With federal designations regarding COVID-19 set to lift next year, about 42,000 children in West Virginia are at risk of losing insurance coverage.
In a presentation during an interim session of the Legislature’s Committee on Children and Families earlier this month, lawmakers heard research conducted by Georgetown Center for Children and Families showing at-risk child enrollees fall into two groups: those who will lose coverage because they are no longer eligible — 23,057 — and those who are still eligible, but will have paperwork issues — 19,173.
Kelly Allen, executive director of the West Virginia Center on Budget & Policy, said West Virginia is now in the driver’s seat, and the future of health coverage for youth in the state is in its leaders’ hands.
“This is very much in our control, depending on how we as advocates and policymakers and legislators approach and process the timeline for renewing and evaluating everybody on Medicaid,” she said. “We can all work together to make sure kids stay covered by collaborating and building on the good work that [the Department of Health and Human Resources] and you all and the CEOs and other advocates are already doing.”
Allen said it is important legislators help make the transition as smooth as possible for enrollees and DHHR, which will take on the task of re-evaluating hundreds of thousands of cases to re-determine eligibility.
Before the COVID-19 pandemic, about 97% of West Virginia’s children had insurance coverage, but the number increased through the federally issued-COVID-19 public health emergency designation, which brought more stability to the insurance system due to a continuous coverage requirement.
That continuous coverage requirement put protection in place for children against social and economic disruptions the pandemic brought with it.
The Georgetown study estimates 7 million children nationally are at risk of losing insurance when a federal COVID-19 public health emergency designation is lifted early next year. Comparatively, before the pandemic the number of children uninsured was 4.4 million.
The study showed about 42,000 of 242,708 West Virginia’s children under age 18 currently enrolled in Medicaid or Children’s Health Insurance Program are at risk.
Of the about 42,000 children, Georgetown estimates 23,057 West Virginia children could lose coverage because they’re no longer eligible for Medicaid and CHIP, who Allen’s peers worry could get lost in the transition to private insurance and not have health insurance coverage.
Another 19,173 children at risk of losing their coverage are still eligible, but could potentially fall through the cracks due to paperwork barriers caused by hangups like DHHR not having an updated address or parents filling out paperwork incorrectly.
Estimates from the DHHR indicate the combined number is much lower at 20,000. Allen said either way you look at it, the numbers are concerning.
“The bottom line here is that anywhere between 19,000 and 42,000 West Virginia children could potentially lose their health coverage in 2023,” she said. “To put these numbers in context, in 2019, the total number of uninsured kids in West Virginia was 13,600.”
Allen’s peers worry the cases could get lost in the transition to private insurance and not have health insurance coverage.
Allen warned legislators children who experience gaps in health insurance lose access to health care, forcing families to delay care, refill prescriptions less frequently and use emergency rooms for basic health care needs, which could burden the health care system.
Once the declaration is lifted, every single enrollee will have to go through a renewal process, which will take a lengthy amount of time to make sure it’s done right and no child falls through the cracks. Allen said groups within the DHHR are doing work to make sure the transition goes smoothly once the declaration is lifted, but there is still more the Legislature could do.
Having adequate staffing on the teams to process those renewals would help that effort, Allen said as an example.
For enrollees who are still eligible for coverage, but still at risk of being dropped, Allen said making sure DHHR has the right mailing addresses and is providing thorough education in communities would help prevent the unwarranted loss of insurance.
She also asked DHHR to be more understanding of paperwork errors.
Allen also asked legislators to consider these measures for parents when finding solutions.
“Researchers found what they called the welcome mat effect in Medicaid,” she said. “To put it really simply, it means that when parents have health coverage, their kids are more likely to stay covered.”
For children who will become ineligible and transition to other coverage, Allen said it’s important to make sure there are no gaps in coverage. Different tiers of CHIP require a monthly premium, she said, and waiving the premium as families transition could be a major help.
Allen added proper funding for outreach to the community is also important.
Delegate Chad Lovejoy, D-Cabell, said in researching the topic, he found there is a waiver process to the federal government that allows states to see additional time or months to make the transition. He said 38 states have been granted waivers as of December.
“The waivers, I understand, cost nothing to the state. It simply allows you either additional time or additional methods to do the re-determination,” he said. “So I guess my question is, in addition to legislative action, the department could file requests like the other 38 states for those waivers for help.”
Allen said she was unaware if the state had applied for the waiver, but she was interested in anything that could help.
Delegate Lisa Zukoff, D-Marshall, asked about the cost to parents for children who have premiums. Allen said the premiums are well below $100, but waiving that provision — or being forgiving of missed payments — could go a long way.
Sen. Richard Lindsay, D-Kanawha, said it’s important for the next Legislature to take the recommendation to make sure the children are taken care of.
“Everyone I think can agree that if you’re not healthy, you can’t be healthy. Not only can you not be healthy, but you can’t do well at school, and you can’t be happy,” he said.
