Prevention is better than cure, especially for children. Maintaining access to affordable health care coverage empowers them to thrive. However, as a result of Medicaid unwinding, children are losing health care coverage at alarming rates.More than 4.6 million children across the United States have lost access to Medicaid through the unwinding process thus far. In some states, such as Texas, nearly two-thirds of the children enrolled lost their coverage, putting their families at risk of incomprehensible amounts of medical debt should their child become sick. We’re just barely over halfway through unwinding — 48% of enrollees are still awaiting their determinations, meaning that the country likely will see another onslaught of coverage losses over the next few months. 

Many children lost coverage not because of their eligibility, but because of procedural issues such as incorrect phone numbers, old addresses, or paperwork mistakes. On average, states have disenrolled almost three-quarters of recipients during unwinding due to these procedural reasons. In some states, these rates are as high as 94%. This means that millions of children no longer have access to health care, all because their parents missed a form in the mail.

While unwinding has been terrible for kids’ health coverage, another policy has stepped in to help keep kids covered — 12-month continuous eligibility. More than 4.6 million children across the United States have lost access to Medicaid through the unwinding process thus far. This means that children enrolled in Medicaid or CHIP are guaranteed 12 months of continuous coverage even if their household’s circumstances change, preventing gaps in coverage and periods of uninsurance due to income fluctuations or missed paperwork. Though it cannot undo the harms already done by the unwinding, 12-month continuous eligibility is a boon for children’s coverage.

Experience has shown that continuous eligibility works — many states already had this policy prior to the new national requirement, and their child disenrollment rates were about half the rate of states without continuous eligibility. Unwinding highlights how arduous and ineffective the current renewal process is for millions of families, and the success of continuous eligibility policies highlights the benefits of keeping kids enrolled. 

Keeping kids covered is a cost saver for both families and states. On average, states lose $400-$600 in administrative costs for each child that rotates in and out of Medicaid coverage, a process called “churn.” Research also shows that Medicaid enrollment significantly reduces families’ medical debt. This stability helps support a family’s overall financial health, making them less likely to carry non-medical debt as well. Both of these factors allow parents to purchase other necessities for their children such as food, clothing, and housing. 

While 12 months of continuous eligibility is a great start, it’s not enough to keep our kids covered. KFF reports that after the 12-month window passes, child churn more than doubles. Children need consistent access to health care coverage to receive the routine and emergency medical care that they need during their earliest years. 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. Most churn gaps last 3-9 months, meaning that young children could miss nearly half of these critical appointments. This means that doctors may not detect emerging conditions or developmental delays in a timely manner, delaying diagnosis and treatment. 

To keep kids covered Congress must pass five-year continuous eligibility, which keeps kids covered during the most important years for their development. Continuous eligibility eliminates churn in early childhood, ensuring that children can receive all of their vaccines, screenings, and routine checkups at an affordable cost to their parents. With five-year continuous eligibility, children, regardless of their socioeconomic background, can receive the care they need to be successful as they begin school. This simple extension also reduces administrative burdens for both families and state governments by reducing the frequency of the redetermination processes.

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. Rep. Neguse’s legislation reduces the administrative burden of deciding to provide early childhood continuous eligibility, making it easier for states to implement. 

Unwinding has been devastating for children, and the ramifications of this political failure will be evident for years to come. However, continuous eligibility offers an opportunity to ensure that no child or family will have to constantly navigate these bureaucratic hurdles that keep kids from coverage. Implementing five-year continuous eligibility will help keep kids worrying about important kid things — like quicksand and mall Santas — instead of spending their childhoods sick.