By Andy Marso
October 19, 2015

For two years now, the staff at Kansas Action for Children has been trying to unravel a mystery: Why is Medicaid enrollment dropping among the state’s youngest children?

Enrollment of low-income children age 1-5 peaked in October 2012 and has been dropping steadily since.

A look at Medicaid enrollment for Kansas children:
Under 1 year old: From 17,166 in October 2012 to 14,438 in September 2015.
Age 1-5: From 57,780 in October 2012 to 51,171 in September 2015.
Source: KDHE Division of Health Care Finance Kansas Medical Assistance Report

Enrollment of children younger than 1 in low-income families also dropped during that period. Shannon Cotsoradis, president and CEO of Kansas Action for Children, a Topeka-based nonprofit, said she wants more research to determine whether eligible children are missing out on health coverage.

“It’s possible there’s a benign reason for this, but it’s not possible to determine whether or not this is a trend that should be raising the red flag without more data,” Cotsoradis said. “Which is really the bottom line.”

In Kansas, children age 1 to 5 are eligible for the state’s privatized Medicaid program, known as KanCare, if they live in families earning less than 150 percent of the federal poverty level, or $36,144 annually for a family of four. Children under the age of 1 are eligible in families earning up to 171 percent of the poverty level, or annually $41,472 for a family of four.

The overall child poverty rate in Kansas is trending down, declining from 19 percent in 2013 to 18 percent in 2014, but Cotsoradis said it is “highly unlikely” that explains the drop in Medicaid enrollment.

Families with younger children, she said, are statistically more likely to be below the poverty line than families with older children.

Cassie Sparks, a spokesperson for the Kansas Department of Health and Environment, said officials at the state’s lead Medicaid agency don’t know why enrollment is dropping among young children.

“We do know there have been no policy changes in eligibility relative to this group,” Sparks said via email.

Cotsoradis suspects the drop in Medicaid enrollment could be related to a decision made by officials in another state agency, the Kansas Department for Children and Families.

In November 2011, DCF officials decoupled applications for Medicaid and Temporary Assistance for Needy Families (TANF), a cash-assistance program for low-income families. Cotsoradis said the change creates another step for families new to TANF and Medicaid, and one reason for the drop in TANF participation since 2011.

About a year after the DCF decision, Cotsoradis started noticing a decline in the number of families enrolling young children in Medicaid. She said the lag time made sense because only children born after the TANF changes or children whose family incomes had changed dramatically would have been affected.

“You wouldn’t expect to see an immediate impact, right, because you’d have kids who were already eligible,” Cotsoradis said. “It would be the new crop of kids coming in and applying for TANF that would be impacted, and we start to see a decline after 2013.”

A new state computer program, the Kansas Eligibility Enforcement System (KEES), was expected to coordinate eligibility for a number of assistance programs, including Medicaid and TANF, starting in October 2013. The new system is expected to make the enrollment process easier for recipients and less cumbersome for state officials as well.

But full rollout of the system has been delayed numerous times.

Cotsoradis said the state should not wait to find out if KEES will change the enrollment numbers, especially if its youngest citizens are missing routine vaccinations and health screenings due to lack of health coverage.

“These are the most disadvantaged young children in our state who are going without access to health care,” Cotsoradis said.

The total number of children in Kansas has declined slightly during the last three years, which may factor into the change in the number covered by Medicaid.

It’s possible that more of the state’s youngest children are also getting coverage through another government health program with less restrictive income limits.

Kansas children not eligible for Medicaid whose families make up to 244 percent of the federal poverty level are eligible for coverage under the Children’s Health Insurance Program, or CHIP, a federal health care expansion approved in 1997.

Kansas Action for Children representatives say they’re not sure whether low-income Kansans in the 0-5 age group are falling off the Medicaid rolls as their family income increases and landing on CHIP, which provides the same coverage.

Average CHIP enrollment has fluctuated the last few years. For fiscal year 2015 it was 54,417, up from 51,176 in fiscal year 2013.

Read more from Kansas Health Institute.