This story was updated Thursday, May 31, 2019, at 7:10 p.m. with more information.


Report on Medicaid and CHIP enrollment decline


A national decline in kids enrolled in Medicaid and children's health insurance — with the sharpest enrollment rate drop occurring in Tennessee — means more children likely have been left without health insurance, according to a report released Thursday.

About 828,000 fewer children nationwide were enrolled in Medicaid and the Children's Health Insurance Program (CHIP), representing a 2.2% drop at the end of 2018 compared to 2017, according to the new report from the Georgetown University Center for Children and Families.

Until recently, child Medicaid and CHIP enrollment had increased or held steady for years as the overall child uninsured rate fell to a record low. But in 2017, the child uninsured rate increased for the first time in nearly a decade.

The new report suggests more children will be without health insurance when data on the overall child uninsured rate is released in September, revealing how many children switched to private insurance and how many became uninsured in 2018.

Dr. Lanre Falusi, a pediatrician and spokeswoman for the American Academy of Pediatrics, said during a press call Thursday that Medicaid and CHIP are "lifeline programs" for lower income families, and she's "deeply concerned" by the report.

"Children are not just little adults. They have unique health needs and require unique health care," Falusi said, adding that children who are enrolled in Medicaid miss fewer school days, do better in school, and are more likely to graduate and earn higher wages.

Enrollment changes were uneven across the states, but combined enrollment for Medicaid and CHIP dropped in 38 states by 912,000 children. Tennessee saw the greatest percentage decline of all the states at 10.1%, and Georgia saw a 1.6% decline.

The remaining 13 states had a cumulative enrollment gain of 84,000 children, including Alabama with a 2% enrollment increase, resulting in a net decline of 828,000 nationally.

The findings come less than two months after Chattanooga Mayor Andy Berke called on Tennessee lawmakers to remedy problems with the state's Medicaid program, TennCare, after the Tennessean reported 130,000 low-income children in the state, including 5,500 in Hamilton County, lost their health insurance coverage over the past two years.

In a letter sent to state leaders in April, Berke asked for enrollment process reforms and TennCare oversight hearings in the General Assembly. He said the current enrollment process is "fraught with pitfalls," such as mailing and operational errors that result in eligible kids losing coverage.

"The data backs up the disturbing information that we learned a couple months ago," Berke told the Times Free Press on Thursday. "According to this information, 88,000 kids [in Tennessee] were disenrolled in Medicaid or CHIP in the last year. We also know there are more uninsured kids in Tennessee now. We have to push back the politics and start helping families in our community."

Berke said his office has been working with the Tennessee Justice Center to help individual families whose children are eligible and have lost TennCare coverage, but "that's not enough" given how many need assistance.

"Tennessee is seeing much more dramatic declines in kids receiving access to these benefits than every other state," he said. "We can't just do it one family at a time."

Response letters from Gov. Bill Lee and Lt. Gov. Randy McNally sent earlier this month and obtained through open records requests attribute enrollment declines to the state's new ability to verify income, which allows for more accurate income level assessments, and a strong economy in which fewer people qualify for TennCare and swap to private insurance.

"While the restart of the redetermination process, as well as the improved economy in Tennessee, has resulted in a decrease from the 2016 enrollment numbers TennCare currently serves almost 200,000 more people, including approximately 87,000 more children, than were enrolled prior to [2014]," a letter from Lee states.

Authors of Thursday's report said they found little evidence to support claims that the improving economy was responsible for the decline in enrollment.

"There was no surge in the economy or real wage growth that would account for the enrollment plunge in 2018," said Tricia Brooks, the lead author of the report. "There are clearly other factors at play, and they are putting children at risk."

For example, Brooks said the federal government cut outreach and consumer assistance funding to help families with enrollment, and proposed immigration policies have kept many eligible families from seeking or renewing coverage for their children.

On the state level, authors said policies and practices, such as cumbersome processes for enrollment and renewal, and stricter rules or more frequent reviews of eligibility, could have influenced the declines.

A statement from the Tennessee Justice Center on Thursday said children often learn that they have no insurance only when they visit clinics and pharmacies. "The state has taken no steps to get to the bottom of the problem or propose a system to get these children back having the coverage they need for a healthy start and an opportunity filled life."

Enrollment declines are concentrated in seven states — California, Florida, Illinois, Missouri, Ohio, Tennessee and Texas — which account for nearly 70 percent of the losses. Nine states — Idaho, Illinois, Maine, Mississippi, Missouri, Ohio, Tennessee, Utah, and Wyoming — had decreases of more than double the national average.

Contact Elizabeth Fite at or 423-757-6673.