Kansas ranked 11th nationally in the percentage of children who lost Medicaid coverage as states unwound from a law ensuring that beneficiaries wouldn’t lose coverage from the federal medical insurance program for the less affluent, a new study shows.
Overall, there have been 56,965 Kansans under the age of 19 who have lost Medicaid coverage since last April, representing a decline of 16.9%, according to the study by Georgetown University’s Center for Children and Families.
It was the 11th largest percentage decrease nationally, although the actual number of children losing coverage ranks Kansas 21st, according to the study that analyzed enrollment numbers from last April through the end of December.
Nationally, there were 4.16 million fewer children enrolled in Medicaid and the Children’s Health Insurance Program than the month before each state started renewing eligibility after the Medicaid continuous coverage protections ended following the COVID-19 pandemic.
South Dakota, Montana and Utah saw the largest percentage declines with at least 25% fewer children enrolled in Medicaid than before unwinding process started in 2023.
South Dakota had a 28% decline, followed by Montana with a 27% drop and Utah with a 25% decline, according to the study.
By comparison, Oklahoma was ninth nationally with a 17% decline.
Arkansas was sixth at 21%. Iowa was right behind Kansas at 14%. Missouri was much further down the list, with an 8% decline in children’s enrollment through December.
Texas, Florida, Georgia and California saw the largest number of declines in children enrolled in Medicaid or the Children’s Health Insurance program.
They accounted for half of the total national decline, the study reported.
Texas alone accounted for more than 1 million of the total decline in children enrolled in Medicaid and the Children’s Health Insurance program, the study reported.
The Lone Star state represented almost a quarter of all disenrollments for children nationally.
Texas was followed by Florida (589,671), Georgia (300,073), California (197,625) and Ohio (121,577).
The study found that eight states – Montana, Idaho, South Dakota, Arkansas, New Hampshire, Utah, Arkansas and Colorado – cut off so many children in 2023 that they had fewer children enrolled in December than before the pandemic.
“This is a troubling finding given that all but one of these states had relatively low participation rates of eligible children covered by Medicaid/CHIP prior to the pandemic – suggesting that red tape barriers are likely resulting in high rates of children becoming uninsured,” the study said.
The states that tended to be the most proactive to the challenges presented by unwinding tended to have fewer children losing coverage, said Anne Dwyer, associate research professor for Georgetown University’s Center for Children and Families.
“We saw some states that were being more proactive in terms of responding to the challenges that we saw,” Dwyer said.
“We definitely saw a lot of variation in how proactive certain states were being versus some states that were not as proactive,” she said.
For instance, the Centers for Medicare and Medicaid Services allowed states to adopt strategies to address significant operational issues with determining someone’s income and eligibility and keeping them from losing coverage even if they were eligible.
Some states received approval for as many as 14 or 15 waivers from the federal government to adopt those strategies, while others adopted one or none. Kansas received approvals for eight waivers, federal data show.
While the study shows that the numbers of children losing Medicaid coverage are worse in other states, the study presents a concern for children’s advocates in Kansas.
“The findings from the report are concerning for Kansas kids and their health,” said Heather Braum, senior policy adviser for Kansas Action for Children.
“We’re concerned that many children who have lost their Medicaid/CHIP health coverage do not have access to health care,” Braum said in an email.
“Even short gaps in coverage cause children to miss vital prescriptions or not be able to see a doctor when they are sick.
“These data indicate that thousands of Kansas children are likely going without the protection that health coverage provides, which will lead to poorer health in the short and long term while their families are exposed to high medical costs and medical debt.”
Because the income eligibility for children is much higher than adults, Braum said she is worried that many children are losing coverage even if they’re likely still eligible.
A spokesperson for the Kansas Department of Health and Environment said the agency was one of the earliest states to begin unwinding, and the data used in the report did not account for how far along each state was in the 12-month unwinding process.
Jill Bronaugh also pointed out that the data showed Kansas was near the middle of the pack – 21st nationally – in the number of children who have been disenrolled.
Bronaugh said the biggest reason children lose coverage is when a renewal is submitted and they are over the income limits.
Other factors, such as the unemployment rate, also impact Medicaid enrollment.
“The report did not account for variances between states,” she said.
She also said the fact that Kansas has not expanded Medicaid was a factor.
“As you know, Kansas is not a Medicaid expansion state, which means KanCare members are subject to strict income limits,” she said.
Expanding Medicaid, she said, would have increased passive renewal rates, decreased the number of members who would be at risk for procedural termination, and decreased call volumes, which the KanCare Clearinghouse faced.
“Throughout unwinding, KDHE has closely monitored discontinuance data, pausing discontinuance when necessary to ensure members were not impacted by factors such as postal service timelines,” she said
“Doing so gave members more time to return renewals and potentially avoid procedural termination,” she said.
The agency, she said, adopted several strategies from the Centers for Medicare and Medicaid Services that allowed for automatic renewals for beneficiaries through independent income verification.
KDHE made other system changes that allowed the Medicaid program to enhance outreach to members through more effective calls, texts and emails, in addition to conducting robocall campaigns to alert members when their renewals have been sent, she said.
“KDHE recognizes the disruption that losing Medicaid coverage causes for members,” Bronaugh said.
“The agency remains committed to ensuring that eligible Kansans keep their health care and that the KanCare program is compliant with federal and state regulations and guidelines,” she said.
Braum, and others, have praised the state for working with advocates to improve the processes and procedures and direct outreach efforts to families while the unwinding process unfolded.
“We have appreciated their collaboration, willingness to listen to feedback, and explore and implement numerous solutions available to them,” she said.
But looking forward, the issue isn’t going away.
If anything, the unwinding process exposed flaws in the Medicaid enrollment system that could affect how people are renewed for Medicaid coverage in the future.
“I think what the unwinding has shown is that the enrollment system needs improvement,” Dwyer said.
“We’ve seen that a lot of families are getting caught up in these paperwork burdens, that systems were not working the way that they really should be working,” she said.
“We have a lot of lessons learned from the unwinding process and that we really need to keep the work up to make sure children with lost coverage can get back on.”
Among other things, Dwyer said that means making sure call centers are still accessible and that states are still working with community groups to help reach out to those people who need to renew their coverage.
Braum agreed.
“More improvements are still needed long-term, as the renewal process continues forward, including much more outreach and education to families eligible for Medicaid or CHIP,” she said.
Those efforts, Braum said, should focus on increasing enrollment assistance, increasing the hours families can reach eligibility staff, and identifying and removing unintended barriers that families face when attempting to apply or renew their coverage.
“At day’s end, we should all want to make sure no eligible child goes without Medicaid/CHIP coverage, and we must all work to improve the systems, processes, and policies in place to improve that coverage,” she said.
