Student Well-Being

A Wave of Students Are Losing Medicaid Coverage. What It Means for Schools

By Evie Blad — August 09, 2023 6 min read
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Millions of children are expected to lose Medicaid coverage because of the expiration of a pandemic-era policy that brought three years of unprecedented stability in the program, and advocates say schools should be on the alert for ways they can help students and their families stay enrolled.

Since that policy ended March 31, many states have started a yearlong process of reviewing the eligibility of Medicaid recipients. As a result, federal officials estimate as many as 4 million children will fall off the rolls for logistical reasons, like a change of address or missing paperwork—even though their family’s income still qualifies them to participate.

Schools, which have more consistent contact with families than faceless state health agencies, can help prepare parents and guardians for the shift and minimize the damage, advocates for low-income children said.

“We talk all the time about how the school building doors are the one set of doors that most kids in this country walk through on a daily basis,” said Sarah Broome, a consultant who helps schools use Medicaid to cover student health services. “We have to take advantage of the fact that we can be this great resource for families. You don’t have to be an expert in this. You just have to know it’s happening.”

Back-to-school season could be an ideal time for school leaders to communicate with families about Medicaid shifts, Broome said. Efforts could be as simple as including messages in school enrollment packets or setting up tables at open-house nights to allow community organizations to assist families, she said.

Millions of students could lose Medicaid coverage

The shift is part of the end of a 2020 rule called continuous enrollment, which required states to allow Medicaid recipients to remain in the low-income health care program uninterrupted and without filling out regular paperwork. That temporarily eliminated a problem known as “churn,” in which families cycle in and out of eligibility for the health coverage, leading to interruptions in children’s access to health care and services.

Overall Medicaid participation surged as a result, growing about 30 percent since the rule was enacted.

Now, participants risk losing eligibility for the first time since 2020. While some families will be disqualified because of increases in income and other factors, some may miss out on a chance to reenroll because they don’t even know the eligibility review is happening, Broome said. Low-income families tend to move more frequently than others, and something as simple as out-of-date contact information could cause them to miss the forms needed to maintain coverage.

The changes come as schools seek to expand their use of Medicaid to pay for student therapies, mental health, and special education services. The turmoil caused by students’ disenrollment could bring some unpredictability to those efforts—and to schools’ budgets, Broome said.

Medicaid pays for about $4 billion in school-based services a year, according to an estimate from AASA, The School Superintendents Association. That makes Medicaid the third or fourth largest federal funding stream for many schools.

And, more broadly, students’ health can affect everything from attendance to classroom engagement, so schools have an interest in ensuring students have access.

“We don’t want families to go to the emergency room and find out they don’t have coverage,” said Sasha Pudelski, the director of advocacy at AASA.

The organization has been preparing for the end of the continuous enrollment requirement for months, working with health organizations to develop resources for school leaders to communicate the change to families.

States’ timelines for the review process, known as “Medicaid unwinding,” vary widely. While some states, like Oregon, have created broad outreach campaigns to prepare for the shift, others, like Arkansas, have expedited their renewal processes, more quickly purging families from their rolls.

At least 3.9 million Medicaid enrollees of all ages had been disenrolled in the time period between the expiration of the continuous enrollment policyrule and Aug. 8, about 75 percent of them for procedural reasons, according to a tracker from the Kaiser Family Foundation that uses data from 42 states and the District of Columbia. Among the 11 states that broke down those data by age, about 30 percent of those who lost coverage were children.

Schools lend a hand with Medicaid changes

Educators and school social workers in the Evanston/Skokie, Ill., district have prepared for the unwinding process for months, said Maredeth Teamer, a former social worker and special education teacher who now oversees Medicaid billing.

About 700 of the district’s 6,200 students are on Medicaid, and Teamer has coordinated with community organizations to compile resources for those who may be affected by the rule change. She has also held informational meetings with school employees, like special education coordinators, who are most likely to field families’ questions about the unwinding process, and she plans to provide printed resources in school offices for families who may lack home internet access.

“We started the conversation before unwinding happened,” Teamer said. “We can give warm referrals [to community organizations that are prepared to help with Medicaid] to our families because we know about it and we prepared.”

The federal Centers for Medicare and Medicaid Services has advised schools and community partners to send two key messages to families in the wind-up to state renewals.

  • Families should be on the lookout for letters about their Medicaid and the state Children’s Health Insurance Program, or CHIP, status. (This program serves children in families that are low-income but fall above the Medicaid threshold.)
  • They also should contact their state Medicaid agencies to ensure their addresses are up to date.

Educators don’t have to be experts in the complicated federal program, Broome stressed. But, if families lose coverage, schools should be prepared to connect them to outside organizations that can help. Some families may be able to reenroll with updated information. In other families, increases in household income may be enough to disqualify adults from Medicaid eligibility but low enough that children still qualify for CHIP, she said.
The shift comes as many schools, including Evanston/Skokie, are experimenting with billing Medicaid for a broader range of student services.

The Bipartisan Safer Communities Act—a legislative package Congress passed after the May 24, 2022, school shooting in Uvalde, Texas—prompted new federal guidance on how schools can bill Medicaid for services beyond those required in the Individualized Education Programs required for students with disabilities. Twenty-one states have changed their Medicaid rules to allow schools to bill the program to help cover the costs of personnel like nurses, therapists, and speech pathologists.

“It can really benefit all parties,” Teamer said, adding that addressing students’ needs on-site cuts back on classroom absences and transportation issues that can be a barrier to receiving care.

Teamer plans “rolling audits” of students’ Medicaid status throughout the school year, reviewing changes in her billing software database regularly to identify students whose coverage has lapsed and contact their families to offer resources. She wants to ensure no student—and no family—falls through the cracks.

“We want to be prepared for those conversations—helping families who come to us after the fact” of losing coverage, she said.

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A version of this article appeared in the August 23, 2023 edition of Education Week as A Wave of Students Are Losing Medicaid Coverage. What It Means for Schools


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