Oklahoma's improvement in child uninsured rate is best in the U.S., researchers say

Oklahoma's recent decline in uninsured children represents the biggest improvement among all states, according to a new report examining the COVID-19 pandemic's impact nationally on child insurance rates.

The report, released Wednesday by Georgetown University's Center for Children and Families, shows that in Oklahoma the rate of uninsured children declined from 8.6% to 7.4% between 2019 and 2021.

The organization, described as a nonpartisan policy and research center, credited the drop to the implementation of Medicaid expansion in Oklahoma, along with pandemic-related continuous coverage protection.

"Oklahoma did a really terrific job of enrolling a lot of folks for Medicaid quickly," said Joan Alker, center executive director and lead author of the report.

"The state still has a ways to go," she added.

At 44th, Oklahoma continues to place in the bottom 10 with its rate of uninsured children.

But the recent improvement "is really good news for children," Alker said.

Nationally, the child uninsured rate declined from 5.7% to 5.4% between 2019 and 2021, according to census data examined by the researchers.

The state-by-state analysis found an improvement in the rate and/or number of uninsured children in 12 states while it stabilized in most other states.

Only three states went in the wrong direction, the report stated, with Idaho, where the number of uninsured children increased 46%, seeing the worst trend.

While Oklahoma's gains are positive, officials cautioned that the state shouldn't rest on its laurels.

About 75,000 Oklahoma children remain without health care insurance, according to Oklahoma Policy Institute. Moreover, experts warn that the recent gains both in Oklahoma and nationally could be lost when pandemic-related continuous coverage protection expires.

The protection, which ensures that Medicaid coverage must remain in place while the federal COVID-19 Public Health Emergency continues, is expected to last at least until April 11, 2023, when states will have to re-determine eligibility for more than 80 million individuals. In that process, some 6.7 million children will be at risk of losing coverage, Georgetown estimates.

Emma Morris, Oklahoma Policy Institute revenue and health care policy analyst, said Oklahoma can take action to protect and build on the gains that have been made.

"The state could implement what's called continuous eligibility specifically for our child population, which would allow kids who are insured by Medicaid to have 12 months of continuous coverage regardless of small income fluctuations or not meeting administrative requirements," she said.

Another helpful action, Morris added, would be to make more children eligible for Medicaid.

"There are several other states with higher eligibility levels," she said. "So Oklahoma could think about maybe raising our qualifying income limit for children to match that of other states."

Medicaid expansion took effect in Oklahoma in July 2021, and it was likely the main driver for boosting child coverage rates in the state.

Alker said: "We've seen this phenomenon in other states. We call it the 'welcome mat' effect. What that means is that even though many of these children were already eligible for Medicaid in Oklahoma, some of their families didn't know that. We've found that when you open the door for parents, children walk through that door, too, and the whole family gets covered.

"This is great news whenever it happens, but especially in Oklahoma, which really had one of the highest child uninsured rates in the country."

Among demographic groups in Oklahoma, Native American children, who have a high uninsured rate, and white children saw the largest increases in their coverage rates, Alker said.

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