Paperwork mistakes should not end a child's health coverage

ANOTHER VIEW

When states finish culling their Medicaid rolls for the first time since the pandemic began, nearly 7 million eligible people will have lost their health insurance, according to federal estimates - and more than half will be children. This slow-moving public health disaster can be avoided, if state officials act now - or the federal government forces them to.

States had years to prepare for this transition, which started when President Biden officially ended the covid public health emergency in April. Medicaid covers low-income Americans. Beneficiaries whose incomes rose since they enrolled - rendering them ineligible for the program - could not be kicked off with the pandemic raging. Now, they can be.

But eligible people can fall through the cracks during the reduction. Even before the pandemic, the complicated Medicaid renewal process was an obstacle to seamless coverage for those who qualified. States should have streamlined the system to ensure people were not kicked off their health coverage without good reason.

Yet in just the handful of months since Mr. Biden's proclamation, states have disenrolled millions of people because of paperwork that was unreturned, improperly completed or received past the deadline. During this great Medicaid "unwinding," some states stand out for their conscientious efforts to ensure that those who qualify for insurance remain securely covered. The rest should take notes.

Virginia is a model. Of the 290,000 Medicaid renewal applications the state has finished evaluating, it has denied only 6 percent for procedural issues, according to data from Georgetown University's Center for Children and Families. The state averted paperwork challenges by relying on automation - something all states should be doing. Federal directives mandate that states try to make Medicaid eligibility determinations by sifting through troves of data they already have, such as state payroll and welfare program records. Virginia did this successfully in 66 percent of evaluated Medicaid cases.

Texas, by contrast, has automated less than 1 percent of its Medicaid renewals. Consequently, of the state's 612,000 completed Medicaid renewal applications, 66 percent resulted in disenrollment because of paperwork errors. That's more than 400,000 people. And Texas is not alone in its low rate of automated renewals.

The ramifications of these bureaucratic lapses are most acutely felt by children, who urgently require immunizations, wellness checkups and screenings to ensure their healthy development. Kids make up 30 percent of Medic-aid disenrollments in the 11 states providing age breakouts, according to data from KFF. In Georgia, a public-information request revealed that about two-thirds of the nearly 96,000 residents who lost Medicaid coverage in June were children - and 94 percent of those children were disenrolled for procedural reasons.

If states cannot quickly stand up a system as effective as Virginia's, they have some stopgap options. Oregon and Washington allow children to remain under Medicaid protection until age 6 without requiring renewals. California is set to enact a similar policy in 2025. Meanwhile, states such as Minnesota have voluntarily paused procedural disenrollments for Medicaid recipients.

Texas has not announced a similar action. Fortunately, the federal government is beginning to step in. The Biden administration has compelled six states to pause procedural removals and reinstate coverage to some who were denied. The Centers for Medicare and Medicaid Services is also examining disenrollment problems in about a dozen other states.

But it would be better if state officials did not have to be ordered to try harder. Medicaid is supposed to serve some of the country's most vulnerable people: low-income Americans and their children. State Medicaid programs should help them access care - not hinder them.

- The Washington Post