In Maine, more than 5,500 children lost coverage through Medicaid and CHIP from December 2017 to June 2019.
When April’s school-aged son contracted an infection in his jaw and required an immediate surgery earlier this year, April wanted to take him to a pediatric specialist. But that wasn’t an option.
The state of Maine had unenrolled her children from Medicaid, leaving them without health insurance coverage while April was unable to afford the high cost of specialist care.
April, whose full name is withheld to protect her privacy, previously received coverage for herself and her family through MaineCare, the state’s version of Medicaid. That changed when she and her husband surpassed the income threshold for MaineCare in 2018, forcing them onto the state’s transitional MaineCare program for six months. When those six months ended, in February 2019, April’s family lost their coverage.
April ended up taking her son to the emergency room for his infection. She later learned that both of her kids were still eligible for CubCare, the state’s version of the Children’s Health Insurance Program (CHIP), and should have been automatically enrolled in that program in February, when the family’s coverage through transitional MaineCare ended, according to advocacy group Maine Equal Justice Partners.
CHIP provides low-cost coverage to children in families that earn too much money to qualify for Medicaid, but likely can’t afford private health insurance — children exactly like April’s.
“It shouldn’t have happened,” April said. “It increased the stress level for me because I’m the mom, and I pretty much handle all of this for my children and my entire family, and it made me feel like the state didn’t care what was going on with my family.”
Maine’s Department of Health and Human Services (DHHS), which oversees the state’s Medicaid and CHIP programs, did not respond to repeated requests for comment. The office of Maine Gov. Janet Mills (D-ME) also did not respond to a request for comment.
Similar scenes are playing out not just in Washington County, Maine, where April lives, but all across the country. The New York Times reported in October that more than a million children have lost health insurance coverage from Medicaid and the Children’s Health Insurance Program (CHIP), between December 2017 and June 2019, the most recent month with complete data.
The number of uninsured children nationwide now exceeds four million.
This decline in public insurance coverage spurred a .6 percent increase in the overall uninsured rate among children in 2018, representing an additional 425,000 children without healthcare coverage, according to the US Census Bureau. Most of the decrease, according to the Bureau’s report, was because children’s Medicaid and CHIP coverage rates declined.
The drop-off doesn’t appear to be an anomaly, either; 2018 marked the second consecutive year that the uninsured rate and number of uninsured children increased, a trend that the Georgetown University Center for Children and Families (CCF), an independent, nonpartisan policy and research center, referred to as “unprecedented” since comparable data began to be collected in 2008. All told, the number of uninsured children nationwide now exceeds four million.
The loss of coverage has hit states like Maine particularly hard; the number of uninsured children rose from 13,000 in 2017 to 15,000 in 2018 — a 15.4 percent increase. The state’s uninsured rate for children now sits at 5.5 percent, more than twice as high as any other state in New England.
Like most states, Maine has also experienced a significant dropoff in the number of children who received coverage through Medicaid or CHIP.
In December 2017, 110,245 Maine children were enrolled in Medicaid or CHIP, but by June 2019, that number was down to 104,759, according to a Kaiser Family Foundation analysis of data from the Centers for Medicare and Medicaid Services (CMS).
In total, about 5,500 Maine children—including April’s son and daughter—lost coverage through Medicaid or CHIP over the 18 month period.
Melissa Hackett, Communications and Outreach Associate at the Maine Children’s Alliance, disagrees. “The data doesn’t bear that out,” she said.
“In a booming economy, we would expect to see more children insured, and, nationally, there’s been a conversation that, ‘Oh, kids are dropping off CHIP because their parents can afford private health insurance,’ but we’re not seeing that trend in the state or nationally,” Hackett said.
A New York Times analysis of Census Bureau Data found that 13 of the 14 states that experienced the highest increases in rates of uninsured children from 2016 to 2018 had Republican governors at the time. Ten of those 13 states failed to implement Medicaid expansion as of December 2018, including the five with the highest increases in uninsured rates: Tennessee, Georgia, Texas, Idaho, and Utah.
Maine was also one of those 14 states, and Hackett believes former Republican Gov. Paul LePage’s refusal to expand Medicaid is a contributing factor to the increase in uninsured children in the state. The Maine Legislature passed bills to expand Medicaid five times starting in 2013, but LePage vetoed all five bills.
Congressman Jared Golden (D-ME), formerly the Democratic assistant majority leader in the Maine House of Representatives from 2016 to 2018, was among those who voted to expand Medicaid and continued to express support for it after 59 percent of Mainers voted in favor of a ballot measure expanding Medicaid in 2017.
Maine’s Medicaid expansion was eventually implemented in 2019, under the state’s new Democratic governor, Janet Mills. The expansion has already provided coverage to more than 40,000 Maine adults, including 7,377 parents and caretakers.
The expansion does not directly provide coverage to children, but “there’s certainly a correlation in parents having health insurance and children having insurance and coverage,” Hackett said.
Alison Weiss, Communications Director of the nonprofit Maine Equal Justice Partners, agrees. “It’s well understood children tend to gain coverage as their parents gain coverage in low-income families,” Weiss said.
A new report released last week from Georgetown’s Center for Children and Families reached the same conclusion: States that did not expand Medicaid to parents and other adults under the Affordable Care Act (ACA) saw their rate of uninsured children increase three times more than states that did expand Medicaid.
“I think those national trends have a local effect too. There’s not as much outreach and there’s been some concern about whether or not those health insurance options are going to stay.”
“We certainly believe that the delay in implementing Medicaid expansion is a big part of why not as many children are enrolled in the CHIP program as should be,” Weiss said.
Hackett and Weiss also cited red tape barriers, such as the state’s waiting period, as a factor in the lower enrollment numbers. Maine requires children to be uninsured for three months before enrolling in CHIP coverage, a policy that Hackett thinks has a negative impact on enrollment.
“Anytime you can have continuous and immediate enrollment and not have red tape barriers to families to keep their children enrolled, to get them enrolled, that is something we can improve on in terms of keeping more kids enrolled,” she said.
April and her husband aren’t the only Americans who found that improving their economic situation could actually cause them to lose health insurance. According to Hackett, some low-income Maine families are now making enough money to put them above the threshold to qualify for CHIP, which in Maine is income up to 200 percent of the Federal Poverty Line, but still not enough to afford private healthcare.
“That gap is something we’re really concerned with,” said Hackett, who believes federal-level healthcare policy, such as the repeal of the ACA’s individual mandate and the delay in CHIP funding in 2018, has also had an impact on enrollment.
“I think those national trends have a local effect too. There’s not as much outreach and there’s been some concern about whether or not those health insurance options are going to stay,” Hackett said.
Joan Alker and Lauren Roygardner of Georgetown’s Center for Children & Families reached the same conclusion in their new report studying the increase of uninsured children.
“This serious erosion of child health coverage is likely due in large part to the Trump Administration’s actions that have made health coverage harder to access and have deterred families from enrolling their eligible children in Medicaid and CHIP,” they wrote.
Representatives like Jared Golden are trying to take action on the federal level to lessen the burden locally. Earlier this year, he introduced his “Healthcare Roadmap,” a plan to ensure all Mainers have quality, affordable healthcare.
Golden’s roadmap includes co-sponsoring legislation to make Maine eligible for additional federal funding for its Medicaid expansion, which he says would give Mainers “access to tens of millions of dollars in new funding to support affordable care.”
The bill’s sponsor, Rep. Marc Veasey (D-TX), said it would allow thousands of low-income families to enroll in Medicaid, an outcome that would increase children’s access to healthcare, according to Alker and Roygardner’s research.
Despite Golden and Veasey’s efforts, progress at the federal level is unlikely, given Republicans’ long-term opposition to Medicaid and the Trump administration’s support of a lawsuit seeking to strike down the ACA, which would stop Medicaid expansion.
While Hackett hopes to see improvement at federally, she stays focused on progress at the state level.
“We’re really looking on the state level to see what we can do to make sure that the improvements that we’ve made in the last ten years, and significantly since the ACA implementation—that we don’t lose those,” Hackett said.
In Maine, that state level effort includes advocating for a bill that would increase the threshold for CHIP eligibility in Maine from 200 percent of the FPL to 325 percent. Federal funds will cover children with family incomes up to 300 percent of the federal poverty level and raising the threshold could cover thousands of more Maine children, including those whose parents fall in the gap between making too much to qualify for CHIP, but not enough to afford private insurance.
That legislation would also eliminate the 90-day waiting period, allowing children to be enrolled in CHIP immediately after losing another form of coverage, and make it so that parents no longer have to pay premiums for CHIP. The bill stayed in appropriations in 2019, but will be taken up again in Maine’s 2020 legislative session.
When that happens, Hackett and the Maine Children’s Alliance will once again push for the bill to be passed, because the stakes of children not having healthcare are clear to them. Reams of data show that having healthcare coverage, whether through Medicaid or private coverage, improves children’s health.
“When children have health insurance coverage, we know they can get more care. There’s a correlation when they don’t have coverage and don’t get care,” Hackett said.
Alker and Roygardner came to the same conclusion.
“Continuous health coverage is essential for children— improving their access to needed preventive and routine care, improving their health, educational and economic outcomes as adults, and protecting their families from medical debt and bankruptcy when a child breaks a bone, or worse, has cancer,” they wrote.
April and her husband remain uninsured, but they eventually did get their children re-enrolled in CubCare in May 2019 after Maine Equal Justice Partners worked directly with DHHS to get their kids back into the program.
But the gap in coverage has had a lasting impact on April’s family.
“They were both restricted with their health, they weren’t able to receive the full amount of care that they needed,” she said. “Their well-being was affected, their quality of life was affected, and it put a strain on me and my entire family.”