K-12 Dive | By Naaz Modan | March 6, 2023
Much of the expected coverage loss will be due to administrative churn and impact district reimbursements as well as overall student health and attendance.
Starting in April, millions of children currently insured under Medicaid or the Children’s Health Insurance Program could lose their coverage, potentially impacting district finances.
Since March 2020, children and families’ enrollment in their public health insurance programs have automatically renewed without confirming their eligibility on a yearly basis, as required pre-pandemic.
Partly as a result, children’s enrollment increased by 11% between February 2020 and June 2021. As of June 2021, more than 40 million children — or about half of the nation’s children — were enrolled in Medicaid or CHIP, according to the Georgetown University Health Policy Institute’s Center for Children and Families.
In April, the continuous enrollment will expire, rendering uninsured those who don’t renew their eligibility.
“It’s gonna be one of the most significant events Medicaid has ever seen,” said Jenny Millward, executive director of the National Alliance for Medicaid in Education. For schools that benefit from the Medicaid reimbursement program, unenrolled children and families means a loss in reimbursements for services such as physical and speech therapy schools will still be required to provide.
About 6.7 million children expected to lose coverage
The disenrollment of many children is likely preventable, said Millward and other education advocates. Even prior to the pandemic, for example, missing paperwork was the primary cause for 150,000 children losing Medicaid coverage in Texas.
Now, an increase in housing instability and income fluctuations during the pandemic make procedural hurdles, like not receiving renewal paperwork due to changes in home addresses, even more likely.
“Unless parents act quickly to confirm their home address and complete the Medicaid enrollment paperwork, an estimated 72% of children may lose coverage during this renewal process even though they are still eligible for Medicaid coverage,” said Sasha Pudelski, advocacy director for AASA, The School Superintendents Association, in an email.
An estimated 6.7 million children could become uninsured starting April, according to estimates from the Georgetown University Health Policy Institute. A federal report from 2022 suggests the majority of children predicted to lose coverage are still likely eligible.
Sunsetting continuous enrollment will disproportionately impact children of color, with two-thirds of children who are likely to lose coverage being kids of color, according to UnidosUS, one of the largest Latino nonprofit advocacy organizations in the country. That includes 2.4 million Latino children and 1.4 million African American children.
People with limited English proficiency and people with disabilities are also at greater risk for losing Medicaid coverage during this time period due to barriers in accessing re-enrollment information, according to the Kaiser Family Foundation.
Impact on students, district finances likely
Upcoming changes in Medicaid coverage and policy could take a toll on districts and the families they serve, education policy experts and advocates say.
″Medicaid eligibility rates impact school-based Medicaid reimbursement as well as how districts certify students as qualifying for free-and-reduced lunch in some states,” Pudelski said. “If fewer students suddenly qualify for Medicaid, this will directly impact district finances.”
Medicaid is the third or fourth largest federal revenue stream for school systems, according to the Medicaid in Schools Coalition.
Students with less access to healthcare are also more likely to be chronically absent and rely on limited school-based health services instead, Pudelski added.
Districts urged to work with state agencies
Public schools are uniquely positioned between families at risk of losing Medicaid coverage and the state trying to reach them.
AASA emphasizes that district leaders play a critical role in ensuring families are aware of these Medicaid changes.
Districts should focus on communicating with families about updating their contact information with state Medicaid agencies, said Millward. “We’re really encouraging the state education and Medicaid agencies to coordinate these efforts with the local school districts,” she added.
Chicago, for example, has deployed public service announcements, radio commercials and social media advertisements in a variety of languages that can be shared “so that no one feels like they need to reinvent the wheel,” said Millward.
Almost every state is partnering with schools and community advocates for this purpose, said Jack Rollins, director of federal policy for the National Association of Medicaid Directors.
“Because schools and local districts are so well-positioned to be effective messengers to those families,” Rollins said. “And they can carry forward information about what is happening, why it’s so important to be on the lookout for communications from the state Medicaid agency, and why it’s so important to respond to any request for information that the state’s sending out.”