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Millions of kids qualify for Medicaid. Biden funds outreach to boost enrollment

Ana Elsy Ramirez Diaz holds her baby as he is seen by Dr. Margaret-Anne Fernandez during a checkup visit at INOVA Cares Clinic for Children in Falls Church, Va. A portion of the clinic's patients are insured through the Children's Health Insurance Program.
Matt McClain
The Washington Post via Getty Images
Ana Elsy Ramirez Diaz holds her baby as he is seen by Dr. Margaret-Anne Fernandez during a checkup visit at INOVA Cares Clinic for Children in Falls Church, Va. A portion of the clinic's patients are insured through the Children's Health Insurance Program.

Today the Biden administration announced $49 million in grants to help community groups sign more families and children up for health insurance – especially the more than half of the country's 4 million uninsured children who qualify for free coverage through Medicaid or CHIP, the Children's Health Insurance Program.

"This is our largest investment to date in this type of initiative," says Chiquita Brooks-Lasure, head of the Centers for Medicare and Medicaid Services. "So many children, even though they're eligible, don't know it – their parents don't know that they are eligible for coverage – there still needs to be so much education done."

She points to the Biden administration's successes in boosting private insurance enrollment by investing in outreach workers who can walk people through the enrollment process – one on one – for free. "That's the same thing that we're trying to do here with the Connecting Kids to Coverage initiative – really making sure we are using trusted messengers," she says.

"This is absolutely good news that these grants are going out – it is needed now a lot because we have this looming crisis with respect to children becoming uninsured," says Joan Alker, executive director of the Georgetown Center for Children and Families. The looming crisis is this: When the COVID-19 public health emergency eventually ends, states will begin to unwind a period of two years when no one had to prove they still qualified for free health insurance.

That process, which is likely to be chaotic in many places, could lead to 6.7 million children who now have Medicaid losing their coverage, according to an estimate from the center. Some will lose coverage because they no longer qualify. Others will lose coverage because of administrative errors or missing documentation.

It's clear to Alker that the federal health officials working on this understand that the pending crisis that could lead to millions more uninsured children "is a really big deal," she says, and Tuesday's historic grant announcement is evidence of that. "I think clearly the Biden administration has looked for the pennies under the couch to get this amount out this year."

Society is not in good shape if the country's children don't have health insurance, Alker adds. A broken arm in a playground can mean financial disaster for a family. Missed wellness visits can mean missed developmental checks, routine immunizations or control for conditions like asthma. "We have a lot of research to show that it's very, very cost effective to provide health insurance to children – in the long run, this will pay many dividends back to society," she says.

Insurance for children works a bit better than insurance for the rest of the population in the U.S. In 2020, about 94% of children were insured, thanks in large part to Medicaid and CHIP. Low-income families can get free, comprehensive coverage for their kids, and they can enroll at any time of the year.

The challenge for community outreach workers around the country is to spread the word – to find families who think they don't qualify, and walk them through the process. That means showing up at summer block parties and street fairs and trying to let as many families as possible who need coverage know that they can get help signing up.

In the coming months, the $1.5 million grant to the Greater Flint Health Coalition will mean outreach workers can attend Genesee county "back-to-school fairs, any sort of meet-the-teacher night, kindergarten roundup," says Nichole Smith-Anderson, the organization's special projects director. "We've also worked really closely with the schools where, as their kids are doing enrollment information, we have a little question that says, 'Do you need support with health care coverage?' that parents can fill out, and then we're able to get in contact with them that way."

Getting parents' contact information and following up after back-to-school events is often simpler than trying to enroll on the spot, notes Emily Roller, director of health insurance initiatives at the Virginia Health Care Foundation, which also received about $1.5 million on Tuesday.

The pending unwinding when the public health emergency ends is also looming over everything, Roller adds. "We will be working closely with our colleagues at the Virginia Department of Medical Assistance Services to be their boots on the ground that can inform how the policies and procedures that they're putting in place are really lived out in people's experiences," she says.

At the federal level, "we are laser focused on how we address the unwinding of the public health emergency when it happens," Brooks Lasure says. "It's just such a priority of the [Biden] administration to continue to enroll people in coverage and connect them to care – and there's no one more in need of care in our country than the nation's children."

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Selena Simmons-Duffin reports on health policy for NPR.