An estimated 840,000 fewer children were covered by Medicaid and the Children's Health Insurance Program in 2018 compared with the year before, according to an analysis by Georgetown University's Center for Children and Families drawing on new CMS data.
Total Medicaid and CHIP enrollment totaled 72.4 million in January 2019, down about 2.2 million from January 2018, according to the CMS data.
CMS Administrator Seema Verma tweeted that her agency's preliminary analysis suggests the improving U.S. economy is a factor in the enrollment declines in Medicaid and CHIP.
"It's always been clear that as the economy improves, unemployment drops & incomes grow, (and) people move off of public assistance programs like Medicaid," she wrote.
But many Medicaid experts say gains in employment and job-based health coverage are not the main drivers of the enrollment reductions. They attribute the declines to onerous state eligibility redetermination processes and cuts in funding for enrollment education and outreach.
They also say families of mixed immigration status are increasingly afraid to sign themselves and their children up for coverage because of the Trump administration's crackdown on immigration and its proposed rule to penalize legal immigrants for using public benefits.
The loss of public coverage for 840,000 children "is a huge red flag suggesting the number of uninsured children continues to go up," said Joan Alker, executive director of the Center for Children and Families. "I'm absolutely confident that many of these children who lost Medicaid and CHIP last year don't have employer-sponsored insurance."
Families USA recently reported that burdensome state eligibility redetermination processes have pushed down Medicaid enrollment in a number of states, raising questions about whether eligible adults and children are being wrongly dropped from coverage.
Enrollment fell most sharply in states like Arkansas, Missouri and Tennessee, which have established tougher new eligibility redetermination processes.
The redetermination processes may violate federal rules requiring state Medicaid agencies to use all available data to renew a beneficiary's eligibility before requesting any additional information from the person.
Meanwhile, providers and insurers say many legal immigrants are dropping Medicaid and CHIP or declining to enroll out of fear that using these programs will hurt their ability to stay in the U.S.
Leaders of many healthcare organizations, including the American Hospital Association, America's Essential Hospitals, the American Academy of Family Physicians, and the American Academy of Pediatrics, warn that this is hurting their ability to serve low-income children and families.
In October, the Department of Homeland Security published a proposed rule that would allow federal immigration officials to consider legal immigrants' use of public health insurance, nutrition and other programs as a strongly negative factor in their applications for legal permanent residency.
That rule, which drew tens of thousands of negative public comments, has not yet been finalized.
Correction: A previous version of this article reported a somewhat higher total reduction in coverage. The Center for Children and Families revised the figure downward to 840,000 after discovering data errors.
