Oklahoma led the U.S. in improvements to child insurance rates. Here's why

Oklahoma’s child health insurance rate saw the biggest improvement in the country, a new report found.

Experts say Medicaid expansion and continuous Medicaid coverage during the pandemic helped drive the gains in children’s health care coverage, but the state has work to do to retain that progress.

The report, from the Georgetown University Center for Children and Families, found that across the country, the number of uninsured children decreased from 2019 to 2021. Oklahoma saw the largest improvement, with the state’s rate of uninsured children dropping from 8.6% in 2019 to 7.4% in 2021, though the state still ranks 44th in the country.

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American Indian children and white children in Oklahoma saw some of the greatest increases in health coverage during that period.

The reasons for the improvement are twofold, experts said.

When the COVID-19 pandemic hit in 2020, the federal government required states to keep Medicaid recipients enrolled as long as there was a federal public health emergency for COVID-19 in place, even if they no longer met eligibility requirements.

The public health emergency is still in effect, and it will remain in place until at least April 2023. It’s been extended repeatedly and could be extended beyond April.

Children in all states have benefited from those pandemic-related rules on continuous coverage, said Joan Alker, executive director of the Georgetown University Center for Children and Families and lead author of the report.

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But Oklahoma likely jumped to the top of the nation in improving coverage rates because of Medicaid expansion and a “welcome mat” effect, Alker said.

Medicaid expansion didn’t change eligibility rules for children, but it did lead to more families getting coverage because of expanded eligibility for adults, she said.

“When you open the door for parents, children walk through that door too, and the whole family gets covered,” Alker said. “This is great news whenever it happens, but especially in Oklahoma, which really had one of the highest child uninsured rates in the country.”

Since expansion took effect in June 2021, over 330,000 Oklahomans have gained SoonerCare coverage, according to the Oklahoma Health Care Authority, which administers the state’s Medicaid program.

When the public health emergency ends and the federal continuous coverage protection lifts, as many as 6.7 million children could lose coverage nationwide, even many who remain eligible, Alker said.

“This has been a number of years that these families have not had their coverage renewed. Their addresses may have changed. The letter may get lost in the mail,” she said, describing red-tape hurdles families could face when renewals restart.

The state Health Care Authority has already begun outreach asking SoonerCare recipients to ensure their contact information is up to date.

Health coverage plays a big role in kids’ overall wellbeing, said Gabrielle Jacobi, child wellbeing policy analyst at the Oklahoma Policy Institute. When children are healthy and staying up to date with immunizations and well checks, they can attend school regularly, setting them up for future success, she said.

Currently, about 75,000 Oklahoma children don’t have health insurance, according to the Oklahoma Policy Institute.

To protect the gains Oklahoma has made in children’s health coverage, the state could implement continuous Medicaid eligibility for children, said Emma Morris, revenue and health care policy analyst with the Oklahoma Policy Institute.

That would allow kids with Medicaid coverage to keep that coverage for 12 months, regardless of small fluctuations in their family’s income or not meeting administrative requirements, Morris said.

Some states allow children to qualify for Medicaid at higher income levels.

“Oklahoma can think about raising our qualifying income limit for children to match that of other states,” Morris said.

This article originally appeared on Oklahoman: Oklahoma’s child health insurance rate saw the biggest improvement