CHIP Waiting Periods Must End

Health

When my oldest brother was a few months short of 65, he started asking me what I knew about Medicare. (Turns out I know little.) He was in the process of enrolling, even though his birthday was four months away.

You can do that with Medicare. In fact, you can even begin using Medicare before you actually turn 65! The Department of Health and Human Services’ website says “coverage starts the first day of the month you turn 65. If your birthday is on the first day of the month, your coverage starts on the first day of the prior month.”

So, if my 65th birthday is July 20, I can get coverage under Medicare on July 1. If my birthday is July 1, I’m covered starting June 1.

Smart, right? Providing seamless coverage is exactly how health insurance should work. Unfortunately for children, the opposite is true.

While most states got rid of waiting periods after the Affordable Care Act limited their length to 90 days (some states previously had waiting periods for kids that were as long as six months!), a total of 13 states still require children to wait those 90 days to enroll in the Children’s Health Insurance Program (CHIP).

What does a waiting period mean to a parent or grandparent who wants to enroll their child in CHIP? It means they must weigh the risk of having that child go without coverage for a month or two or three before they can be covered by CHIP. If the child is enrolled in the parent or grandparent’s employer or other coverage plans, they would actually have to drop that coverage and then wait the 30, 60, or 90 days depending on state rules.

If your child has a condition that needs regular care or medication, waiting for those 30 to 90 days may feel just too risky. Even if your child doesn’t typically need medical care very often outside of well-child visits, you may not want to risk your child being uninsured for any length of time. So, parents and grandparents who are unwilling to risk their child’s health can’t take advantage of the benefits of CHIP even though their child is eligible.

The 13 states that still have waiting periods are — Arizona, Arkansas, Florida, Illinois, Indiana, Iowa, Louisiana, Maine, New Jersey, South Dakota, Texas, Utah, and Wyoming. Two of those states, Texas and Florida, have very large numbers of uninsured kids, some of the biggest in the country. The uninsured rate for children in Texas is more than 11% and in Florida, it is nearly 8%. The national rate is 5.5%.

Kids are the only population for whom waiting periods still exist. We should take a lesson from Medicare and approach children with the idea of make coverage timely and accessible. Newborns should be covered, whether by Medicaid, CHIP, or private coverage, before they leave the hospital so they go to their first well-child appointment days later with coverage. We should keep children covered continuously from birth through age five while their brains are growing and they see their medical provider numerous times until they go to kindergarten. We should streamline enrollment and renewal systems to prevent eligible kids from falling off coverage. We should get rid of the five-year wait for lawfully present immigrant children and pregnant women to be eligible for CHIP and Medicaid.

It shouldn’t be harder for kids to get covered than older adults. We know what to do. After all, CMS is The Centers for Medicare & Medicaid Services. They know how to do this for older adults and should promote such coverage for kids. States should design their CHIP programs without waiting periods, and Congress should eliminate the option for them all together. They should do it for kids.