Too many South Carolina kids miss out on Medicaid insurance now. Here’s how to fix that. | Opinion

The child with sickle cell disease and a sudden fever needing emergency care. The toddler with autism needing speech and occupational therapy. The child with attention deficit hyperactivity disorder unable to access medication. The infant due for a visit and vaccines but suddenly without insurance coverage.

What do these children — all real scenarios in my pediatric practice — have in common? They all lost insurance coverage in the Medicaid “unwinding” — even though they all still qualified for Medicaid.

What is the Medicaid unwinding? It is a critical issue that puts tens of thousands of children at risk and leaves our emergency health care system and hospitals in jeopardy of being overburdened.

In 2020, a public health emergency was declared with the COVID-19 pandemic and a Medicaid rule was passed that ensured everyone enrolled in Medicaid would maintain coverage throughout the pandemic. When the public health emergency expired in 2023, each state began a process of Medicaid unwinding, which meant in theory, those who still qualified for Medicaid would maintain coverage while those who no longer qualified would need to seek health insurance elsewhere.

But that is not how the process played out.

Approximately 60% of children in South Carolina are covered by Medicaid. But there were 67,500 fewer enrolled in Medicaid in March 2024 than April 2023, a precipitous drop of 10.4%, according to Georgetown University’s Center for Children and Families. The number of disenrolled children is troubling. A KFF analysis found nearly 70% of people disenrolled from Medicaid nationwide, many of them children, still qualify for coverage.

Maybe the family filled out a form incorrectly, or didn’t receive it due to a move or temporary housing instability, or lacks the literacy skills to complete it. The impact of these procedural disenrollments reaches far beyond the patients themselves.

Children without insurance coverage still get sick, but they are far more likely to end up in the emergency room or hospital because they have lost access to their pediatrician and health care team. Direct medical costs and costs to the state in an emergency room setting are far higher than in an outpatient setting.

In addition, the emergency room will only address the acute problem that brought the child there. There is no preventive care, so the child is far more likely to get sick over time and keep using the emergency room.

This problem is not unique to South Carolina; every state is dealing with the Medicaid unwinding. And South Carolina has sought to minimize harm.

We have physicians and staff working within the South Carolina Department of Health and Human Services who are great advocates for children and who are doing their best to mitigate the effects of the unwinding. We also have a robust network of pediatricians across the state who are doing all they can to protect children from harm.

But there is more to do.

Each week I see children in my office who have lost their Medicaid but who still qualify for coverage. I try my best to help them. My office staff offers as much support as possible. We reach out to our patients with Medicaid to be sure that they are keeping their enrollment information up to date.

And South Carolina Department of Health and Human Services is working hard to help these families as well. But we must continue to work together.

We must find innovative ways to reach families at risk of losing coverage and help them remain enrolled, such as Medicaid staff having direct communication with pediatric offices and school districts to overcome bureaucratic barriers that slow these processes down. We must streamline the process to recertify children who qualify for Medicaid but have lost coverage through procedural disenrollment. We must ensure that children and families do not fall through the cracks of a system that is difficult to understand and navigate.

The future of the state’s children depends upon it.