# Children's Enrollment in Children's Health Insurance Program (CHIP) Coverage During the Medicaid Unwinding

## TL;DR

This study found that children's Medicaid enrollment dropped significantly during the unwinding of pandemic-era protections, with no corresponding increase in CHIP enrollment.

## Contribution

The study provides new evidence that Medicaid declines were not offset by CHIP enrollment growth, particularly in states with combination CHIP programs.

## Key findings

- Medicaid enrollment fell by 6.5 percentage points on average during the unwinding period.
- CHIP enrollment remained stable despite larger Medicaid declines in combination CHIP states.
- Findings suggest millions of children lost Medicaid coverage without transitioning to CHIP.

## Abstract

To examine changes in children's Medicaid and CHIP enrollment during the Families First Coronavirus Response Act unwinding and assess whether CHIP enrollment offsets Medicaid declines.

We used linear probability models with monthly indicators to estimate changes in enrollment from April 2023 to September 2024 overall and by CHIP structure type.

We used monthly children's enrollment data from the U.S. Centers for Medicare & Medicaid Services for 32 states and the District of Columbia.

During the unwinding, Medicaid enrollment declined from 48.1% to 41.2% of children, while CHIP enrollment remained stable (8.7% to 8.6%). We found average declines of 62,032 (95% confidence interval [CI]: −108,018 to −16,045) Medicaid‐enrolled children per state (6.5 percentage points [pp], 95% CI: −8.1 to −5.0). Medicaid declines were larger in states with combination CHIP (−8.7 pp, 95% CI: −10.3 to −7.2) than Medicaid expansion CHIP (−4.5 pp, 95% CI: −6.0 to −3.1). We found no evidence of significant changes in CHIP enrollment overall or by CHIP structure.

Children's Medicaid enrollment fell sharply without offsetting CHIP gains during the unwinding, underscoring the need for policies that prevent administrative disenrollment and ensure seamless coverage transitions.

What is known on this topic○The Families First Coronavirus Response Act (FFCRA) continuous coverage provision prevented Medicaid disenrollment during the COVID−19 public health emergency, improving coverage stability for children.○Projections estimated that millions of children could shift from Medicaid to CHIP during the rollback of the FFCRA (the “unwinding”), despite overall projected declines in Medicaid and CHIP enrollment.○Prior research found overall declines in children's public coverage during the unwinding, with larger reductions in states with separate CHIP components, but did not disaggregate Medicaid and CHIP enrollment.
What this study found○During the first 17 months of the FFCRA unwinding, children's Medicaid enrollment declined substantially (−6.5 percentage points [pp] on average) with no significant changes in CHIP enrollment.○Declines in children's Medicaid were larger in combination CHIP states (−8.7 pp) than in Medicaid expansion CHIP states (−4.5 pp), yet CHIP enrollment remained stable in both sets of states.○Findings suggest that millions of children lost Medicaid without transitioning to CHIP, highlighting the need for policies to facilitate seamless coverage transitions.

What is known on this topic○The Families First Coronavirus Response Act (FFCRA) continuous coverage provision prevented Medicaid disenrollment during the COVID−19 public health emergency, improving coverage stability for children.○Projections estimated that millions of children could shift from Medicaid to CHIP during the rollback of the FFCRA (the “unwinding”), despite overall projected declines in Medicaid and CHIP enrollment.○Prior research found overall declines in children's public coverage during the unwinding, with larger reductions in states with separate CHIP components, but did not disaggregate Medicaid and CHIP enrollment.

The Families First Coronavirus Response Act (FFCRA) continuous coverage provision prevented Medicaid disenrollment during the COVID−19 public health emergency, improving coverage stability for children.

Projections estimated that millions of children could shift from Medicaid to CHIP during the rollback of the FFCRA (the “unwinding”), despite overall projected declines in Medicaid and CHIP enrollment.

Prior research found overall declines in children's public coverage during the unwinding, with larger reductions in states with separate CHIP components, but did not disaggregate Medicaid and CHIP enrollment.

What this study found○During the first 17 months of the FFCRA unwinding, children's Medicaid enrollment declined substantially (−6.5 percentage points [pp] on average) with no significant changes in CHIP enrollment.○Declines in children's Medicaid were larger in combination CHIP states (−8.7 pp) than in Medicaid expansion CHIP states (−4.5 pp), yet CHIP enrollment remained stable in both sets of states.○Findings suggest that millions of children lost Medicaid without transitioning to CHIP, highlighting the need for policies to facilitate seamless coverage transitions.

During the first 17 months of the FFCRA unwinding, children's Medicaid enrollment declined substantially (−6.5 percentage points [pp] on average) with no significant changes in CHIP enrollment.

Declines in children's Medicaid were larger in combination CHIP states (−8.7 pp) than in Medicaid expansion CHIP states (−4.5 pp), yet CHIP enrollment remained stable in both sets of states.

Findings suggest that millions of children lost Medicaid without transitioning to CHIP, highlighting the need for policies to facilitate seamless coverage transitions.