Thousands of Virginia Children at Risk of Insurance Gap

by Madison Hirneisen


As Virginia prepares to resume the Medicaid renewal process that was paused during the COVID-19 pandemic, advocates and researchers have raised concern thousands of Virginia children could be at risk of experiencing a gap in insurance coverage due to challenges in the process.

At the start of the COVID-19 pandemic, Congress enacted a provision requiring states to maintain continuous coverage for all Medicaid beneficiaries for the length of the pandemic public health emergency. However, the recently enacted Consolidated Appropriations Act of 2023 de-links the continuous coverage provision from the public health emergency beginning April 1.

States have until May 2024 to complete eligibility checks for the millions of individuals enrolled in Medicaid. Virginia is set to begin conducting these reviews for the more than 2 million residents enrolled in Medicaid in March, and has 14 months to complete it.

report released this month by the Georgetown University Center for Children and Families revealed Virginia children’s enrollment in Medicaid and CHIP increased by 160,000 between February 2020 and August 2022. Overall, Medicaid and CHIP enrollment in Virginia grew to more than 1.9 million – an increase of 518,700 – between February 2020 and August 2022.

The Virginia Department of Medical Assistance Services estimates 14 percent of Medicaid enrollees will lose coverage, while an additional 4% will lose coverage, but re-enroll within a few months. That estimate could mean a loss of coverage for over 146,400 Virginia children, according to an estimate from the Virginia Poverty Law Center.

While many children enrolled in Medicaid and CHIP – known in Virginia as Family Access to Medical Insurance Security (FAMIS) –  are likely still eligible for public coverage, advocates and researchers have raised concern that administrative challenges in the renewal process and limited staffing capacity to handle an increased workload could mean thousands of eligible Virginia children are at risk of losing coverage.

Sara Cariano, a senior health and policy analyst at the Virginia Poverty Law Center, said there are essentially two categories that will result in Medicaid coverage termination – either a family is no longer eligible for coverage due to increased income, or coverage is terminated due to administrative closures when folks are still eligible.

Advocates are more worried about the latter when it comes to coverage termination for Virginia’s children enrolled in Medicaid, Cariano said. She explained an administrative closure can happen for a number of reasons, including if a family somehow missed a renewal notice in the mail or if they do not submit enough pay stubs for the agency to get a good picture of the family’s income.

Of the 34.2 million children enrolled in Medicaid, researchers from Georgetown estimate as many as 6.7 million children nationwide are at risk of losing coverage. Researchers estimate that 72 percent of children losing coverage will remain eligible for Medicaid, but are “likely to lose coverage due to bureaucratic snafus” and red tape.

“These kind of administrative closures where folks are still eligible, but they’re still losing coverage – those are of high concern,” Cariano told The Center Square in an interview.

Cariano also noted staffing issues within local Department of Social Services offices adds another layer of complexity to the situation. She said with many offices currently understaffed, it becomes more difficult for Medicaid enrollees to communicate with workers and for Medicaid applications to be processed within the 45-day timeliness standard for renewal.

“I personally do believe that one of the largest challenges that we’re going to have in Virginia – and I’ve heard this from advocates nationwide in their states as well – is that staffing challenges are really going to impact the state’s ability to tackle this large increase in work,” Cariano said.

The Department of Social Services was unable to provide a response in time for publication for comment regarding staffing issues.

Based on income eligibility guidelines, the Virginia Poverty Law Center estimates children in a family of three making $50,963 annually would remain eligible for Medicaid or FAMIS.

The VPLC recommends families ensure their contact information is up to date with their local Department of Social Services office to make sure they receive information in the mail regarding coverage.

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Madison Hirneisen is a staff reporter covering Virginia and Maryland for The Center Square. Madison previously covered California for The Center Square out of Los Angeles, but recently relocated to the DC area.

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