Advocates worried the rate of Pennsylvania children lacking health insurance would worsen in 2023, particularly due to the post-pandemic unwinding of automatic renewal of coverage under public plans.
It had already climbed by nearly a full percent the year prior. Instead, the rate stabilized with just a slight uptick in the aggregate count — growing by about 2,000 kids, far fewer than expected, according to a new analysis.
Without any improvement, however, Pennsylvania still has the fifth largest number of uninsured children in the nation, researchers at Pennsylvania Partnerships for Children found.
The estimated 147,000 children without health insurance exceed the entire population of Lebanon County, the 24th most populous county in the commonwealth.
“One of the first things that could be done is just to make sure children who are eligible retain their coverage. It’s very easy for families with children who are eligible for Medicaid or CHIP (Children’s Health Insurance Program) to unfortunately lose their coverage when they’re still eligible,” said Becky Ludwick, vice president of public policy, Pennsylvania Partnerships for Children.
Ludwick reiterated the policy proposal included in PA Partnerships’ 2024 State of Children’s Health report — improving and expanding automated renewals.
According to Ludwick, the Department of Human Services could determine re-enrollment without a paperwork prompt from a family, pursuing the determination for continued coverage automatically.
She also spoke of the need for community engagement so those eligible are aware of free or subsidized options through Medicaid, CHIP or Pennsylvania’s online insurance marketplace, Pennie.
About 47% of children in Pennsylvania are insured through one of the three programs.
According to the State of Children’s Health report, nearly 7% of Pennsylvania families that meet the income limit for Medicaid coverage still have uninsured children. All of those children could be covered.
The Centers for Medicare and Medicaid Services approved a waiver application from the Department of Human Services that would provide continuous enrollment in Medicaid and CHIP for all children from birth through age 6.
Children younger than age 6 are more likely than their school-aged peers to be uninsured, according to the PA Partnerships analysis.
The waiver would also provide 12 months of coverage for persons released from a state correctional institution.
DHS must work with the legislature to settle whether the waiver will be initiated.
Unwinding
When a pandemic-era rule allowing continuous coverage for all recipients of Medicaid and CHIP regardless of eligibility ended in April 2023, advocates feared children would lose insurance in droves.
That didn’t materialize.
PA Partnerships discovered that of the more than 460,000 children affected, 8 in 10 remained covered through one of the three aforementioned public programs. The report states that fewer than 2 in 10 lost coverage, with more than 42% dropped not due to eligibility but administrative issues.
It’s unclear how many remain uninsured or receive coverage through a private option.
The report covers 2023 only and the federal unwinding process as it was known continued into June 2024. A fuller scope of the impact is pending.
Lost in the system
Lacey Cassidy, 35, of Berks County, is a stay-at-home mom of two children, ages 7 and 3. Her husband is a plumber. Family coverage isn’t an option through his work.
Cassidy finds insurance for herself and her kids through the public marketplace and CHIP, for which the latter has income-based free coverage, low cost or full cost. The family doesn’t qualify for free coverage, she said, rather, they receive a moderate subsidy.
Cassidy has continually struggled to enroll and maintain insurance through CHIP and Pennie, whether it be fluctuations in income jeopardizing enrollment or what she describes as a communication breakdown over state filing deadlines.
She once lost insurance while pregnant and fears a late application post-unwinding could cost her kids’ CHIP coverage next year. That would mean a potential return to the marketplace, public or private, for all three. It would bring insurance costs she said they likely can’t afford, potentially piling onto a credit card as in the past.
“Honestly, if I didn’t use the advocacy network group I would be lost,” Cassidy said of help she received through the Pennsylvania Health Access Network.
She wondered aloud how many others are overwhelmed when navigating the system.
“I don’t think that some people, officials, whoever handles it, realize how much it affects the mental well-being of a family. I’ve spent hours crying, wondering if my kids can see a doctor,” she said.
Lisa Davis, director of the Pennsylvania Office of Rural Health and outreach associate professor with Penn State, said a lack of insurance means kids don’t get wellness appointments as babies or toddlers. Immunizations and public school enrollment could be at risk, she said.
“Kids get sick with everything,” Davis said. “What if they need to have their tonsils out or any kind of surgery? That is a real challenge.”
One result, whether in rural or urban areas, is that families take their children to hospital emergency rooms for care that should be done through a family doctor, Davis said. Another is that even if they’re insured through Medicare, they may have to travel hours to find a pediatric dentist who accepts the insurance.
“There is no reason why any child should be uninsured and not receiving the care they deserve,” Davis said.