State Variation in Child Medicaid Drop-offs Post-Pandemic
TL/DR –
The Children’s Health Insurance Program (CHIP) and Medicaid saw a decrease of 4.16 million child enrollees by December 2023, a higher loss rate being evident in the second half of the year. Texas, Florida, Georgia, and California accounted for half of this national decline with South Dakota, Montana, and Utah having the highest percentage of child Medicaid/CHIP population drops. The report suggests that the majority of children losing Medicaid coverage are likely still eligible and that the number of children enrolling in marketplaces and separate CHIP programs is only slightly offsetting the declining total child Medicaid/CHIP enrolment.
Medicaid/CHIP Enrollments Drop by 4.16 Million Among Children by December 2023
As states began renewing eligibility after the discontinuation of COVID-related Medicaid continuous coverage protections, Medicaid and the Children’s Health Insurance Program (CHIP) saw a decrease of 4.16 million children in nationwide enrollment by December 2023. This period is referred to as the Medicaid “unwinding.” Texas, Florida, Georgia, and California accounted for half of the total national decline, with Texas alone accounting for over one million of the total decline. Download the Full Report (PDF)
Background
During the COVID-19 public health emergency, states maintained continuous coverage for Medicaid enrollees in exchange for increased federal Medicaid matching rates. With the public health emergency winding down, Congress ended the continuous coverage requirement as of April 1, 2023, under the Consolidated Appropriations Act (CAA), 2023 and enacted provisions to promote a smoother Medicaid renewal process for the approximately 94 million people enrolled in Medicaid at the end of 2022.
Significant Decline in Child Medicaid/CHIP Enrollment in 2023
By the end of 2023, enrollment in Medicaid/CHIP nationwide for children declined by 4.16 million compared to aggregate enrollment before the unwinding began. The states with the greatest Medicaid and CHIP child enrollment losses in 2023 were Texas, Florida, and Georgia with Texas exceeding one million children. South Dakota, Montana, and Utah experienced the largest percent declines in their child Medicaid/CHIP enrollment with reductions of one-quarter or more compared to enrollment before the unwinding.
Children Moving to Separate CHIP or the Marketplace?
CHIP covers children whose incomes are just above Medicaid. With Medicaid enrollment declines offset by CHIP gains by only 10.3%, and children accounting for approximately 10% of Marketplace enrollment, only a modest share of the net decline in total child Medicaid and CHIP enrollment was offset by new enrollment in the marketplaces and separate CHIP programs.
Appendix
Methodology
This report uses data from the Centers for Medicare & Medicaid Services (CMS) State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Data to analyze child enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) by state. These data show changes in net Medicaid and CHIP child enrollment, which takes into account any enrollment declines offset by any enrollment increases.
Endnotes
References used for this report can be found in the original document.
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