Congress has an opportunity to shore up Medicaid and CHIP for the more than 84 million Americans — including 44 million children — who depend on the programs for health coverage. They can do so by: 

  • Enacting permanent, required 12-month continuous eligibility for children in Medicaid and CHIP.
  • Enacting permanent, required continuous eligibility for pregnant and postpartum individuals in Medicaid and CHIP.

Medicaid and CHIP provide health coverage to more than 84 million Americans, including 44 million children. Unfortunately, Medicaid and CHIP enrollees are often unjustly disenrolled from the programs owing to paperwork complexities, or minor and temporary fluctuations in income. Luchieny and her family are just one example of how this can happen:

 


 

Continuous coverage helps the health and quality of life of enrollees. Churn and its impact are widespread, even though most children who lose Medicaid are either still eligible or will become eligible again within a few months. A 2015 analysis found the average child to be enrolled in Medicaid for only 10 months of the year, and a 2021 report found that found that 8 percent of children on Medicaid and CHIP churned each year.

A 2020 George Washington University study commissioned by ACAP found that nearly 600,000 additional children on Medicaid would have access to preventive care visits and nearly 175,000 additional children would get needed specialty care if Congress were to mandate 12-month continuous eligibility for children in Medicaid and CHIP.

In addition:

  • Churn creates costly administrative burdens for providers and health plans by disrupting providers’ and plans’ care regimens for children.
  • Churn forces Federal and state governments to devote scare resources to managing bureaucratic eligibility processes and support higher monthly costs of people who churn.
  • Churn disproportionately harms children of color and contributes to health inequities because children of color are more likely to be enrolled in Medicaid and CHIP, compared with their white peers. Families of color are also more likely to live in poverty and experience temporary fluctuations in income, leading to an increased risk of churn for their children.

Under current rules, it’s surprisingly easy for children to lose their coverage in Medicaid or CHIP. Here’s one story:

Momentum for continuous eligibility is growing. Early in the COVID-19 pandemic, Congress passed the Families First Coronavirus Response Act, requiring all states receiving enhanced Medicaid funding to provide continuous Medicaid coverage to all enrollees and bringing eligibility churn in Medicaid to a temporary halt, providing security to millions.

  • By enacting the American Rescue Plan Act, Congress gave states an option to extend continuous coverage to Medicaid and CHIP pregnant enrollees through one full year after the birth of a child.
  • The House-passed Build Back Better Act included permanent requirements for 12-month continuous Medicaid and CHIP eligibility for children and 12 months of postpartum Medicaid and CHIP coverage.
  • 215 local, state, and national groups have signed a letter urging Congress to provide continuous eligibility to children in Medicaid and CHIP.
  • The Stabilize Medicaid and CHIP Act of 2021, H.R. 1738 and S. 646, would require 12-month continuous eligibility for everyone in Medicaid and CHIP.

Americans Need Coverage They Can Count On.

Pass 12-month continuous eligibility for children and 12 months postpartum coverage in Medicaid and CHIP.

 


 

Related:
Enrollment in Medicaid by Congressional District – District-by-district information on Medicaid voters