Stopping churn: Why some states want to guarantee Medicaid coverage from birth to age 6

Before the Covid-19 public health emergency began in 2020, millions of children were switching to and from Medicaid each year – an indication that many lost coverage because of administrative problems, not because their family’s income had increased and they had not were eligible.

Spurred by the lessons of the pandemic era, several states are rethinking their enrollment policies for the youngest Medicaid members. Oregon leads the way after receiving federal approval to implement a new continuous registration policy.

In 2023, when the public health emergency is expected to end, Oregon becomes the first state To allow children who are eligible for Medicaid to enroll at birth and remain enrolled through age 6, regardless of changes in household income and without reapplying.

“This is really a no-brainer in terms of supporting children,” he said Jennifer Wagley, executive director of Our Children Oregon, an advocacy group. She said having children’s insurance — especially in their younger years when their bodies and minds are still developing — will ensure they don’t miss out on important checkups and care services due to insurance gaps.

Three other states are in the process of implementing similar policies for their Medicaid plans, which provide health coverage to low-income people and are funded by the states and the federal government. Washington state asked the Biden administration in July for permission to offer continued coverage to children up to the age of 6, and a decision is likely to be made in the next few weeks. California lawmakers have approved a proposal that beginning in 2025, children should remain insured until age 5, subject to federal approval. and New Mexico has requested public comment plans to keep children enrolled through age 6 and is expected to seek federal approval later this year.

Medicaid enrollment nationally is at a record high after the federal government banned states from dropping members during the public health emergency unless they died or moved out of the state. This rule has helped push the country’s uninsured rate to a record low.

Of the nearly 90 million people who receive Medicaid and the Children’s Health Insurance Program, a state program that covers children in households with incomes above Medicaid eligibility, about 41 million are children.

Johanna AlkerExecutive director of Georgetown University’s Center for Children and Families, called states’ shift to longer periods of continuous reporting for children a “silver lining of the pandemic for children.”

She noted that the proportion of uninsured children in the US fell from 6.7% to 3.7% from Q4 2020 to Q1 2022, largely due to the emergency regulation that has prevented states from accepting Medicaid enrollments to drop.

“States need to work hard on this new policy so that every baby leaves the hospital with health insurance and parents don’t have to worry about health insurance until the child goes to preschool,” she said.

When the public health emergency ends next year, nearly 5.3 million children could lose Medicaid health coverage, according to a federal analysis which was published in August. Approximately 1.4 million of them would be delisted because they no longer qualify, but nearly 4 million eligible children would lose coverage for administrative reasons, such as: B. because they do not submit the documents in time.

Because Medicaid household income eligibility thresholds are typically higher for children than for adults, children are less likely to lose coverage due to minor changes in income. But children can lose eligibility if parents don’t renew coverage each year or don’t respond when a state seeks information to confirm that a family’s income has remained low enough to qualify.

Medicaid enrollments are generally required to report any changes in household income or other criteria during the year that might affect their eligibility, and states must respond to those changes. That’s a challenge for Medicaid beneficiaries and government agencies because people’s incomes often fluctuate. As a result, insureds may lose coverage, be forced to switch between Medicaid and the subsidized market on Affordable Care Act insurance exchanges, or experience coverage gaps if paperwork proves difficult.

To address this issue, approx half of the states entitle children to Medicaid for one continuous year regardless of changes in household income. This group includes both Republican- and Democrat-controlled states, including some states — such as Alabama and Mississippi — that have not expanded Medicaid under the ACA.

Prior to the transition to continuous coverage for children up to age 6, Oregon offered 12-month continuous eligibility for children. Nonetheless, state Medicaid officials estimate that in 2019, prior to the onset of the pandemic, more than 70,000 children under the age of 6 — a third of those enrolled — were transitioning into and out of Medicaid. About 29,000 of those children had coverage gaps of more than six months, state officials told KHN.

Oregon officials estimate that after four years of implementation, the new enrollment policy will benefit more than 51,000 children in 2027, at a cost of $177 million.

“The public health emergency has clearly demonstrated the value of continued health insurance, particularly for populations that suffer from health disparities and have had historical barriers to accessing health care,” said Elizabeth Gharst, a spokeswoman for the Oregon Health Department. which oversees the state’s Medicaid program.

The six-year guarantee will also reduce the administrative burden on the state by not having to process some applications every year. And officials hope it will reduce the program’s medical costs because children who remain on Medicaid have access to preventive and primary care services, which can reduce the need for treatments related to delays in finding care.

Oregon offers Medicaid and CHIP coverage for children of families earning up to 300% of the federal poverty linethat’s $83,250 for a family of four.

Lori CoynerOregon’s senior Medicaid policy adviser said the change will reduce health inequalities because it will help children of color maintain coverage and access care.

In addition to allowing children to stay longer on Medicaid, Oregon received federal approval in October to become the first state to grant children ages 6 and older and adults uninterrupted eligibility for two years, regardless of changes in their household income.

National, KFF estimates that about 11% of children enrolled in Medicaid lost their coverage for at least one day in 2019 before being restored. Washington State also reports 11%.

In California, where a policy of continuous coverage is being considered, Medicaid officials estimate that of the nearly 1.2 million children under the age of 5 who are insured, about 64,000 — or 6% — were delisted and then in the same year were registered again

Mike Odeh, senior health director for California advocacy group Children Now, believes the state’s churn estimate is underestimated. He estimates that 89,000 children are affected each year. The California Legislature included the continuing eligibility provision in the budget approved in June. California would cover children from birth to age 5 in Medicaid beginning in 2025, as long as the state can afford it.

The California Medicaid agency estimates that the policy change would cost $39 million in 2025, assuming implementation in January, and $68 million for fiscal year 2025-26. The state is still weighing when to seek federal approval.

Odeh hopes that the state will make progress soon. “We’d rather see the state pay for childcare than for the paperwork,” he said. Having to re-enroll every year, he added, can be a barrier for low-income families. “We want them to be healthy and ready for school,” Odeh said.

Medicaid officials in Washington state said they have long considered granting children continuous eligibility for multiple years. “Families on Medicaid are very busy and the last thing on their mind is renewing their coverage — putting this at the bottom of their priority list,” said Amy Dobbins, executive director of the Office of Medicaid Eligibility and Policy.

She said the Covid public health emergency, with more children being insured and receiving health services, has only strengthened the case for continued eligibility.

Dianne Hasselman, interim executive director of the National Association of Medicaid Directors, predicts some states may be cautious about following Oregon’s lead. “State legislatures may also be concerned about increasing enrollments in the Medicaid program, especially at a time when enrollments have already increased significantly,” she said. Additionally, lawmakers might be wary of extending coverage to those with other insurance options, such as from a parent’s workplace, she said.

While pleased that some states are keeping children on Medicaid until age 6, Georgetown’s Alker stressed that Oregon’s new policy — at the end of the public health emergency — will go into effect, as will millions of others Children lose insurance coverage.

“States that don’t meet the needs of children after the health emergency ends are likely to see a massive increase in uninsured children,” Alker said. “So there are very different results ahead.”


KHN (Kaiser Health News) is a national newsroom producing in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three major operational programs at KFF (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information on health issues to the nation.

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