Columbia pediatrician Dr. Deborah Greenhouse treated kids Dec. 7 in her office with strep, bronchiolitis and other maladies from a wave of respiratory illness sweeping South Carolina. She shudders to think what that would look like if thousands more were uninsured and had to seek care at an already crowded Emergency Room.
“That would further burden an already overwhelmed health care system for children,” Greenhouse said. “Families should not face uncertainty when what they need most is support and peace of mind.”
Across the country, thanks to emergency rules put in place during the pandemic, many families gained health insurance coverage and the number of uninsured children dropped, according to a Dec. 7 report from the Georgetown University Center for Children and Families. Between 2019 and 2021, there were 210,000 fewer uninsured children in the U.S., and the rate dropped from 5.7 percent to 5.4 percent, according to the report, which used data from the U.S. Census Bureau.
In South Carolina, the number of uninsured kids declined from 69,000 to 63,000, a drop of 9.5 percent, the report found. The uninsured rate for children went from 5.8 percent to 5.3 percent, although South Carolina continued to rank 32nd among the states.
Much of the improvement came from pandemic-era measures like the Families First Act, said Joan Alker, executive director of the Georgetown Center. In exchange for an extra 6.2 percent in Medicaid funding, states like South Carolina agreed not to kick any children or families off Medicaid while there was a federally decreed Public Health Emergency.
That emergency declaration of 90 days has been extended several times and is currently set to expire Jan. 11, 2023. However, because the Biden administration said it would give states at least 60 days’ notice before the decree is allowed to expire, and that time period has already passed, it will almost certainly be extended to April 11. States could then begin the process of reviewing families and children to see if they are still eligible for Medicaid coverage then.
In the meantime, the number of people and children on Medicaid nationally and in South Carolina has grown substantially. Nationally, enrollment in Medicaid and the Children’s Health Insurance Program rose from 70.7 million in February 2020 to 90.55 million in August, a 28.1 percent increase, according to a Post and Courier analysis of federal data.
Medicaid enrollment in South Carolina went from 1.23 million in February 2020 to 1.29 million as of Sept. 30, according to the S.C. Department of Health and Human Services, an increase of 4.88 percent. Children on Medicaid in the Palmetto State went from 650,713 to 742,705, an increase of 14.1 percent, according to an analysis by The Post and Courier of state and federal data.
Some children were previously eligible for Medicaid or other programs and weren’t enrolled but then gained coverage when their parents became eligible for Medicaid and signed up the whole family, Alker said. Researchers also believe there is an undercount in the federal data which would account for the gap between those who gained coverage under Medicaid and the smaller improvement in the uninsured rate. Children in lower-income families saw the biggest gains in coverage, she said.
“The improvement of the child uninsured rate has been a bright spot for children during the dark days of the pandemic,” Alker said. “(But) while this is welcome news for America’s children, it may be short-lived.”
Once the public health emergency ends, states can then reassess eligibility, and advocates fear many will fall victim to “procedural losses,” children and families who get kicked off because of administrative mistakes, Alker said. The center had earlier estimated that it could be as many as 6.7 million kids who lose coverage nationwide, many from things like the state sending the re-enrollment notice to the wrong address if a family has moved and the information has not been updated.
South Carolina Medicaid has a detailed plan to keep that from happening, checking family income eligibility electronically through other state databases such as the Department of Employment and Workforce, or by checking federal sources, the office confirmed. Those being re-evaluated will get a 60-day notice, with a follow up 30 days out, before eligibility is cut off. Unlike some other states, South Carolina also plans to use calls and texts to try and reach families, the state agency said.
The state needs to do all that it can to keep that coverage going, Greenhouse said.
“We can’t let children down right now,” she said.
Reach Tom Corwin at 843-214-6584. Follow him on Twitter at @AUG_SciMed.