Pennsylvania children risk losing health coverage unless the state acts to protect them | Opinion

Pennsylvania Children at Risk of Health Coverage Loss. Here’s What Our Leaders Must Do.

By Manal El Harrak and Dr. Kelly Leite

The pandemic has brought no shortage of challenges to our country in the past two years. One silver lining, however, has been the uninterrupted access that children have had to health coverage through Medicaid and the Children’s Health Insurance Program (CHIP). Nearly half of all children in the United States are insured through these programs, according to a report by the Georgetown University Center for Children and Families. In Pennsylvania alone, more than 1.4 million children—or 47% of our children under age 19—are enrolled in Medicaid and CHIP.

Having Medicaid coverage has meant that families have had access to essential care and increased economic security during an otherwise very tumultuous time.

But in the coming months, tens of thousands of children are at risk of losing this foundational coverage as Pennsylvania begins to roll back from the continuous coverage requirement that has been in place during the COVID-19 public health emergency and resume pre-pandemic operations. At this point, Pennsylvania will redetermine eligibility for all Medicaid and CHIP enrollees, including many children, parents and pregnant mothers.

This shift represents the largest challenge to public health coverage in a decade. And it could be disastrous for our children if Pennsylvania is not thoughtful and proactive in its approach to confirming children’s Medicaid eligibility and supporting those who are no longer eligible in the transition to other sources of coverage—like CHIP or our state’s insurance marketplace, Pennie™.

According to data from the state obtained by Pennsylvania Partnerships for Children, 202,000 children have enrolled in Medicaid since the start of the pandemic—a 17% increase. We’ve seen tens of thousands of children moving from CHIP to Medicaid during the same time. However, changes in their eligibility could have occurred during the past two years, meaning these children could lose their Medicaid coverage and are at considerable risk of becoming uninsured or experiencing a disruption in coverage.

Children routinely lose coverage when Medicaid renewals take place, sometimes for something as small as a renewal letter getting lost in the mail. Studies show that when kids lose coverage, they’re more likely to have unmet health care needs that can interfere with their success in school—and as we continue to grapple with record-high inflation and a public health crisis, interrupting access to care for even short periods could have severe repercussions for the financial security and long-term health outcomes of Pennsylvania families. When health issues arise in families that are uninsured, they often face financial strain from covering large medical bills or forego seeking treatment altogether.

And there have been larger Medicaid enrollment percentages for children of color. Enrollment has increased by 34% for Asian children, 23% for Hispanic children, 17% for Non-Hispanic Black children and 27.5% for children of two or more races. There was a 47.5% increase for children identified in the All Other/Unknown category. Within this category, American Indian/Alaskan Native children increased by nearly 29% and Native Hawaiian/Pacific Islander children increased by 111.5%, yet each accounted for approximately 800 children due to the smaller population size in Pennsylvania.

Non-Hispanic white children had the smallest percentage growth, yet still represent the largest number of children enrolled in Medicaid.

Even before the pandemic, gaps in coverage were more likely to impact children in communities of color. It is important to ensure existing disparities in health care access don’t deepen when the PHE ends.

Collaboration and thoughtful preparation will be central to this transition. We urge the Pennsylvania Department of Human Services to take the time to get this right and make sure that no child becomes uninsured. As states begin to resume renewal operations, we urge them to consider the following strategies to establish safeguards to keep children covered:

• Use the full 12 months permitted to complete renewals

• Proactively update contact information for parents

• Enhance the automated renewal process, where the state reviews electronic data sources to renew coverage automatically

• Ensure a smooth transition to CHIP for children who are no longer eligible for Medicaid

The COVID-19 pandemic has reinforced the critical importance of quality health care coverage for kids in Pennsylvania. Thankfully, during this unprecedented time, Medicaid and CHIP have helped kids and families to weather the storm. We encourage DHS to use as much time and resources as allowable to plan for the behemoth task ahead - to help ensure eligible children and their families remain connected to health care.

Kelly Leite, DO, FAAP is a pediatrician in Dauphin County and member of the PA Chapter of American Academy of Pediatrics.

Manal El Harrak, MBA is the CEO of Sadler Health Center and a board member at Pennsylvania Partnerships for Children.

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