information. 

Westerfield said the waivers have had a “positive impact” on the disenrollment process. 

He said that the department has also instituted monthly text blasts to families with information about when and how to return renewal forms and launched a self-service portal to make it easier to complete renewals online. 

Nationwide, most people disenrolled from Medicaid have been able to regain coverage, though they may have experienced a temporary lapse. 

According to a KFF survey, 47% report that they were able to re-enroll in Medicaid, 28% acquired other health care and about 23% remain uninsured. 

Mississippi, along with 39 other states, is projected to complete the unwinding process this month, as reported by CMS. The state has 2,000 cases left to review out of 750,000 total cases, according to Westerfield.