The number of children who don’t have health insurance has been increasing. And it has been increasing faster in Idaho than the rest of the country.

The number of uninsured children in America went up by more than 400,000 from 2016 to 2018, reaching more than 4 million, according to an analysis the Georgetown University Center for Children and Families released in late October. This represents 5.2 percent of children nationwide, up from 4.7 percent two years before.

In Idaho, 4.9 percent of children were uninsured in 2016, 4.6 percent in 2017 and 6.1 percent in 2018. That one-year increase of 1.5 percent, which represents about 7,200 children losing health coverage, was the highest rate of increase in the country — the numbers in West Virginia and Tennessee, which saw the second- and third-highest percentage increases from 2017 to 2018, went up by eight-tenths of 1 percent.

“These findings should be a clear call for actions among our political leaders if they care about children’s health,” Joan Alker, the lead author of the report, said on a conference call with reporters.

Federal data shows month-to-month fluctuations in Medicaid Child and CHIP enrollment in Idaho, with a noticeable drop this summer. There were 197,414 children enrolled in July 2018. Coverage peaked at 202,303 children in December, then fell sharply from June 2019, when 196,683 children were covered, to July, when 186,636 children were.

The Georgetown report mentions Idaho along with West Virginia, Tennessee, Alabama, Ohio and Montana as states that saw increases of 25 percent or more in the number of uninsured children from 2016 to 2018.

What’s driving this? One explanation is that the strong economy is leading to more people not qualifying for Medicaid. However, children’s advocacy groups say federal policies, particularly changes to the renewal process, are leading to children losing coverage.

Liz Woodruff, assistant director of Idaho Voices for Children, said factors include changes to renewal and enrollment, cuts in federal funding for outreach, confusion due to by failed attempts to repeal the Affordable Care Act and anti-immigrant policies at the federal level that lead some immigrants whose children are eligible to not apply. Eight percent of Hispanic children in Idaho are uninsured, compared to 5.9 percent of non-Hispanic white children. Native American children have the highest uninsured rate at 9 percent.

“We think there has been a chilling effect that may be impacting Latinx American citizen children in Idaho,” Woodruff said.

Alker put the national decline down to similar causes.

“This level of backwards movement at the state level has never happened since we started writing this report 10 years ago,” she said.

Many of the children losing coverage, Woodruff said, had been on Katie Beckett Medicaid, a program for children with serious illnesses or disabilities. Woodruff put this down to changes to the renewal process.

“My impression is that under the current federal administration, there was a sense that Idaho needed to be more stringent,” she said.

Idaho Voices for Children has been collecting the stories of families with children who have lost their Medicaid coverage and so far has found several in the Treasure Valley and northern Idaho. ProPublica did a story in late October highlighting 4-year-old Paul Peterson, who lives with his parents in Kootenai County. The boy had a stroke when he was 1 year old, and his parents found out when they brought him in for a scheduled surgery on Aug. 20 that his Medicaid had lapsed and they would have to reapply. The Petersens said they never received notice that they needed to renew and, as a result, were forced to pay for some of their son’s medical expenses out-of-pocket.

Lori Wolff, deputy director of the state Department of Health and Welfare, said the Centers for Medicare and Medicaid Services reviewed the state’s procedures earlier this year and said Idaho had to reverify people’s eligibility for the program when they renew their coverage yearly, rather than allowing them to renew automatically. Some people, she said, don’t fill out their renewal forms, leading to coverage losses. However, Wolff said that in her experience this isn’t the main reason for people dropping Medicaid coverage.

“One of the things that didn’t come out totally clear in that (ProPublica) article is our enrollment drop in Medicaid is not totally based on these renewal changes,” she said. “In fact, the folks who have closed, most of them have not been due to these renewal changes.”

Wolff said the strong economy is a bigger factor.

“The biggest reason we’re seeing is with the economy, more people are becoming ineligible because their income is over the limit,” she said. “We are seeing the same enrollment declines in our SNAP (food stamps) program as well.”

Medicaid expansion enrollment in Idaho opened on Nov. 1, and coverage starts Jan. 1. Woodruff said in a statement this could help reduce the number of uninsured children as families sign up.

“It’s incredibly important that Idaho realizes the full benefits of Medicaid expansion, and not add further barriers to coverage through work reporting requirements,” she said. “It’s through clean implementation of Medicaid expansion that Idaho can ensure all families have access to health coverage and we can prevent further declines in children’s coverage.”

Reporter Nathan Brown can be reached at 208-542-6757. Follow him on Twitter: @NateBrownNews.