Kids Are Losing Health Care Due to Red Tape. Why Don’t School Leaders Speak Up?
Haspel: Children don't learn well when they are sick or in pain. But 5 million are being left uninsured as states scramble to purge Medicaid rolls.
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Children do not learn well when they are sick, are in pain or have blurry vision. The link between children’s health and school performance is established to the point of truism. It is surprising, then, to hear near-silence from education leaders as more than 5 million kids are losing their health insurance — many for no other reason than red tape. America’s schoolchildren need their champions to call for action.
Kids are caught up in a chaotic process known as Medicaid unwinding. During COVID, states were not permitted to disenroll anyone, but since December’s congressional budget deal, they have been engaged in rapidly redetermining the eligibility of everyone enrolled in Medicaid or the related Children’s Health Insurance Program (CHIP).
Instead of merely removing individuals now above the income eligibility limits, a horrifying number of people — fully 75% of those losing coverage — have been thrown off Medicaid for procedural reasons. These include people not returning paperwork because, among other things, states sent it to old addresses, technology problems prevented them from updating their information or they were confused about the process. Many state support call centers are slow or faulty, resulting in high rates of abandoned calls when people try to get assistance in proving they remain eligible.
A huge portion of those affected are children. In states that break out data by age band, kids make up an average of one-third of all disenrolled. That average hides wide variation; children make up more than half of the disenrolled in Georgia, Missouri and Idaho, and more than 40% in Minnesota. As Joan Alker, executive director of Georgetown’s Center for Children and Families, told the Los Angeles Times, “We are expecting children to take the biggest hit here. They’re not going to have somewhere else to go.” Indeed, the center’s data shows kids do not appear to be moving in substantial numbers to other health insurance programs: in other words, these disenrollments will leave many children uninsured.
The issue’s complexity can mask its very real impact on kids. Medicaid and CHIP cover medical, dental and vision needs. Without it, lower-income children have little access to everything from routine well-child visits and vaccinations to eyeglasses and care for a painful cavity — and that doesn’t include the significant number of kids with chronic medical conditions. Even if a child is lucky enough to remain healthy, another family member needing medical attention while uninsured can quickly disrupt the stability of entire households.
This should be a five-alarm fire for education leaders still contending with the impacts of the pandemic. There is even an extra element of self-interest for schools: as Education Week reported, schools commonly use students’ Medicaid to get reimbursed for things like mental health and special education services, making it the “third or fourth largest federal funding stream for many schools.” District budgets therefore stand to take a hit from wrongful disenrollments.
Yet despite all this, figures from superintendents to teachers union heads have been almost entirely silent on the issue. A review of the websites of the major associations for principals and superintendents, as well as the two main teachers unions, reveals no statements or official stances. I have not been able to find a single example of an education leader suggesting that states pause procedural disenrollments of children until they can ensure that none are being erroneously removed from the rolls.
To be fair, schools do seem to see a role for themselves in communicating with and helping parents navigate the recertification process. The Centers for Medicare and Medicaid Services released a toolkit for early childhood education and K-12 providers, with items like template letters and robocall scripts. That is all well and good, and districts should be applauded for implementing these measures. But knowing about the need to update your address does little when you can’t submit information on a broken state website or states still mail forms to an outdated address.
Almost all states have proven themselves unable to effectively execute the unwinding process fairly and in a way that minimizes errors. For example, many have been using parents’ income to determine children’s eligibility for Medicaid even though the threshold for kids is much higher. This proved so harmful that the centers recently demanded that the states make amends, including options of pausing disenrollments or automatically granting all children an extra year of eligibility. Such an extension would buy time to correctly contact families, work out technical problems, meet call center demands and increase the number of accurate automatic renewals.
Some states, like Minnesota, have imposed a temporary pause on procedural disenrollments. More widespread and longer moratoria, however, will not occur without public pressure; states, the Biden administration and Congress all have a role to play. Children’s health advocates and medical groups have been sounding the alarm, but they need help. The education sector is large and powerful. Now is the time for its leaders to stand up and be heard: Not one more child should lose health coverage because of red tape.
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