Ohio among the largest drops in children enrolled in Medicaid, feds say

HHS Secretary Becerra says he is ‘deeply alarmed’ in letter to Gov. DeWine.

By Samantha Wildow / December 28, 2023

Health and Human Services’ top executive is concerned with the number of children in Ohio that have been dropped from Medicaid or the Children’s Health Insurance Program.

Ohio is among nine states that have seen large increases in children enrollment drops in the past year, the U.S. Department of Health and Human Services says, but Gov. Mike DeWine’s office attributes this to being among the most populous states.

“Maintaining access to uninterrupted health coverage, particularly for children, is critical to the health and well-being of Americans and provides hardworking families the financial security they need to have peace of mind,” Xavier Becerra, secretary of the U.S. Department of Health and Human Services (HHS), said in a letter to Ohio Gov. Mike DeWine.

As of September, Ohio had approximately 3.18 million enrollees in Medicaid, including 1.04 million kids, according to HHS.

“I am deeply alarmed that, as of September 2023, your data shows that children’s Medicaid and CHIP enrollment in your state has declined by 86,053 children or (6%) compared to March 2023,” Becerra said in his letter.

In 2020, the federal government declared a public health emergency that provided support and health care for families in response to the COVID pandemic. For the past three years, nearly all Medicaid members were able to stay enrolled in their plans regardless of changes in eligibility or status. Previously, Medicaid recipients had to reenroll so the state could determine their eligibility.

The public health emergency ended in May, but the continuous Medicaid enrollment provision ended in March, requiring eligible Ohioans to reenroll for Medicaid. If they have not enrolled, they were dropped from Medicaid.

Before April 1, nearly 3.5 million Ohioans had some type of Medicaid coverage with the majority — more than 3.2 million — being on a Medicaid managed care plan.

Medicaid and CHIP benefits cover almost 40 million children, half of all children in this U.S., Becerra said. In Ohio, the state provides CHIP benefits as an expansion of the state’s Medicaid plan rather than operating a separate program for CHIP, according to the Ohio Department of Medicaid.

“Ohio is our nation’s (seventh) largest state, so it is unsurprising that Ohio ranks where it does in this ranking of raw numbers,” said Dan Tierney, press secretary for Gov. Mike DeWine.

Ohio also is further along in the redetermination process since continuous enrollment during the COVID public emergency ended, according to Tierney.

“HHS has communicated with our administration and noted Ohio is farther ahead in redeterminations than other states, which means Ohio Medicaid is doing a better job complying with these directives than other states, which is something to be commended,” Tierney said.

Nationally, more than 88 million people were enrolled in Medicaid and CHIP coverage as of September 2023, according to HHS. Before the pandemic, in February 2020, about 71 million people were enrolled in Medicaid and CHIP, including about 35 million children.

Ohio has not had the largest drop in volume or percentage of children covered. Texas and Florida both had some of the largest drops in volume, with 524,909 in Texas and 366,633 children in Florida losing their Medicaid or CHIP coverage, according to HHS. Both of those figures were decreases of 12% in the number of children enrolled.

The largest percentages are between Idaho and South Dakota, both decreasing the number of children covered by 27%. Idaho dropped 56,580 children from the program, and South Dakota went down by 27,572 children enrolled, according to HHS.

HHS is asking states with large decreases in the number and/or percentages of children enrolled in Medicaid or CHIP to not let “red tape” get in the way of coverage.

“I urge you to ensure that no eligible child in your state loses their health insurance due to ‘red tape’ or other bureaucratic barriers during the Medicaid enrollment process,” Becerra said.

Among suggestions for states, HHS has encouraged those with large decreases in the number and/or percentage of children covered under Medicaid or CHIP to:

• Adopt federal strategies developed to make renewals easier for children and families, including by leveraging guidance and tools published by the Centers for Medicare and Medicaid;

• Remove barriers, like CHIP enrollment fees and premiums, which make it harder for children to transition to CHIP coverage if they are no longer eligible for Medicaid; and,

• Reach additional families by reducing call center wait times and partnering with pediatric providers, managed care plans, schools, and community organizations.

For state fiscal year 2023, Ohio spent approximately $36.1 billion, including both state and federal funds, on the Medicaid program as a whole.