COLUMBUS, Ohio — The Trump administration notified Ohio it would not consider a request that children from ages birth to four be continuously covered by Medicaid.
The federal government’s notification this summer means that many parents of the 152,000 Ohio children who lack health coverage will continue to worry that an illness could set the family back with high medical bills.
Ohio is one of 22 states with statistically significant increases in the rate of uninsured children between 2022 and 2024, according to a new report from Georgetown University.
During that period, an additional 30,000 Ohio children became uninsured, bringing the total uninsured to 152,000, or 5.6% of the state’s children.
The increase is attributed to the state disenrolling children from Medicaid and the Children’s Health Insurance Program, starting in 2023, when federal pandemic coverage mandates lifted. That allowed the Ohio Department of Medicaid to review the 3.5 million Medicaid beneficiaries for eligibility; over 600,000 lost coverage.
Even as the disenrollments began, the General Assembly wanted to ensure the youngest Ohio residents get a healthy start. Lawmakers required in the 2023 budget law that the Department of Medicaid provide continuous coverage for the first four years of a child’s life. The state began the process of applying for a waiver from the federal government to fulfill the law.
“Ohio had proposed to keep kids enrolled through their fourth birthday, so that no matter what happened with their family’s income, they would just be continuously enrolled, from birth through their fourth birthday, if they qualified at birth,” said Emily Campbell, CEO of the Center for Community Solutions, a Cleveland-based health and social services think tank.
But this year, state lawmakers changed their minds. In the budget bill passed in late June, they repealed the continuous coverage provision from 2023. Gov. Mike DeWine, however, vetoed that provision, saying in his June 30 veto message that access “to needed healthcare for babies and young children is critical to early childhood development.”
However, the federal government got the last word in the debate.
On July 17, the federal Centers for Medicare and Medicaid Services announced it sent letters to states that it was shifting away from policies that extend beyond Medicaid’s statutory limits, including continuous coverage waivers.
“This shift in approach reflects the agency’s commitment to preserving these vital programs for the most vulnerable Americans and using taxpayer dollars carefully,” CMS said.
Cleveland.com | The Plain Dealer reached out to the Ohio Department of Medicaid for comment.
Disenrollment mistakes?
Campbell said the continuous coverage would have helped many of the children who have lost health coverage since 2022.
She and another child health care observer offered reasons that children were disenrolled from Medicaid and CHIP that didn’t have to do with eligibility. Some children may have been disenrolled mistakenly, they said.
Complicated processes, bureaucracies and technology glitches may have resulted in people being disenrolled who were nevertheless still eligible for Medicaid and CHIP, which are joint state-federal health care programs for people who are low-income, or have certain health conditions, such as pregnancy or disabilities.
“We were very worried about eligible children being disenrolled by mistake during this unwinding process,” said Joan Alker, the executive director and co-founder of the Center for Children and Families at Georgetown, which produced the report about Ohio and the other states with rising rates of uninsured children.
Reassessing eligibility fell on county Job and Family Services offices, many of which don’t have enough staff for the work, Campbell said.
“Any time that there is a change in public policy or regulation, it always takes state and local government some time to be able to work through all of that, and it’s added work – and adding work – especially here in Cuyahoga County to a Job and Family Services department that is already stressed and stretched,” she said.
Mistaken family assumptions?
Income limits for children on CHIP are higher than for adults on Medicaid, which means some parents may mistakenly believe that once they lost their health coverage, their children did, too, Campbell said.
CHIP covers children from families that earn up to 200% of the federal poverty level. That’s $64,300 for a family of four.
Income limits for adults vary by Medicaid program but are lower.
For the program known as Medicaid expansion, the limit is 138% of the poverty level, or $44,367 for a family of four. In the Medicaid program for parents and caretaker relatives with children under age 19 in the home, it’s 90% of the poverty level, or $28,935 for a family of four.
“So, if the parents lose their Medicaid coverage, they don’t always realize that their kids can maintain that coverage,” Campbell said. “We do see kids getting wrapped up with their whole families because, of course, we operate in families.”