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Pandemic let these families stay on Medicaid. Now their kids risk losing health care

: [POST-BROADCAST CORRECTION: In the audio of this story, as in a previous version of the web story, we incorrectly call Kathreen Friend a pediatric registered nurse. In fact, she is a pediatric nurse practitioner.]


Millions of children in the U.S. get their health insurance through the federal Medicaid program. Since the start of the pandemic, the federal government has allowed those children to stay on Medicaid without having to reenroll or jump through any other bureaucratic hoops. But as Sebastian Martinez Valdivia reports, that could soon end. Many are worried about the health of these children.

KATHREEN FRIEND: OK. What did you find out over there, you two?

SEBASTIAN MARTINEZ VALDIVIA, BYLINE: Kathreen Friend is a registered nurse here in Doniphan, Mo. It's a small town of 1,800 near the Arkansas border, but there's a lot to do. In the morning, she went over to the school to help run the sports physicals clinic. In the afternoon, she's had nonstop appointments at the safety-net clinic where she works.

FRIEND: So is she wanting to do the X-ray today?

MARTINEZ VALDIVIA: Friend is the only pediatric specialist in this county in the heart of the Missouri Ozarks.

FRIEND: I see a large volume of kids every single day. We try our best not to turn anyone away. We try to get them all in. It makes for long hours and long days, but we try to get people taken care of.

MARTINEZ VALDIVIA: The clinic treats all sorts of things, from broken bones to ear infections to COVID-19. And Friend says most of her young patients are on Medicaid. Medicaid enrollment in Missouri has grown by more than 400,000 people since the start of the pandemic. That's one of the biggest increases in the country. And it happened after voters backed a plan to expand Medicaid to more Missourians in 2020. But once you get Medicaid, keeping that coverage can be hard. In many states, including Missouri, Medicaid patients have to prove they still qualify every year. This process is called redetermination, and it requires a lot of paperwork and follow-through. But when the pandemic started, the federal government announced a public health emergency. That meant people on Medicaid stayed on that coverage and didn't have to worry about reenrolling. But that federal protection could end soon. And in Missouri, some experts say it could get pretty chaotic because the state has a poor track record when it comes to managing Medicaid. Dr. Maya Moody is a Missouri pediatrician who has seen the impact firsthand.

MAYA MOODY: I mean, we were turning away kids left and right, and it just broke our hearts.

MARTINEZ VALDIVIA: Moody is remembering what happened back in 2019, when the state removed 100,000 kids from Medicaid. Missouri had been rolling out a new computer system, and many of the children who lost coverage were still eligible.

MOODY: These are kids that we needed to see, and they were our routine patients. These are families that we know really well. And so that has been one of the true blessings of the public health emergency, is that we haven't had to turn anybody away.

MARTINEZ VALDIVIA: The state later said there was an error where if parents lost coverage, the children in their household also automatically lost coverage, even if the kids actually still qualified. State officials say they've fixed that problem. But as soon as the public health emergency connected to the pandemic comes to an end, all states will have to resume regular eligibility checks. Sara Collins is a senior scholar with the Commonwealth Fund.

SARA COLLINS: States are going to be faced at the end of the public health emergency with our gargantuan task of redetermining eligibility for people who have stayed on Medicaid over this two-year period.

MARTINEZ VALDIVIA: And because so many people quit during the pandemic, it's unclear if states have the workers they need to do it. That leaves Dr. Moody, the pediatrician, worried that Missouri just isn't ready. She says Medicaid patients will need to be proactive about keeping that coverage.

MOODY: We have already started to talk to folks about making sure that they're getting their documents together and they're ready to reapply.

MARTINEZ VALDIVIA: The federal government has recommended a cautious approach, for states to take on their caseload in chunks. And Missouri, through a spokesperson, has confirmed it will work gradually over a year to check everyone's eligibility. The state is checking addresses to make sure people get the paperwork they need to reenroll. But Kathreen Friend, back at the clinic in the Missouri Ozarks, says people move around a lot. And even if they get the paperwork, they might not know what to do with it.

FRIEND: I really worry about that too, 'cause that's a big lax anyway. It was before, you know? And so now that it's just easy - I don't have to do anything; I just keep getting coverage - then they're just going to think they keep getting coverage.

MARTINEZ VALDIVIA: It's unclear when her patients will have to reenroll. If the federal government extends the public health emergency one more time, then that process could start as soon as January.

For NPR News, I'm Sebastian Martinez Valdivia. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Corrected: November 6, 2022 at 11:00 PM CST
In this story we incorrectly call Kathreen Friend a pediatric registered nurse. In fact, she is a pediatric nurse practitioner.
Sebastián Martínez Valdivia