Millions of eligible children disenrolled from Medicaid following pandemic policy rollback

Children account for nearly 40 percent of the 10.6 million Medicaid disenrollments reported by states as of Nov. 14, according to the Kaiser Family Foundation, which tracks state Medicaid data.

As of September 2023 in California, nearly 704,000 people have been disenrolled, 21 percent (more than 151,000) of whom were children.

School-based health centers have been recognized for increasing access to care among underserved communities and in rural areas. For many of the millions of students receiving school-based health services, schools are the first — and sometimes only — option to receive health care. And with at least 70 percent of students who access mental health services also doing so in a school-based setting, expanding access is even more critical as demand continues to rise.

A recent change in California’s Medi-Cal program authorizes schools to bill Medi-Cal for services provided to all Medi-Cal eligible students, not only those with an individualized education programs.

On Nov. 16, 2023, Gov. Gavin Newsom signed CSBA-sponsored Assembly Bill 483, which expanded access to school-based health and mental health services by simplifying the process for schools to participate in the Local Education Agency Billing Option Program (LEA BOP) and receive federal Medicaid reimbursement for health services provided to Medi-Cal eligible students. At the time the bill was signed, more than half of all children statewide were enrolled in Medi-Cal.

The LEA BOP reimburses local educational agencies for the federal share of approved health-related services (typically 50 percent) provided by qualified practitioners. Covered services include occupational therapy, speech therapy, physician and nursing service, psychology, physical therapy and physical/mental health evaluation and more.

However, if students lose coverage, districts that bill Medicaid for services could take a hit to their finances.

Reasons for disenrollment

Twenty-one states reported the ages of those who disenrolled, according to the Kaiser Family Foundation. Of the more than 2 million children disenrolled in those states, about 70 percent occurred as a result of procedural reasons, including outdated contact information or because people failed to complete renewal packets on time.

Until March 31, 2023, pandemic-era policies allowed Medicaid recipients’ coverage to automatically renew without determining whether or not they remain eligible.

An estimated 6.7 million children could ultimately become uninsured as a result of those pandemic-era policies ending, according to an estimate from the Georgetown University Health Policy Institute released in February 2023. “The vast majority of children (73.6 percent) losing coverage will remain eligible for Medicaid but are likely to lose coverage due to bureaucratic snafus,” they found.

Of the people whose coverage had been renewed as of Nov. 14, 57 percent were renewed on an ex parte basis while 43 percent were renewed through a renewal form. Ex parte (or administrative) renewals occur by verifying ongoing eligibility through available data sources, such as state wage databases, before sending a renewal form or requesting documentation from an enrollee, according to the Kaiser Family Foundation.

Schools — which already have access to families’ contact and home address information — can help students renew their coverage through reminders via letters, text messages, social media and other communications to make children and families aware of the change in public health policy that may render them ineligible due to a lack of proper paperwork.