Before the start of the coronavirus pandemic in February 2020, there were 71 million people enrolled in the Medicaid and Children’s Health Insurance Program (CHIP). Now, with the expiration of the Covid-19 Public Health Emergency (PHE) in May 2023, millions of people face the loss of their Medicaid and CHIP coverage during the renewal process known as Medicaid redetermination that reassessed family incomes and health care benefits. This change has dramatically changed the state of health care at the federal and state level.
In order to take a closer look at the numbers and how we got here, we have to examine the registration at its height. National Medicaid and CHIP enrollment peaked at 94.5 million people in April 2023, one month before the end of continuous enrollment, an increase of 23.1 million enrollees or 32.4% from February 2020. from February 2020 to April 2023, the number of adults increased. by 45% while child enrollment increased by a modest 20%.
As of June 2024, 79.9 million people nationwide are enrolled in Medicaid and CHIP plans, and children make up nearly half (47%) of the total enrollment. Between May and June 2024, Medicaid and CHIP enrollment dropped by 17%. Another contributing factor could be a new federal law that went into effect in June, requiring states to switch enrollees between Medicaid and CHIP when their circumstances change. While some of the children who lost coverage may have been eligible for CHIP, they may have slipped through the cracks because of documentation issues or the failure of other states to transfer enrollees between of programs.
At the state level, many completed the re-enrollment process with a higher total of Medicaid and CHIP enrollees than they started in February 2020, including seven states where enrollment levels were high at least by 30%. In contrast, Texas, Florida, Georgia, and California saw the largest declines in children’s Medicaid and CHIP enrollment, accounting for half of the total national decline. Texas alone had more than a million fewer children enrolled in Medicaid/CHIP followed by Florida (about 600,000), Georgia (more than 300,000) and California (about 200,000).
While the decision-making process has largely been completed, the Centers for Medicare & Medicaid Services (CMS) has raised concerns about over-enrollment during the holidays, especially important for children.
Effects on oral health
In the US, 38% of children aged zero-18 have dental benefits through Medicaid or CHIP. Unlike coverage for adults, states are mandated to provide dental benefits to children covered by Medicaid and CHIP. At a minimum, Medicaid requires benefits to include dental services for pain and infection relief, dental restoration, and dental health care.
For families with income above Medicaid requirements, children rely on CHIP coverage to prevent disease and promote oral health, restore oral health and function, and treat emergencies. Medicaid and CHIP facilitate needed access to oral health services, which help close the dental care gap for children from low- and moderate-income families. By providing coverage, it ensures that economic status does not prevent a child from receiving necessary dental services.
The federal government has recognized the importance of oral health and its impact on physical health and has set new guidelines. Beginning in 2024, states must report Child Health Quality Measures for Medicaid and CHIP. Measures include oral exams, fluoride application, and dental sealants.
In September 2024, CMS also released comprehensive guidance to support states in ensuring that the 38 million children with Medicaid and CHIP coverage — nearly half of the children in this country — receive the health services they need. This guideline, Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), requires that “eligible children and youth have the right to receive a full range of preventive, diagnostic, and treatment services—including well-child visits, mental health, dental, vision, and hearing services These requirements are designed to ensure that children receive the health services they need early, yes and that health problems can be avoided or diagnosed and treated as soon as possible. Because of the EPSDT requirements, Medicaid provides some of the best health care in the country for children and youth.
This is the most comprehensive EPSDT guidance that CMS has released in ten years, and I applaud the agency’s action.
What is at stake for children
Health care in America is a volatile situation, especially during an election year. However, we must remember what is at the heart of this matter – the health of children.
CMS has acknowledged that poor oral health can have a detrimental effect on children’s health, school performance and success later in life. However, alarmingly, it has been found that nearly half of all American children do not receive regular dental care. Worse, only 18% of dentists treat 100 children and adolescents with Medicaid coverage each year, while 67% treat none.
Over the past two decades, social determinants of health (SDOH) such as socioeconomic status and race have been recognized as major contributors to oral disease in children. About half of all American children do not receive regular dental care because of some form of SDOH. Children from vulnerable communities have less access to oral health care and often have more dental problems. And for children with special needs, progress in accessing dental care has slowed, in part because of the challenges faced by dental professionals without the in-depth training needed to treat patients with and difficult situations.
Children’s health is a different matter, and we must call for action for all states to continue Medicaid and CHIP resources for children, especially dental care. By expanding access to dental services, promoting continuity of care, reducing inequality, and enabling cost containment, we can contribute to the well-being and overall development of these vulnerable children.
To create a happy, healthy smile for the public, it is important to treat and support oral health in accordance with physical health. Ensuring access to proper oral care is critical to eliminating barriers that persist across the country, especially in disadvantaged communities where the need is greatest.
Photo: Tom Werner, Getty Images
Bryan Carey is the CEO of Benevis, a leading provider of dental health care for practices focused on providing life-changing oral care and orthodontics to underserved communities. He has spent more than 20 years improving and improving health care services for providers and patients, ultimately making health care more equitable and accessible to those who need it most. Carey holds an Applied Baccalaureate Degree in Economics from Georgetown University and an MBA from the Wharton School.
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