Millions of Students May Lose Medicaid Coverage. Schools Can Help Them Stay Enrolled [Education Week, Bethesda, Md.]

Feb. 7—School and district administrators can play a key role in ensuring that millions of students don't lose coverage during a change in federal Medicaid policy that could threaten their enrollment, children's health advocates say.

Children and families who use Medicaid have enjoyed unprecedented stability in their health coverage during the COVID-19 pandemic thanks to a federal policy called "continuous coverage," which is set to expire March 31. Under that rule, states were required to allow Medicaid recipients to remain in the low-income healthcare program uninterrupted and without filling out regular paperwork.

The policy's end will start a cascade of state reviews of Medicaid recipients that could lead participants to lose coverage—including some who otherwise qualify but get tripped up by administrative issues, like changes of address or missed paperwork.

The end of continuous coverage, the most impactful health insurance event since the 2010 enactment of the Affordable Care Act, could cause upheaval for students. And it could be challenging for schools, which have are billing Medicaid for more student services, like mental health treatments, children's health advocates have warned.

School and district administrators, who are typically more trusted and known to families than state Medicaid officials, can help minimize the risk of lost coverage by informing families of the policy change and helping them prepare, said Dr. Laura Guerra-Cardus, the director of state Medicaid strategy at the Center on Budget and Policy Priorities, a think tank that advocates for social programs.

"The potential massive loss of healthcare coverage really requires an all-hands-on-deck effort, and we cannot assume it is being handled elsewhere," she said.

Millions of students could lose Medicaid coverage

The continuous coverage policy, enacted as part of the 2020 Families First Coronavirus Response Act, helped Medicaid participants avoid periodic lapses in coverage, known as "churn" that can result in gaps in health treatments and mental health services until families re-enroll.

Overall Medicaid enrollment has grown by about 28 percent since February 2020, in part thanks to the pandemic-related requirement.

After the continuous coverage period ends, the U.S. Department of Health and Human Services estimates that about 3.9 million children ages 17 and younger will eventually lose Medicaid coverage due to states' reviews, despite otherwise being eligible. As those reviews continue into 2024, another 1.4 million children who currently receive Medicaid coverage will be deemed no longer eligible because of factors like increases in family income, the agency estimates.

Because Medicaid recipients have avoided many renewal requirements since 2020, the review of their status may take them by surprise, Guerra-Cardus said.

She is preparing materials for educators, including notes to families and web postings to alert them of the deadline.

Among the things families need to know:

— Families, especially those who have relocated during the pandemic, should contact their state Medicaid offices to ensure their contact information is up to date.

— Families should watch their mail for letters about Medicaid and the state Children's Health Insurance Program, or CHIP, status. (This program serves children in families that are low-income but fall above the Medicaid threshold.)

— Recipients must submit any renewal forms they receive to maintain coverage, which states could mail at any point in the next year, between March 2023 and February 2024.

— Families who no longer qualify for Medicaid after the review may qualify for coverage through their state's health insurance exchange.

Administrators should be particularly aware of ensuring English learners and highly mobile families are aware of the changes, said Guerra-Cardus. But Medicaid is a widely used program, so all families should be included in an ongoing messaging campaign.

The risk of 'churn' for schools

The continuous coverage provision was originally set to expire along with the ongoing federal COVID-19 health emergency declaration, which President Joe Biden plans to end in May. But Congress moved the Medicaid deadline to March as part of a government spending bill it passed in December 2022.

The earlier deadline has created new urgency for public health groups, which have anticipated the coverage cliff since continuous coverage was first created.

Churn could also be a big concern for schools that rely on Medicaid to help cover the costs of some student services, including mental health treatments.

"Losing Medicaid coverage is not good for kids, or for schools," Guerra-Cardus said.

The Bipartisan Safer Communities Act—a legislative package Congress passed after the May 24 school shooting in Uvalde, Texas—prompted new federal guidance on how schools can bill Medicaid, provided funding for states to simplify the process, and required Medicaid officials to create a technical assistance center for school administrators.

Medicaid pays for about $4 billion in school-based services a year, according to an estimate from AASA, the School Superintendents Association. That makes Medicaid the third- or fourth-largest federal funding stream for many schools—an incentive for schools to help address the end of continuous coverage.

But advocates also say schools are some of the most consistent, trusted messengers in many communities.

"School districts are one of the few systemic ways you can get information to families," Guerra-Cardus said. "This moment warrants that."

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