Children's Enrollment in Children's Health Insurance Program (CHIP) Coverage During the Medicaid Unwinding.

Area of Science:

• Health Services Research
• Public Health Policy
• Child Health Insurance

Background:

• The Families First Coronavirus Response Act (FFCRA) temporarily suspended Medicaid disenrollments.
• The unwinding of continuous enrollment provisions presents challenges for maintaining children's health coverage.
• Understanding enrollment dynamics in Medicaid and the Children's Health Insurance Program (CHIP) is crucial.

Purpose of the Study:

• To analyze shifts in children's Medicaid and CHIP enrollment during the FFCRA unwinding period.
• To determine if CHIP enrollment compensated for any declines in Medicaid enrollment.

Main Methods:

• Utilized monthly children's enrollment data from 32 states and the District of Columbia (April 2023-September 2024).
• Employed linear probability models with monthly indicators to estimate enrollment changes.
• Differentiated analysis by CHIP structure type (combination vs. Medicaid expansion).

Main Results:

• Medicaid enrollment among children decreased significantly, from 48.1% to 41.2%.
• CHIP enrollment remained stable, fluctuating between 8.7% and 8.6%.
• No significant increase in CHIP enrollment was observed to offset Medicaid declines, particularly in states with combination CHIP.

Conclusions:

• Children experienced substantial Medicaid enrollment losses during the unwinding without corresponding CHIP gains.
• There is a critical need for policies to prevent administrative churn and ensure continuity of coverage.
• Seamless transitions between Medicaid and CHIP are essential for child health insurance stability.