Expanding Access: Continuous Eligibility for Children in Medicaid and CHIP

For the 38 million children who rely on Medicaid and the Children’s Health Insurance Program (CHIP), consistent access to health care is critical. For low-income families, Medicaid and CHIP provide critical financial protection against high medical costs. Consistent coverage ensures families are not burdened by unexpected medical expenses, contributing to their overall financial stability. Consistency in coverage also allows providers to develop stronger relationships with children and their parents and children with consistent coverage are more likely to be in better
health.

Many individuals experience “churn” on and off Medicaid coverage, often due to administrative challenges during coverage redetermination rather than changes in eligibility. Churning refers to the cycle of losing and regaining coverage within a short period. These hurdles, such as short deadlines or difficulties obtaining required documents like paystubs, can result in temporary disenrollment. This leads to gaps in coverage, which can delay treatment and worsen health outcomes.  New policies at federal and state levels seek to address churn by providing continuous eligibility (CE) for children enrolled in Medicaid and CHIP allowing individuals to maintain Medicaid coverage for a set period despite changes in their circumstances. CE reduces both coverage gaps and administrative costs by minimizing the need for frequent re-enrollment. 

New Federal Requirements for Continuous Eligibility 

As of January 1, 2024, all states are required to provide 12 months of CE for children under age 19 in Medicaid and CHIP. This requirement, previously a state plan option, was added by Section 5112 of the Consolidated Appropriations Act of 2023 (CAA 2023) addressing issues of churn for children in Medicaid and CHIP. The Centers for Medicare & Medicaid Services (CMS) also recently provided guidance to States on the CE requirement. According to the Assistant Secretary for Planning and Evaluation (ASPE), over 17 million children in states without prior 12-month CE policies may benefit from the new requirement. Additional information on the new CMS proposed rule is provided in a recent Aurrera Health Group blog post “Proposed Federal Policies Address Nation’s Maternal Health Crisis.” Some states have extended CE further: New Mexico, Oregon, and Washington now cover children from birth to age six through 1115 waivers, and as of November 14, 2024, CMS approved similar section 1115 demonstration waiver amendments for Colorado, Hawaii, Minnesota, New York, and Pennsylvania. Other states, including California and Illinois, are developing similar plans.

The Importance of Outreach and Community Collaboration 

Even with CE policies, states can still benefit from outreach and education. It is estimated that nationally around 6 million non-elderly individuals (ages 0 to 64) are eligible for Medicaid or CHIP but are not enrolled. Of the unenrolled but eligible, around 34% are children. Effective outreach and education are essential to maintaining CE for children, promoting better health outcomes, financial security for families, and overall well-being. Many families may be unaware of their eligibility for Medicaid or CHIP or the importance of maintaining coverage. Outreach efforts help identify and enroll eligible children, ensuring they receive the health care they need. Education helps families understand how to navigate complex system dynamics and requirements, complete necessary paperwork, and know when coverage renewals are coming. Regular education and communication help families stay informed about policy changes and reduces confusion due to misinformation.  

By partnering with local, community-based organizations states can tailor outreach to specific populations. For example, Medicaid and CHIP programs can partner with schools through the School-Based Services Medicaid program across their states to provide education regarding their programs.  

For example, in Nebraska, the Medicaid and CHIP agency provides program flyers to all public schools across the state, which are sent home with the children at the beginning of the school year. The flyers include information on Medicaid and CHIP income guidelines and how to apply.  

Washington state has the “Apple Health Ambassador” program where members of the community enroll to assist with educating and messaging to Medicaid members and the general public. Ambassadors are provided with training, a monthly forum to ask questions and receive program information, and a communications toolkit.  

Aurrera Health’s Commitment to Support Medicaid Stakeholder and Member Communications 

The Aurrera Health team is ready to help states and other stakeholders implement new eligibility policies including supporting strategizing about how to communicate with members. To learn more about how we can assist your state or organization in implementing new Medicaid and CHIP policies, please reach out to Lauren Block. 

Note: update on November 15, 2024 reflects five new section 1115 demonstration amendments approved on November 14, 2024.

Catherine Gekas Steeby [Deputy Director]