SALT LAKE CITY — Newly released data shows Utah is one of 38 states that contributed to a steep nationwide decline in CHIP and Medicaid enrollment in 2018, coming in as the third highest in the nation.

A national study by Georgetown University Health Policy Institute pointed to a correlation between this decline and an increase in the number of uninsured children.

"We know that what has driven the trends in lower uninsured rates (prior) to 2017 is higher participation in Medicaid and CHIP," Edwin Park, co-author of the study, said Thursday in a phone interview.

Park noted, "What we are concerned about is that a substantial reduction in Medicaid and CHIP likely means that many of these kids are going to end up uninsured."

A previous study by the institute marked 2017 as the year the nation experienced its first increase in the rate of uninsured children in close to a decade.

According the study, Utah's rate of uninsured children surpassed the national average and follows a similar trend in terms of Medicaid and CHIP enrollment in 2018.

The new study places Utah's rate of decline for enrollment in the federally funded programs at 7.3 percent.

Rep. Ray Ward, R-Bountiful, who advocated for partial Medicaid expansion during this year's legislative session, said he hopes that the expansion will help bring down the number of uninsured children and families in the state.

Ward noted that a decrease in Medicaid enrollment alone was not necessarily cause for concern.

"If those numbers have gone down because the economy is doing better and people have jobs that put them at a high enough income rate that they don’t need Medicaid because they’ve got a regular job, that that is awesome," he said.

The study rules out economic growth as a significant factor influencing declining enrolment in the federal programs.

"These enrollment declines aren’t closely correlated to economic conditions," said Park, noting that "some of the states with the largest enrollment declines may have had reductions in the unemployment rate and some of them may have had increases in the unemployment rate.”

According to the Bureau of Labor Statistics, Utah's rate of unemployment was 3.1 percent at the beginning of 2018 and remained steady until the end of the year. In October, November and December it rose to 3.2 percent before dropping back down to 3.1 percent at the beginning of 2019.

Unemployment was one of a number of factors the study used to determine the statistical relevance of economic growth on declining enrolment in Medicaid and CHIP.

The study noted that historically, CHIP and Medicaid growth have slowed rather than declined during periods of economic growth.

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The national average of uninsured children is 5 percent, which amounts to about 3.9 million children. In Utah that average is higher, it was 6 percent in 2016 and went up a percentage point in 2017, the data shows.

According to the study, another factor considered when excluding economic growth as a variable were reports from the Congressional Budget Office and the Office of the Actuary.

The study noted that both offices "consider changes in economic conditions in assumptions used to project Medicaid and CHIP enrollment." However, neither predicted a decline in enrollment for the programs in 2018.

Rather than economic growth, the study points to policies at the state and federal level as factors influencing the rate of enrollment in the federal programs.

It lists cuts in marketing, outreach and grants for consumer assistance; the lapse in CHIP funding that occurred at the end of 2017; as well as the "chilling effect of anti-immigrant rhetoric and policies" as potential impacts.

Ward said he believes immigration policy could impact the rate of uninsured children by leaving people in a state of "limbo."

"One of the things that makes me either sad or upset is that we haven't resolved the issue (of immigration) on a national level," he said, noting that "we've been debating possible solutions, not just for years but decades."

Ward said "I really feel like it's important that we come to some solution nationally so that people could have clarity about their lives."

State specific impacts are not discussed in the study. Nor does it elaborate on potential impacts of Medicaid expansion at the individual state level.

Park noted, however, that the five top states in the study, in terms of declining enrollment rates in the programs, are all states that have not opted into full Medicaid expansion.

A separate report from Georgetown University Health Policy Institute found that states with a Medicaid expansion program that extended to parents with income below 138 percent of the poverty line saw less of an increase in the rate of uninsured children.

Kelly Whitener, an associate professor at Georgetown who provides technical assistance for Voices for Utah Children's Finish Line Project, said the partial Medicaid expansion approved by Utah lawmakers could have a positive impact on future numbers.

"Extending coverage to include more parents than have traditionally been covered in the state could help bring more kids in," she said, noting that "we do see in the research that when parents have coverage children are more likely to have coverage."

However, she said some of the increased enrollment that might be expected due to Medicaid expansion in Utah could have been thwarted by confusion about the partial expansion program.

"You had Prop. 3 and then you had a lot of legislative debate" she said, referring to the voter-approved initiative on Medicaid expansion that was replaced by a partial expansion bill.

"I could see where it would become very confusing for families," she said.

Ward dismissed the notion that debate on the replacement bill could have a negative impact on Utah's enrollment rates for CHIP and Medicaid.

"When I talk with individuals about why they do or don't enroll in Medicaid I cannot even recall a person who made their decision based on the public debate about the issue," he said.

Kolbi Yong, Utah Department of Health spokeswoman, said it is too early to determine if the partial Medicaid expansion had an impact on enrollment numbers for the program that was implemented at the beginning of April.

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