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Many low-income toddlers are left without health insurance after their first birthday

Jul 15, 2016

Typically, when a mother is covered by Medicaid, her children are automatically covered when they are born.

But many low-income toddlers inadvertently lose their health insurance on their first birthday, according to Kaiser Health News.

People covered by Medicaid have to renew their coverage annually. But a federal policy requires babies' eligibility to be reevaluated when they turn one.

According to Kaiser, there can be hiccups in retaining toddler's coverage because their first-year review is tied to their birth date, which is generally different than the annual renewal date for the rest of the family. Parents may be unaware they need to renew their baby separately, or may forget. Shelby Gonzales is with the Center on Budget and Policy Priorities. She told Kaiser:

Many people lose Medicaid coverage for procedural reasons. But there are all sorts of things that are unique about babies turning one that present extra challenges.

In other cases, computer systems sometimes drop babies after their first birthday if no renewal has been processed. This is a problem in states that are behind in renewals - something that is not uncommon, according to Gonzales. And states that don't seek babies' Social Security numbers until they turn one may have a tougher time getting the income and other data they need to process the renewal.

Researchers at The Urban Institute analyzed data from the 2014 American Community Survey and found kids between one and two years old are less likely to have health insurance than infants under one, and say this suggests some children may be losing coverage at their first birthday.

Lapses in coverage can lead to inconsistencies in health care. It can also leave low-income families footing the bill for doctor visits and prescriptions, straining budgets that may already be tight. Jill Hanken is a lawyer with the Virginia Poverty Law Center. She tells Kaiser:

You hate any baby to lose coverage. A 1-year-old needs to have consistency with their health care and visits with the pediatrician. Regular well-baby visits ensure kids are developing properly and get scheduled vaccines, among other things.

In the past, State of Opportunity has told you about issues surrounding services like Medicaid.

A 2016 study in the International Journal for Equity in Health found nearly half of parents of minority kids in the U.S. aren't aware their children qualify for state and federal health care programs, leaving many children uninsured when they don't have to be.

Parents of uninsured children cited a number of reasons for lapses in insurance including: their insurance expiring without them reapplying, applying but never receiving a reply, missing paperwork, and spouses who were supposed to cover the children.

Dr. Glenn Flores is author of the study. He said in a press release:

Our findings indicate an urgent need for better parental education about Medicaid and the Children's Health Insurance Program (CHIP). The findings also indicate a need to improve Medicaid/CHIP outreach and enrollment.

Some states are currently working on ways to fix the problem of first-year coverage gaps. In Connecticut, advocates try to identify families who are at risk for losing coverage and reach out to them with information about how to avoid gaps in coverage or disenrollment. And according to Kaiser, advocates in both Connecticut and Virginia say they are awaiting updates to antiquated eligibility systems.

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