WASHINGTON — The U.S. Department of Health and Human Services has notified Arkansas Gov. Sarah Huckabee Sanders about the decline in children enrolled in two federal health insurance programs, urging the state to take steps to “ensure that no child in your state who still meets eligibility criteria” loses their coverage.
Health and Human Services Secretary Xavier Becerra’s letter Monday coincided with the release of new data showing child enrollment in Medicaid and the Children’s Health Insurance Program declined by 2.2 million children from March through September.
The nationwide drop occurred as states returned to regular renewals with the federal coronavirus public health emergency ending. Medicaid and CHIP enrollment increased by 32% between February 2020 and March 2023.
States have been “unwinding” their insurance rolls, resulting in many residents losing their health insurance coverage gained during the pandemic. Most states have one year to complete this effort, but Arkansas’ campaign occured over six months due to state law.
According to the federal Department of Health and Human Services, the number of Arkansans enrolled in Medicaid and CHIP declined by 78,506 people between March and September, an 18% decrease over this period. Arkansas had the fifth-largest drop in absolute change and percent change among states.
The federal agency also sent letters to leaders in Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota and Texas, noting Arkansas and these eight other states “account for about 60% of the decline in children’s Medicaid and CHIP enrollment from March through September 2023.”
Rhode Island, Massachusetts, Oregon, New York and the District of Columbia are the only places with increased enrollment.
“Because all children deserve to have access to comprehensive health coverage, I urge you to ensure that no child in your state who still meets eligibility criteria for Medicaid or CHIP loses their health coverage due to ‘red tape’ or other avoidable reasons as all states ‘unwind’ from the Medicaid continuous enrollment provision that was in place during much of the COVID-19 public health emergency,” Becerra wrote to Sanders.
“This is especially important for communities of color and underserved communities across the country — we know more than half of all children in Medicaid and CHIP are Hispanic, Black, Asian/Pacific Islander, or American Indian and Alaska Native.”
The Sanders administration has faced in-state and out-of-state critics over the Medicaid “unwinding” campaign. White House domestic policy adviser Neera Tanden called the effort “particularly egregious” during a September meeting with political and community leaders from Arkansas, Mississippi and Alabama.
Yet top Arkansas leaders have stood by the “unwinding” effort, saying Arkansas has acted in federal compliance. When the U.S. Centers for Medicare and Medicaid Services contacted state Medicaid directors in August regarding issues with states removing eligible people from coverage during the “unwinding” process, the agency did not mention Arkansas as a state of concern.
In a post on X, the social media platform previously called Twitter, Sanders on Monday described Becerra’s letter as “a politically motivated PR stunt.”
“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,” the Republican governor said. “Arkansas is in compliance with state and federal law, while Biden plays politics at Christmas.”
Becerra stated children are more likely than their parents to qualify for Medicaid due to income eligibility thresholds, meaning many children eligible for renewal should not lose their insurance coverage.
“Many states have already taken steps to ensure eligible children stay enrolled,” he added.
“Access to health coverage is critical to the development of children. The evidence is overwhelming that children with access to healthcare achieve better short-term health and well-being as well as long-term health, educational, and economic gains. Every child eligible for coverage should have it.”
Becerra’s letter includes a list of recommendations directed at keeping eligible children enrolled in Medicaid or CHIP; these strategies include easing the renewal process, adopting strategies to allow families to auto-renew their coverage, and better outreach efforts such as working with community organizations and increasing call center capacity.
Camille Richoux, health policy director with Arkansas Advocates for Children and Families, called on Arkansas officials to take advantage of “every opportunity” to ensure children do not lose health care access from not having health insurance.
“For example, Arkansas could use the list of families who have TANF benefits to confirm that a child should still have ARKids coverage,” Richoux said in a release. “That would make it easier for children who we know are eligible to keep their coverage.”
Becerra concluded his letter by noting the agency can assist Arkansas leaders if there are “other factors that can influence child disenrollment rates.”
“HHS stands ready to work with you and your team to take the additional, available steps to make sure children have the health coverage they need and deserve,” he added.
