Study: Medicaid Continuous Eligibility Policies Reduce Unmet Need for Specialty Care, Lead to More Preventive Care Visits

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WASHINGTON—A new study from researchers at George Washington University indicates that policies that allow for 12-month continuous eligibility for children in Medicaid lead to increased access to specialty health care, increased preventive care visits, and fewer gaps in health care coverage.

12-month continuous eligibility is a policy that addresses “churn,” a phenomenon where people with Medicaid and CHIP coverage lose eligibility because of bureaucratic paperwork issues or short-term changes in income. They often return to the program sicker than when they left, costing Federal and state taxpayers more than if they had been continuously covered.

The study, authored by Leighton Ku, Ph.D., M.P.H. and Erin Brantley, Ph.D., M.P.H., analyzes the most recent three years of data from the National Surveys of Children’s Health for children under the age of 18 whose family incomes are below 138 percent of poverty. Virtually all of these children are eligible for Medicaid coverage across the nation. This study compares outcomes for children living in the 24 states which offer 12-month continuous eligibility policies to those living in the 26 states (and the District of Columbia) which do not offer any such policy.

The study found continuous eligibility in Medicaid to be associated with:

  • A 1.5 percentage point increase in the number of children who saw a specialist in the past year;
  • A reduction of unmet needs for specialty care by 6.0 percent, or about one-third;
  • An increase in preventive care visits in the past year by 2.7 percentage points; and
  • A reduction in gaps in insurance coverage by 2.4 percentage points, equivalent to reducing the number with a coverage gap by almost one fifth.

“COVID-19 has led to a steep rise in uninsurance among children, but the unfortunate truth is that the proportion of children with no health insurance had been rising since 2017, reversing the trend of years of progress,” said study author Leighton Ku, Ph.D., M.P.H. “As the economic and budgetary effects of the pandemic will reverberate long after the public health emergency is declared over, continuous access to Medicaid will be a linchpin for children’s health.”

The Families First Coronavirus Response Act called on states to provide continuous coverage for Medicaid enrollees during the period of the public health emergency. But even after the public health emergency ends, the nation will experience higher unemployment, greater poverty and economic volatility.

“Continuous Medicaid eligibility would close some of the gaps in our insurance system and assure better access to care for a longer period. Given that so many people have avoided the doctor’s office in the midst of the pandemic, the real need may not come until after the pandemic subsides,” said Margaret A. Murray, CEO, ACAP. “If continuous eligibility was good during the pandemic, why cast it aside after? Congress should keep 12-month continuous eligibility once the public emergency comes to an end.”

The study also found special challenges for immigrant children, who had less insurance coverage and less medical care. This finding may owe itself to eligibility policies that bar many immigrant children from Medicaid coverage, such as recent public charge regulations by the Department of Homeland Security.

“Children who are immigrants, many of whom are in the United States legally, have no fewer health care needs than all other children,” said study author Erin Brantley, Ph.D., M.P.H. “Assuring continuous Medicaid coverage for eligible immigrant children will provide access to critical care and improve health.”

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About ACAP:

ACAP represents 77 health plans, which collectively provide health coverage to more than 20 million people. Safety Net Health Plans serve their members through Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), the Marketplace and other publicly-sponsored health programs. For more information, visit