Continuous Eligibility ensures that children have access to the care they deserve

Health

Every child deserves access to comprehensive and stable health care that helps them thrive. The COVID-19 Public Health Emergency barred state governments from disenrolling recipients of Medicaid. The prohibition ensured that 35 million children enrolled in Medicaid (and many in the Children’s Health Insurance Program (CHIP)) nationwide maintained access to consistent, stable health coverage. However, states are now in the process of “unwinding” their coverage and are recertifying every participant in Medicaid and CHIP many, with the potential to arbitrarily create gaps in children’s access to health care. The health care coverage gaps created by unwinding should be a call to action to enact more policies that ensure stable health care coverage for children. One such policy would be early childhood continuous eligibility.

Early child continuous eligibility would keep children enrolled in Medicaid or CHIP until their sixth birthday, providing stable health care coverage through the most important years of development. The American Academy of Pediatrics recommends that children visit their physicians at 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months to ensure that they are developing properly. Medicaid specifically provides an Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit that allows children to receive age-appropriate screening and treatment as needed. This routine and regular preventative care allows providers to screen for emotional and behavioral delays, vision and hearing abnormalities, proper physical development, and diseases such as cancer. Even small gaps in coverage can cause children to skip these vital appointments, which are aimed at preventing a lifetime of chronic illness. 

Children with consistent health care coverage, like those with continuous Medicaid coverage during the pandemic, are far more likely to receive this routine care. Children who move in and out of eligibility — a process called “churn” — experience detrimental gaps in their coverage. Low-income families who rely on Medicaid are particularly likely to experience income fluctuations that affect their eligibility, leaving them vulnerable to churn. As a result, they may lose coverage and be forced to forgo necessary care for their children due to high out-of-pocket costs.

The unwinding process is creating artificial, and often unjustified, gaps in health care coverage for millions of families across the country. As of October 2023, 4.8 million children had been disenrolled by the unwinding process. However, only 20 states are breaking down their data to reveal how many children have been disenrolled, meaning that the number may be far higher. Additionally, 70% of disenrollments are due to procedural issues such as misfiled paperwork or outdated addresses. Many of the children who have lost coverage do in fact qualify for Medicaid, but will now be denied access to health care nonetheless. 

The unwinding process underscores the need to expand continuous coverage for children, also known as “continuous eligibility.” On January 1, 2024, all states will be required to provide 12 months of continuous eligibility to children enrolled in Medicaid and CHIP. Continuous eligibility means a child will be guaranteed up to a year of Medicaid or CHIP coverage despite fluctuations in their household’s finances. One-year continuous eligibility offers a welcome first step, but it does not go far enough to protect children through some of their most crucial developmental years. Expanding the policy to provide continuous eligibility through age 5 (also called “early childhood continuous eligibility”) would provide many benefits to the nation’s children. 

Continuous eligibility would also reduce health care costs for states by reducing the administrative burden created by repeatedly recertifying children. Studies estimate that each child churning in Medicaid costs the state government $400-600 in unnecessary administrative costs. Additionally, children who are uninsured are less likely to receive routine medical care and are more likely to have poorly managed chronic conditions, making them more likely to use expensive emergency room services. Without insurance, many of these families will be unable to cover their costs, which may then fall on health care providers as well as state and local governments. 

States recognize the importance of continuous eligibility and are finding creative ways to expand their programs. Colorado passed legislation earlier this year allowing children continuous coverage from ages zero to three (HB23-1300). At the federal level, Oregon and Washington state are implementing continuous eligibility by using section 1115 waivers, which allow states to explore new Medicaid approaches to eligibility and enrollment. Both states now have approved waivers and offer continuous eligibility for children up to age six. New Mexico has also submitted a section 1115 waiver for approval of this same goal. While these efforts are commendable, states need support and assistance from the federal government to explore continuous eligibility without navigating the burdensome and time-consuming waiver process. 

First Focus Campaign for Children supports Rep. Joe Neguse’s (D-CO) Save Children’s Coverage Act (H.R. 1316), which allows states to implement continuous eligibility for children through age 5 via a State Plan Amendment (SPA) rather than submission of a section 1115 waiver, which requires negotiation and approval from the federal government.

While states rush to make Medicaid and CHIP eligibility redeterminations during the unwinding, policymakers have a critical moment to reexamine the status quo of children’s health care coverage. The coming years will likely reveal the detrimental impacts of the unwinding process on our children’s overall health. In the meantime, we continue to encourage the Centers for Medicare & Medicaid Services (CMS) to work with states to encourage thoughtful handling of the unwinding process to reduce unnecessary health care coverage loss for children.