(CNN) — The majority of American children now receive their health insurance through Medicaid and the Children's Health Insurance Program, according to a new report published Wednesday by the Georgetown Center for Children and Families.

But that could change starting this spring. As many as 6.7 million children are at risk of losing that coverage once states restart their reviews of recipients' eligibility, according to Georgetown.

Medicaid enrollment ballooned during the pandemic thanks to an early Covid-19 pandemic relief provision passed by Congress that barred states from involuntarily disenrolling beneficiaries in exchange for higher federal matching funds. But lawmakers voted late last year to end that continuous enrollment provision on April 1, freeing states to start winnowing ineligible recipients.

More than 42 million children were covered by Medicaid and CHIP as of August, up 17.5 percent from February 2020, just before the pandemic started.

Ten states plus the District of Columbia have more than 60% of their children insured through the public programs, according to Georgetown. New Mexico leads the nation with more than three-quarters of its kids covered by Medicaid and CHIP.

By contrast, fewer than a quarter of children in Utah are enrolled in the programs.

The number of children who gained Medicaid and CHIP coverage during the pandemic varied by state. Indiana had the largest surge, with a nearly 45 percent increase. Wyoming, North Dakota, Missouri and Georgia saw their child enrollment grow by roughly a third.

On the flip side, Vermont experienced less than an 8 percent growth in child enrollment in Medicaid and CHIP.

Unwinding begins in April

More than 83 million people, including more than 34 million children, were covered by Medicaid as of August. And another 4 million children were enrolled in Medicaid financed by CHIP. All will have their eligibility reviewed, and in some cases, the children will continue to qualify even if their parents do not.

"If they're getting the message that they're losing their own coverage, a lot of times a parent understandably thinks that their child is also losing coverage," said Joan Alker, executive director of the Georgetown Center for Children and Families.

A total of roughly 15 million people could be dropped from Medicaid when the continuous enrollment requirement ends, according to an analysis the Department of Health and Human Services released in August. About 8.2 million folks would no longer qualify, but 6.8 million people would be terminated even though they are still eligible, the department estimated.

When states reevaluate families' eligibility, they need to look separately at adults and children, Alker said. Officials should work with pediatricians, schools, child care centers and others to explain the situation to parents and make sure the children retain coverage if they continue to qualify.

Nearly three-quarters of the children projected to be dropped will remain eligible for Medicaid but will likely lose coverage because of administrative issues, such as their parents not submitting the necessary paperwork or procedural errors, according to Georgetown.

Although states have 14 months to complete the unwinding process, some will look to do so more quickly.

"My concern is that a large number of children could become uninsured in states that do not take their time and pay particular attention to the unique needs of children," Alker said.

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