Millions of Children (and Their Parents) Could Lose Their Health Insurance Soon

A pandemic-era protection that kept people insured during a public health emergency will expire soon. What happens next?

a piggy bank with a stethoscope, calculator and financial forms
Rapeepong Puttakumwong / Getty Images

As many as 15 million Americans, many of them children, are at risk of losing their health insurance in the months ahead. Since January 2020, federal pandemic emergency guidelines mandated that during the Covid pandemic, no Medicaid enrollees could lose their coverage. But with governments deciding that the public health emergency (PHE) is coming to a close and the federal funds that bolstered state Medicaid programs drying up, that coverage could come to an end this year.

Typically, states review Medicaid enrollees on a rolling basis, reassessing applicants’ age, employment, income, housing, and disability status to determine if they qualify for Medicaid. Since the declaration of the public health emergency caused by the Covid pandemic, those reassessments stopped. Nearly two years later, more Americans than ever are enrolled in Medicaid—76.7 million people, almost 1 in 4 Americans, 6 million of whom are children who qualify for CHIP, the government-funded Children’s Health Insurance Program, or who are covered under their parents’ Medicaid enrollment.

Complicating matters is the fact that states aren’t sure when the PHE will be declared over, meaning they aren’t sure when they’ll need to begin processing the two-year backlog of redeterminations. The Biden Administration recently announced that states would have up to 12 months to complete the mammoth task of reassessing every current Medicaid enrollee’s eligibility—a change from the initial time frame of six months after the PHE is declared over.

The uncertainty surrounding the end of the PHE and, therefore, the end of the Medicaid mandate is also confusing matters. States are scrambling to determine when and how to let residents know their Medicaid could end. Initially, the Biden Administration had an end date of January 15th, 2022, but just two days before extended the deadline 90 days. State officials are finding it difficult to put a communication plan in place when they don’t know when the process will officially begin.

As with any time bureaucratic mountain of paperwork and number crunching, mistakes are bound to be made. In a typical year, some Medicaid renewal and cancellation documents—which are sent via the U.S. Mail, not electronically—get lost in transit or end up at the wrong address, and with so many people facing cancellation, the wave of documents will be unprecedented. And all this comes at a time when many state agencies are short-staffed and underprepared to meet the burden of reviewing the mind-blowing number of Medicaid enrollees.

The best-case scenario for millions of low-income and marginalized people, and children, is that they will still qualify for Medicaid or that they can obtain insurance through an employer or the Affordable Care Act insurance marketplace, which can cost hundreds of dollars a month for coverage. Experts expect many people to fall through the cracks and be left either wholly uninsured or at the very least experience a gap in coverage while they enroll in alternative health plans.

And even small gaps in coverage can have significant impacts on families, especially considering that the pandemic is not yet over and that Medicaid enrollees have the lowest level of vaccinations in many states.