Prior to the onset of the COVID-19 public health emergency in 2020, millions of children were using and leaving Medicaid each year – an indication that many were losing coverage due to administrative issues, rather than family income. increased and made them ineligible.
Spurred by lessons from the pandemic era, several states are rethinking their enrollment policies for younger Medicaid members. Oregon is leading the way after gaining federal approval to implement a new continuous enrollment policy.
In 2023, when the public health emergency is expected to end, Oregon will become the first state to allow Medicaid-eligible children to enroll at birth and remain enrolled until age 6, regardless changes in their household income and without having to submit a new application. .
“It really is a no-brainer in terms of supporting children,” said Jenifer Wagley, executive director of Our Children Oregon, an advocacy group. She said keeping children insured – especially at younger ages when their bodies and minds are still developing – will ensure they don’t miss out on important checkups and care due to deficiencies. in the cover.
Three other states are set to implement similar policies for their Medicaid plans, which provide health coverage for low-income people and are funded by states and the federal government. Washington state asked the Biden administration in July for permission to provide continued coverage for children up to age 6, and a decision is likely in the coming weeks. California lawmakers have approved a proposal allowing children to remain covered until age 5, starting in 2025, pending federal approval. And New Mexico has sought public comment on a plan to keep children enrolled until age 6 and is expected to seek federal consent later this year.
National Medicaid enrollment hit an all-time high after the federal government banned states from removing members during the public health emergency unless they die or leave the state. This rule has helped push the country’s uninsured rate to an all-time high.
Of the nearly 90 million people receiving Medicaid and the Children’s Health Insurance Program — a federal program that covers children in households whose income is above Medicaid eligibility — about 41 million are children.
Joan Alker, executive director of the Center for Children and Families at Georgetown University, called the states’ move to longer periods of continuous coverage for children “the silver lining of the pandemic for kids.”
She noted that between the fourth quarter of 2020 and the first quarter of 2022, the share of uninsured children in the United States fell from 6.7% to 3.7%, largely due to the state. emergency that has prevented states from removing Medicaid enrollees.
“States will need to do a lot of outreach on this new policy so that every baby leaves the hospital with health insurance and parents don’t have to worry about coverage until the child goes to kindergarten. “, she said.
If the public health emergency ends next year, nearly 5.3 million children could lose Medicaid coverage, according to a federal analysis released in August. About 1.4 million of them would be removed from the lists because they are no longer eligible, but almost 4 million eligible children would lose their coverage for administrative reasons, such as failure to submit documents on time.
Because Medicaid household income eligibility thresholds are generally higher for children than for adults, children are less likely to lose coverage due to small changes in income. But children can lose eligibility if parents don’t renew coverage each year or don’t respond when a state requests information to confirm that a family’s income has remained low enough to qualify.
Medicaid enrollees generally must report any changes in household income or other criteria that may affect their eligibility during the year, and states must act accordingly. It’s difficult for Medicaid recipients and state agencies because people’s incomes often fluctuate. As a result, enrollees may lose coverage, be forced to switch between Medicaid coverage and subsidized market coverage on Affordable Care Act insurance exchanges, or experience coverage gaps if paperwork gets out of hand. proves difficult to complete.
To address this problem, about half of the states give children one year of continuous Medicaid eligibility, regardless of changes in their household income. This group includes both Republican-controlled and Democratic-controlled states, including some states — such as Alabama and Mississippi — that have not expanded Medicaid under the ACA.
Before moving to continuous coverage for children up to age 6, Oregon offered 12 months of continuous eligibility for children. Still, state Medicaid officials estimate that in 2019, before the pandemic began, more than 70,000 children under age 6 — one-third of enrollees — entered and left Medicaid. About 29,000 of those children had coverage gaps that exceeded 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 by 2027, at a cost of $177 million.
“The public health emergency has clearly demonstrated the value of continued health insurance, especially for populations who experience health disparities and have had historical barriers to accessing health care,” said Elizabeth Gharst, spokeswoman for the Oregon Health Authority, which oversees the state. Medicaid program.
The six-year guarantee will also reduce administrative costs for the state, since it will not have to deal with certain applications each year. And officials hope it will reduce the program’s medical costs because children who remain on Medicaid will have access to preventive and primary care services that can reduce the need for treatment related to delays in seeking care.
Oregon provides Medicaid and CHIP coverage for children in families with incomes up to 300% of the federal poverty level, or $83,250 for a family of four.
Lori Coyner, senior policy advisor for Medicaid in Oregon, said the change will reduce health inequities because it will help children of color retain coverage and access to care.
In addition to keeping children on Medicaid longer, Oregon won federal approval in October to become the first state to give children 6 and older and adults two years of continued eligibility, regardless of state. changes in their household income.
Nationally, the KFF estimates that about 11% of children enrolled in Medicaid lost coverage for at least one day in 2019 before restoring it. Washington State also reports 11%.
In California, where a policy of continued coverage is being considered, Medicaid officials estimate that of the nearly 1.2 million children under age 5 covered, about 64,000 – or 6% – were taken off the rolls and then re-enrolled. the same year.
Mike Odeh, senior health director for California advocacy group Children Now, believes the state’s churning estimate is too low. He thinks 89,000 children a year are affected. The California legislature included the continuing eligibility provision in the budget approved in June. California would cover Medicaid children from birth through age 5 starting in 2025, provided the state can afford it.
California’s Medicaid agency estimates the policy change would cost $39 million in 2025, assuming January implementation, and $68 million in fiscal year 2025-26. The state always weighs when to seek federal approval.
Odeh hopes the state will move forward soon. “We would rather see the state pay for children who receive care than pay for 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 giving children continued eligibility for several years. “Families on Medicaid are very busy, and the last thing they can think of is renewing their coverage – so it’s at the bottom of their priority list,” said Amy Dobbins, section chief of the Bureau of Health. eligibility and Medicaid policy.
She said the COVID-19 public health emergency, during which more children were covered and received health services, only strengthened the case for continued eligibility.
Dianne Hasselman, acting executive director of the National Association of Medicaid Directors, predicts that some states may be cautious about following Oregon’s lead. “State lawmakers may also be concerned about increased Medicaid enrollment, especially at a time when enrollment has already increased significantly,” she said. Also, lawmakers might be reluctant to extend coverage to people with other insurance options, such as those from a relative’s workplace, she said.
While pleased to see some states keep children on Medicaid until age 6, Georgetown’s Alker stressed that Oregon’s new policy will go into effect — when the public health emergency ends — just as millions of children will lose their coverage.
“States that are not responsive to the needs of children when the public health emergency ends will likely see a massive increase in the number of uninsured children,” Alker said. “Very different results await us.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.
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