Kentucky is among a handful of states that lost only a small percentage of children from its Medicaid program in 2023 even as the number of kids cut from coverage soared elsewhere under annual renewal requirements that had been suspended during COVID-19.

Overall, 4.16 million children were dropped from the government health plan that covers more than half of all U.S. children, according to a new report on the process dubbed the “Medicaid unwinding.”

About 10% of 43 million children nationwide lost coverage, according to the report by the Georgetown University Center for Children and Families, with some states reporting enrollment declines of 25% or more.

Authors of the report said it’s likely many of those children remain eligible for Medicaid but lost coverage for “procedural reasons,” such as incomplete paperwork or failure to receive a renewal notice.

“There are reasons to worry that a high number of children are going uninsured,” Joan Alker, executive director of the Georgetown center, said on a press call Thursday. “Being uninsured is bad for a child’s health and exposes the family to large medical bills they can’t afford.”

Kentucky lost 10,477 children, a reduction of about 2%, from its Medicaid program that covers nearly 640,000 kids, the report said. It was among a half-dozen states with children’s enrollment declines of 2% or less.

“This is a good news story,” said Emily Beauregard, executive director of the advocacy group Kentucky Voices for Health.

Kentucky, she said, took deliberate steps to avoid cutting off children for procedural reasons as it began renewing Medicaid for adults.

“I think we’re one of the few states in the nation that hasn’t seen this decline in enrollment,” Beauregard said.

Kentucky Medicaid officials early on announced they would seek to protect children’s health coverage.?

They delayed, with federal permission, requiring children to renew coverage under the process the state began in May 2023. As a result, children won’t be required to begin renewing coverage until September.

And Kentucky was the first state to adopt an option offered by the federal government to provide 12 months of “continuous coverage” for children and teens, guaranteeing enrollees under 19 would retain coverage for at least a year — rather than being required to renew on the anniversary of their enrollment.

“The state sought this flexibility to ensure our children kept access to the coverage they need and deserve,” Brice Mitchell, a spokesman for the Cabinet for Health and Family Services, said in an email.

Medicaid officials also launched an information blitz, with letters, calls, text messages and other means to contact enrollees to try to make sure they understood the need to renew coverage and respond to requests for information from the state.

Kentucky currently has about 638,400 children enrolled in Medicaid or its companion Children’s Health Insurance Program (CHIP), out of a total enrollment of about 1.5 million. CHIP covers children whose families may earn too much for adults to qualify for Medicaid but are still considered low-income.

The greatest declines in children’s coverage came in Texas, Florida, Georgia and California, according to the Georgetown report. Those states alone account for a loss of about 2.1 million kids — around half of the children’s enrollment decline nationwide.

Some families may have moved to employer-based health insurance or purchased individual plans but the numbers of children dropped from Medicaid overall are too high to account for those getting private coverage, Alker said.

“We don’t know how many of these children are uninsured or had a gap in coverage,” she said.

Dr. Kimberly Avila Edwards, a Texas pediatrician who spoke on the call, said the impact of her state’s cut of 1 million children from Medicaid is “painfully obvious” among her patients — some whose parents discover their children have lost Medicaid only when they show up for an appointment.

“Medicaid is not a luxury,” she said. “It’s a vital program for tens of thousands of children, their families and their communities.”

During the three years of the pandemic, states got extra money for Medicaid costs but had to agree not to cut people off the health plan. Beginning in April 2023, the federal government — which provides the majority of funds for Medicaid — required states to resume asking people to provide proof of eligibility.

Under that requirement, families each year must provide income and other documentation to show they are eligible for the health plan for low-income children and adults.

Some states moved more aggressively than others to drop children from the federal-state health plan — in some cases, cutting children who likely remain eligible, the Georgetown report found.

“Stark differences have emerged in how states have responded to this enormous administrative challenge,” Alker said.?

Overall, Kentucky’s Medicaid enrollment peaked in May 2023 at 1.75 million but has declined to about 1.5 million individuals currently.