The Kids Are Not Alright: Why Pediatricians Need to Take Action to Prevent Medicaid Unwinding

Pediatricians have encountered their fair share of threats to children’s health – from RSV to Covid-19, to the current mental health crisis. But hearing about the effects of Medicaid redetermination on pediatric practices across the country has convinced me that this is another critical threat to children’s health that pediatricians can’t afford to overlook. It will take collaboration from across the healthcare industry and across the public and private sectors.

Since states began the Medicaid unwinding process, over 2.1 million people have already lost their health insurance. Even more frustrating: as of July 13, 75% of disenrollments were due to procedural reasons, according to The Kaiser Family Foundation. In other words, individuals who may still be eligible for Medicaid coverage are being disenrolled simply because they weren’t aware they needed to take action, couldn’t be reached by the state, or because parents didn’t complete paperwork on behalf of their children who are enrolled in Medicaid or CHIP.

About half of all U.S. children receive their insurance coverage from Medicaid or CHIP. Five million of the 17 million people who are at risk of losing their coverage as part of the unwinding are kids. And many of their parents won’t realize they’ve lost coverage until they show up for an appointment at their healthcare provider’s office, seek emergency care, or try to fill a prescription. Imagine coming to an office with a sick child and finding out, in a time of fear and anxiety, that your child no longer has health insurance. The cost of that unplanned urgent care or emergency room visit could put a vulnerable family over the edge. And the consequences of not getting care could be even worse.

This scenario is not just cause for alarm; it’s cause for action. Everyone in healthcare has a duty  to help patients maintain their Medicaid and CHIP coverage. The American Academy of Pediatrics has been preparing and organizing pediatricians for months. But it’s going to take more than just doctors –we need everyone who works with children to take up arms. Pediatricians may be a constant point of contact for families but other providers, like WIC nutritionists, early intervention teams and school nurses, are just as vital to a child’s health. And these providers tend to interact with families more often.

All hands on deck

Although states have established call centers to assist families in evaluating their eligibility and helping them maintain coverage, a March 2023 Kaiser survey found that these programs are facing both staff shortages and staff skills deficits. With so many people already losing coverage – despite public awareness campaigns, state call centers, and even intervention from President Biden – it’s clear that much more support is needed.

What can providers do?

Ahead of back-to-school season, I urge pediatricians and anyone who works with children to proactively reach out to their patients with resources and information about how to maintain coverage.

Ask them to make sure their contact information is updated in state databases. Tell them to expect and respond to any communication from the state about their enrollment status. Keep information on hand about other ways they can afford their healthcare, whether through discount cards, manufacturer coupons, or alternate insurance plans.

And the burden can’t just be on healthcare providers. Everyone who works with children has a duty to pitch in. Some school districts are setting the standard by reaching out to families, urging parents to take any necessary steps to maintain their children’s coverage.

Ahead of back to school, children will be completing their yearly back to school forms, many of which require a well child visit. Again, families who haven’t realized their child has lost coverage will try to schedule these visits and only then learn of their coverage loss, putting providers in an uncomfortable position. Those children may not be able to get physicals done and may have a delay in enrollment as a result. School districts could and should be including information on Medicaid unwinding with their back to school packets. Health departments can continue PSA strategies and branch out to social media and avenues that are more likely to reach as many people as possible. Early intervention services and WIC services can do the same.

Families may be more likely to open a letter or answer a phone call if it comes from a trusted source, rather than from impersonal outreach from the government. Pediatricians, educators and other pediatric healthcare providers are already a trusted profession and familiar presence in families’ lives and parents are more likely to respond to outreach from these sources.

What’s at stake

Research has found that kids who have access to healthcare are more likely to stay healthy throughout their lives. That’s great for children but also great for society as it decreases healthcare costs across the board.  Regular health touchpoints like well-child visits, which are covered by Medicaid, allow providers to  identify health issues early on when they’re easier to treat. If these issues aren’t addressed early, they become harder to treat, more damaging to the child’s long-term health, and more expensive – both to the child and at a population level, to the healthcare system. Without access to health insurance, children also lose access to affordable emergency care, prescription medications like inhalers, and the vaccinations that keep everyone safe by maintaining our herd immunity.  What’s more, in many states, those vaccines are also necessary for school attendance.

That’s right–in addition to missing out on healthcare, the kids who lose coverage via the unwinding may not even be able to go to school, where they receive hot meals, counseling, and services like speech therapy in addition to their education. And time out of school will widen the achievement gap. The implications of Medicaid unwinding go beyond children’s short-term and long-term health.

When we take these anticipated negative outcomes for individual kids and multiply them by 5 million, it’s easy to come to the conclusion that the stability of our already strained healthcare system is at risk. When hospitals treat uninsured patients, they lose revenue, and they already have tight margins. Children’s hospitals, which already care for large Medicaid populations, will bear the brunt of this fall-out. Medicaid unwinding could be the tipping point that causes a children’s hospital to close its doors which means that children in the area will lose access to pediatric emergency rooms and subspeciality care, whether they’re insured by Medicaid or not. Children with chronic medical conditions may need to travel for hours to see a specialty provider or be separated from their families if they are hospitalized. Any family already living in a pediatric healthcare desert knows this difficulty well. That difficulty may become reality for more of the population if children’s hospitals close their doors.

While the immediate effects of the Medicaid redetermination process are already serious, it’s clear the long-term effects will be far reaching and dire. But those of us who work with children are in a unique position to be able to bridge the communication gap between parents and state authorities. Through proactive outreach and providing informational resources, we can help mitigate lapses in or losses of healthcare coverage, safeguarding children’s health.

Children’s health and futures are at stake, and it’s  everyone’s responsibility to help.

Photo: FatCamera, Getty Images