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Medicaid Unwinding Comes to an End in Ohio: More Work is Needed to Ensure Young Child Remain Enrolled

By: Kezia Ofosu Atta, Policy Assistant and Susan Ackerman, Managing Director, Policy, Groundwork Ohio

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Janis Fay, a mother of three children with developmental disabilities in Cincinnati, Ohio, vividly describes her ordeal with Ohio's Medicaid unwinding process: "It’s been terrible."  

 

In a poignant interview with the Association of Maternal and Child Health Programs in February 2024, she recounted receiving a notification in July 2023 assuring continuous coverage for her children, only to discover later, through their orthodontist, that they were, in fact, uninsured. This abrupt loss of coverage has left her family grappling with the financial burden of managing their children’s complex medical needs, including a daughter diagnosed with autism and a son with scoliosis requiring a back brace they can no longer afford.  

 

Janis’s story is all too common; like many families in Ohio, she finds herself in a precarious position—earning too much to qualify for Medicaid but unable to afford adequate health insurance through their employer.  

 

After a three-year pause caused by the pandemic, Ohio resumed its Medicaid eligibility determination process in February 2023. Ohio will complete its redetermination process for all enrollees this month. 

 
 

At the moment, all we know is that 50,000 young children are no longer enrolled in Medicaid. Some may have gained coverage through their parent’s employer or through the exchange, but many are likely still eligible for Medicaid but and are now uninsured.   

 

Unfortunately, this result is not unexpected.  Too often families experience gaps in Medicaid coverage, not because they no longer qualify for coverage, but because they fail to complete the renewal process. This phenomenon, known as program churn, can be particularly harmful to the health and development of young children, as uninsured children are more likely to miss preventive care and developmental screenings. Additionally, Medicaid is often the gateway for enrollment in other supportive services for children, such as WIC, Help Me Grow, and to enrollment in child care. (Children enrolled in child care must submit an annual medical statement from a primary care provider.)  

 

Ohio Medicaid Leveraged a Number of Strategies to Reduce Program Churn 

The Medicaid and CHIP Payment and Access Commission (MACPAC), which advises Congress on Medicaid policy, has assessed churn rates for various eligibility groups with Medicaid. Their study of nationwide data from 2018 found that 18 percent of children enrolled in MAGI3 categories were disenrolled during that year. However, they also found that many of the children who were disenrolled were reenrolled in the program within twelve months. (MAGI is an acronym for Modified Adjusted Gross Income. In layman’s terms this means children who qualify for Medicaid based on their family’s income. The data cited is for children under age 21.)


The Ohio Department of Medicaid (ODM) has implemented a number of strategies including increased automation and business process improvements to eliminate the red tape to ensure that eligible enrollees maintain coverage. Many of these strategies that have helped enrollees retain coverage, such as the use of third-party data to inform eligibility and other automations will be ending, but others, such as text messages and robocall reminders to enrollees, will continue.   

 

Key Reminders about Medicaid Coverage for Children 

  • Children may still be eligible for Medicaid even if their parents are not. Visit Benefits.Ohio.gov or call the Ohio Medicaid hotline at 800-324-8680 for more information.

  • Families may be eligible for subsidized coverage through a marketplace plan. Go to Healthcare.gov for more information. 

Continuous Medicaid Coverage for Young Children is Coming  

Any gaps in coverage can delay preventive care, which is particularly concerning for young children as this is a period of rapid development. The American Academy of Pediatrics recommends a schedule of at least twelve well-child visits at specified periods for children by age three. 

 

Recognizing the importance of coverage for children, the FY 24-25 budget included continuous coverage for children from birth to age three. While this extension has not yet been implemented, the Ohio Department of Medicaid is currently working on a federal Medicaid 1115 waiver to authorize this provision. Continuous coverage will ensure that children do not have a gap in coverage during a critical stage of their development. 

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