The Biden administration on Monday warned the governors of nine states of unusually high losses in Medicaid coverage among children, suggesting that officials are failing to protect young, low-income Americans while winnowing the program’s roster.
Xavier Becerra, the secretary of health and human services, wrote letters to the heads of states that have maximum number or percentage of losing Medicaid coverage to children until September, after a federal policy required states to keep people who passed out of the program.
Appeals to state leaders doubled as a call to expand Medicaid under the Affordable Care Act. Those who received the letter included Gov. Ron DeSantis of Florida, Gov. Brian Kemp of Georgia and Gov. Greg Abbott of Texas. All three are Republicans who lead states that did not expand Medicaid and where hundreds of thousands of children lost coverage this year.
Nine states accounted for about a 60 percent drop in enrollment in Medicaid and the Children’s Health Insurance Program, or CHIP, through September, federal health officials said.
Governors must “make sure no eligible child loses health insurance because of red tape,” Mr. Becerra said at a press briefing Monday morning. He called on state officials to easy transfer of children from Medicaid to CHIP; reduce call center waiting time; and adopt special rules which allows states to streamline their procedures for keeping children enrolled in Medicaid.
The letters, published by the Biden administration on Monday with new data on child Medicaid losses through September, indicated a new aggressive posture during the so-called unwinding of the federal Medicaid requirement.
The process has been marked by technical problems and paperwork errors and delays that have caused thousands of poor children to lose health coverage.
Federal officials have been reluctant to target governors or state Medicaid officials as they try to resolve those bureaucratic problems. Some advocacy groups and public health experts say the administration has not been aggressive enough in calling, halting and resolving lawsuits that have led to large numbers of children losing coverage in some states.
In a post on Xaccused Gov. Sarah Huckabee Sanders of Arkansas, a Republican Mr. Becerra wrote on Monday, said the Biden administration had staged a “politically motivated PR stunt, accusing us of restricting access to Medicaid.”
“That’s wrong. During the unwinding process mandated by federal law, the Biden admin sent letters to several states to pause their unwinding, but Arkansas was never one of them,” he wrote. . “Arkansas follows state and federal law, while Biden plays Christmas politics.”
Child Medicaid enrollment has dropped by more than three million this year, according to the a separate review published Monday by the Georgetown University Center for Children and Families.
Because of data lags and differences in how states report Medicaid losses, that number is likely a significant undercount.
Overall, Medicaid enrollment dropped by nearly eight million, according to the researchers. Nearly seven million children may be uninsured for at least some time as a result of the unwinding, according to Georgetown researchers, which is about one in 10 nationwide.
Through September, Florida, Texas and Georgia had the largest declines in child Medicaid enrollment nationwide, according to data shared by federal health officials Monday. Federal health officials noted Monday that the 10 states that did not expand Medicaid under the Affordable Care Act disenrolled more children than all of them combined.
Stacey Pogue, a senior policy analyst at Every Texan, a research and advocacy group, said Monday that thousands of Texas children are still awaiting decisions from state Medicaid officials, facing a large backlog of applications.
“We don’t have the staffing needed. We don’t need technology,” said Ms. Pogue.
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 didn’t return paperwork to confirm their eligibility worthy.
Children have more 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 just that a small percentage of children have transitioned to CHIP, a sign that states are not doing enough to facilitate those transitions.
Federal officials on Monday also presented numbers showing what they said was a clear correlation between fewer Medicaid losses and the adoption of special waivers from the Centers for Medicare and Medicaid Services; states request waivers to ease the eligibility review process.
The Biden administration said Monday that the waivers, about 400 of them has been approved so farwill be extended until 2024.
Robin Rudowitz, the director of the Medicaid and the Uninsured Program at KFF, said the waivers allowed states to use other government benefit programs to automatically verify Medicaid eligibility, and give managed care organizations have the authority to help program recipients complete application forms.
Some states have sought more ambitious versions. Kentucky and North Carolina recently extended Medicaid eligibility for children by 12 months.
States are “doing so many things at once that it’s hard to isolate what makes the biggest difference,” Ms. Rudowitz. The data presented by the Biden administration on Monday, he added, “is an attempt to try to tie some of the specific policies to what might happen.”