For the fourth time in five years, Maine has led the nation in year-over-year enrollment declines of children in federally subsidized health care programs.

The Centers for Medicare and Medicaid Services data shows that Maine enrolled 175,883 children in 2016 in either MaineCare – the state’s version of Medicaid – or the Children’s Health Insurance Program, which is designed for families who make too much to qualify for Medicaid but also cannot afford private insurance.

That’s a 7 percent decline from 2015 enrollment of 189,181, the largest reduction percentage-wise of any state. Connecticut was next, with a drop of 4.9 percent. Overall, the United States saw an increase of 1.6 percent in enrollment of children last year.

It’s not clear how many of those children no longer on public programs found insurance elsewhere, either through the Affordable Care Act or private insurance. There does not appear to be any agency or group that tracks the insurance status of former Medicaid recipients.

The Maine Department of Health and Human Services, which oversees MaineCare, did not respond to a request for information or comment Friday.

Christine Hastedt, with the advocacy group Maine Equal Justice Partners, said it’s possible that some of these children who lost coverage found it elsewhere.

“I think some might say that the economy has improved in that time, but we know from other data, like childhood poverty rates, that Maine is still lagging behind,” she said. “I think it’s more likely that many of these kids are just not covered.”

BUCKING NATIONAL TREND

Maine has consistently led in enrollment declines for the Medicaid and CHIP programs since 2011, CMS data shows. Except for 2013 to 2014, when Maine saw a small increase in Medicaid enrollment, the state has seen the highest decreases of any state for each year: 8.4 percent from 2014 to 2015, 3.8 percent from 2012 to 2013 and 12 percent from 2011 to 2012.

The total decrease from 2011 to 2016 was 27 percent, from 242,028 down to 175,883. That means in six years, 66,145 Maine children went off public health insurance. This contrasts with the national trend in which about 2.3 million more children across the country had public insurance in 2016 than in 2011 – an increase of 5.4 percent.

Steve Butterfield, policy director for Consumers for Affordable Health Care, said the drop in coverage for Maine children corresponds directly with Gov. Paul LePage’s push for eligibility changes within the MaineCare program. In 2013 and 2014, an estimated 28,000 low-income Mainers lost coverage because of those changes and many more who previously may have been eligible no longer are.

Maine also is one of the 19 states that has refused to expand Medicaid as allowed under the Affordable Care Act.

Data from CMS about child enrollment in Medicaid shows that states that expanded it have seen a noticeable increase in coverage for children. Arkansas and Alaska, for instance, saw the biggest increase in enrollment from 2015 to 2016 – 11 percent and 8.8 percent, respectively.

LePage administration officials have championed their cuts to MaineCare and have credited them, as well as other public benefit reforms, with creating a more fiscally sound government. They have maintained that expanding Medicaid would undo all that progress.

But even without Medicaid expansion, CHIP remains an option for families. The problem, Butterfield said, is that most parents don’t know that even if they are denied MaineCare coverage, their children might still be eligible through the CHIP program because it has different eligibility requirements.

CHIP IS AN ALTERNATIVE

The data seems to support Butterfield’s suggestion. While MaineCare enrollment dropped dramatically from 2011 through 2016, enrollment in the CHIP program for Mainers dropped at an even higher rate.

“(DHHS) does not seem to be interested in executing these programs like they are supposed to,” he said. “Are they doing outreach? Are they following up or are they just trying to reduce enrollment?”

Hastedt, with Maine Equal Justice Partners, agreed that DHHS has not done a good job educating families about CHIP.

“It’s so difficult for most people to actually even have a conversation with someone at DHHS,” she said. “But also, the rhetoric around public benefits is such that people feel humiliated. They don’t want to apply even if they might be eligible. I think this is what some policymakers wanted. But the people we’re talking about here are children.”

Indeed, the state has seen drastic reductions in the caseloads for both Temporary Assistance for Needy Families and the Supplemental Nutrition Assistance Program, also known as food stamps. Some of that reduction can be tied to an improved economy, but some of it also is due to increasingly strict eligibility requirements.

Butterfield said for the state to let federal dollars sit on the table while children go without coverage is immoral. He said the fiscal management argument is short-sighted, at best.

“You don’t get a better return than on the money you spend on kids,” he said. “We can have political disagreements over the role of government, but are we really going put it on kids? Are we really OK with that? I’m not.”

Eric Russell can be contacted at 791-6344 or at:

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