Biden Administration Warns 9 Governors About Medicaid Losses Among Children

The Biden administration on Monday warned the governors of nine states of unusually high Medicaid coverage losses among children, suggesting that officials were failing to protect young, low-income Americans while winnowing the program’s rolls.

Xavier Becerra, the health and human services secretary, wrote letters to the leaders of the states that had the highest number or percentage of Medicaid coverage losses among children through September, after a federal policy that required states to keep people in the program lapsed.

The appeals to state leaders doubled as a call to expand Medicaid under the Affordable Care Act. The letter recipients included Gov. Ron DeSantis of Florida, Gov. Brian Kemp of Georgia and Gov. Greg Abbott of Texas. All three are Republicans who lead states that have not expanded Medicaid and where hundreds of thousands of children have lost coverage this year.

The nine states accounted for roughly 60 percent of the decline in enrollment in Medicaid and the Children’s Health Insurance Program, or CHIP, through September, federal health officials said.

The governors should “ensure that no eligible child loses their health insurance due to red tape,” Mr. Becerra said in a press briefing Monday morning. He called on state officials to ease transfers of children from Medicaid to CHIP; reduce call center wait times; and adopt special rules that allow states to smooth their procedures for keeping children enrolled in Medicaid.

The letters, which the Biden administration published on Monday with new data on child Medicaid losses through September, signaled a newly aggressive posture during the so-called unwinding of the federal Medicaid requirement.

The process has been marked by technical problems and paperwork errors and delays that have caused thousands of poor children to lose health coverage.

Federal officials had been reluctant to target governors or state Medicaid officials as they worked to resolve those bureaucratic problems. Some advocacy groups and public health experts have said that the administration has not been aggressive enough in calling out, halting and resolving processes that had led to large numbers of children losing coverage in some states.

In a post on X, Gov. Sarah Huckabee Sanders of Arkansas, a Republican whom Mr. Becerra wrote to on Monday, accused the Biden administration of having undertaken a “politically motivated PR stunt, accusing us of restricting Medicaid access.”

“That’s false. During the unwinding process mandated by federal law, the Biden admin sent letters to certain states to pause their unwinding, but Arkansas was never one of them,” she wrote. “Arkansas is in compliance with state and federal law, while Biden plays politics at Christmas.”

Child Medicaid enrollment has declined by more than three million this year, according to a separate analysis published on Monday by the Georgetown University Center for Children and Families.

Because of data lags and differences in how states report Medicaid losses, that figure is likely a significant undercount.

Overall, Medicaid enrollment has declined by almost eight million, according to the researchers.Nearly seven million children may be uninsured for at least some time as a result of the unwinding, according to the Georgetown researchers, amounting to almost one in 10 nationwide.

Through September, Florida, Texas and Georgia had the largest drops in child Medicaid enrollment nationwide, according to data shared by federal health officials Monday. Federal health officials noted on Monday that the 10 states that have not expanded Medicaid under the Affordable Care Act had disenrolled more children than all those that have combined.

Stacey Pogue, a senior policy analyst at Every Texan, a research and advocacy group, said on Monday that thousands of children in Texas were still waiting for decisions from state Medicaid officials, who face a substantial backlog of applications.

“We didn’t have the staffing that was needed. We didn’t have the technology needed,” Ms. Pogue said.

According to KFF, a nonprofit health policy research group, more than 70 percent of people who have lost Medicaid this year did so for procedural reasons, such as when a family did not return paperwork to confirm their eligibility.

Children have more generous eligibility limits for Medicaid and CHIP, suggesting that many of those who lost coverage this year should have remained eligible for some form of coverage.

Researchers have pointed out that only a small percentage of children have been moving to CHIP, a sign that states have not done enough to facilitate those transfers.

Federal officials on Monday also presented figures showing what they said was a clear correlation between fewer Medicaid losses and the adoption of special waivers from the Centers for Medicare and Medicaid Services; states have requested the waivers to ease the eligibility-checking process.

The Biden administration said on Monday that waivers, nearly 400 of which have been approved so far, would be extended through 2024.

Robin Rudowitz, the director of the Program on Medicaid and the Uninsured at KFF, said that the waivers had allowed states to use other government benefits programs to automatically verify Medicaid eligibility, and to give managed care organizations authority to help program recipients complete application forms.

Some states have sought even more ambitious versions. Kentucky and North Carolina recently extended Medicaid eligibility for children by 12 months.

States are “doing so many things at one time that it’s hard to disaggregate what’s making the biggest difference,” Ms. Rudowitz said. The data the Biden administration presented on Monday, she added, “was an attempt to try to tie some of the specific policies to what might be happening.”