The Advocate March 2023 - Medicaid Unwinding

There is a major health care coverage change happening that will impact students in your districts who currently rely on Medicaid and the Children’s Health Insurance Program (CHIP) for health insurance. 

Since the pandemic’s Public Health Emergency began in March 2020, children and families enrolled in Medicaid have not been required to complete renewal paperwork in order to stay covered. Beginning April 1, 2023, this continuous coverage protection will end and eligibility will be checked for all people enrolled in Medicaid and CHIP to ensure they still qualify. During this process, known as the “unwinding,” it is estimated that 6.7 million children will lose their Medicaid coverage despite the large majority of them continuing to be eligible for either Medicaid or CHIP. 

In order to reduce loss of health coverage, it is important that parents act quickly to confirm or update their contact information with their state’s Medicaid agency, and provide necessary information to complete their Medicaid renewal when notified. Families could be notified about their renewal paperwork at any point this year or early next year.  

As district leaders, you can play a critical role to ensure families in your districts are aware of these Medicaid changes. 

The first step is to make sure that the state Medicaid agency has the correct contact information so families will receive their renewal notices when the time comes. If they don’t receive the notices, families may not even realize their children have been disenrolled from coverage and are uninsured until it is too late. 

To help inform families about this impending challenge they will face, we partnered with the Georgetown University’s Center on Children and Families, and the Center on Budget and Policy Priorities to create a one-pager in English and Spanish, template letter for district leaders to send to families, sample social media and other resources to help you ensure children in your districts don’t lose Medicaid coverage.  

The end of the Public Health Emergency will disproportionately impact communities of color; two-thirds of the children who are likely to lose Medicaid will be children of color (4.5 million), which includes 2.4 million Latino children and 1.4 million African American children. The same communities of color that already face America’s largest health insurance gaps are expected to experience the deepest further losses of Medicaid coverage. Unless states make significant policy changes, at least 12% of all children of color who live in America will likely lose Medicaid, compared to 6% of non-Hispanic White children. Children losing Medicaid coverage are likely to include at least 13% of all African American children, 12% of all Latino children, 12% of all Native American children, and 10% of all Native Hawaiian and other Pacific Islander children living in the United States.

Based on research conducted before the pandemic, very few families whose children need to re-enroll in Medicaid will even realize they are about to lose coverage. In recent years, most children who lost Medicaid at redetermination were never found ineligible. Instead, states simply mailed requests for paperwork, states did not receive responses from families, and their children stopped being eligible for Medicaid. For example, when Texas ended health coverage for nearly 150,000 children in 2018 and 2019, missing paperwork was the prime cause. While the state mailed income update forms multiple times during each 12-month eligibility period, only 30% of families responded. More than 90% of all terminations resulted from the state not receiving a response. 

Because districts have more direct engagement with parents than state Medicaid agencies, we hope superintendents are able to reach out to parents and let them know about this major change and the importance of ensuring the state Medicaid agency has an updated address for the child. Schools are a central access point for students to be connected to necessary health services, and it is critical to keep children connected to healthcare coverage to receive necessary care. 

Almost all schools depend on Medicaid to help cover the cost of certain special education services. The potential impact of the unwinding will be even greater if your district is in one of the 17 states that has expanded Medicaid reimbursement to cover school health services for all Medicaid-enrolled students. Keeping students connected to Medicaid will be especially important for the fiscal health of these districts.

For the latest updates on the monitoring of the unwinding of the continuous coverage provision (as it’s called), visit Georgetown University Center for Children and Families. You can also see how many students in your school district were enrolled in Medicaid or CHIP on the center’s website.

Check out our district toolkit for more ways to help keep families in your district covered.