Ensure Medicaid Coverage From Birth to Age Six: Millions of kids would switch in and out of Medicaid every year before the covid-19 public health emergency started in 2020, which showed that many were losing coverage due to administrative issues rather than because of their family’s income had grown and made them ineligible.
Several states are revising their enrollment procedures for the youngest Medicaid beneficiaries in light of lessons learned from the epidemic era. After receiving federal authority to establish a new continuous-enrollment program, Oregon is setting the standard.
Oregon will be the first state to permit children who are eligible for Medicaid to enroll at birth and continue enrolled until they become 6 years old regardless of changes in their household’s income and without having to reapply in 2023 when the public health emergency is anticipated to come to an end.
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Why Is Medicaid Coverage Required From Birth?
The executive director of the advocacy group Our Children Oregon, Jenifer Wagley, said that “this is really a no-brainer in terms of protecting kids.” She claimed that keeping children insured will prevent them from missing crucial checks and care due to coverage gaps, especially at the earliest ages, when their bodies and minds are still growing.
Medicaid coverage plans, which offer healthcare to those with low incomes and are supported by state and federal funding, are being implemented in three additional states. Washington State requested approval from the Biden administration in July to offer children continuous coverage up until age 6, and a decision is anticipated within the coming weeks.
In anticipation of federal approval, California legislators passed a plan that will extend children’s health insurance coverage through age 5 beginning in 2025. Additionally, New Mexico has asked for feedback from the public on a proposal to keep children enrolled in school until they turn six, and it expects to ask for federal approval later this year.
After the federal government forbade states from releasing members during the public health emergency unless they died or moved out of state, Medicaid coverage enrollment nationwide has reached a record high. The uninsured rate in the nation has reached a historic low thanks to this regulation.
Roughly 41 million of the nearly 90 million people enrolled in Medicaid and the Children’s Health Insurance Program, a federal-state initiative that provides health insurance for kids living in homes with incomes above the Medicaid qualifying threshold, are children.
The expansion of states’ periods of continuous coverage for kids, according to Joan Alker, executive director of Georgetown University’s Center for Children and Families, is “a silver lining of the epidemic for kids.”
She pointed out that the emergency rule that prevents states from letting Medicaid participants go caused the percentage of children without insurance in the U.S. to drop from 6.7% to 3.7% between the fourth quarter of 2020 and the first quarter of 2022.
States will need to conduct extensive outreach over this new law to ensure that every newborn has health insurance when they leave the hospital and that parents won’t have to worry about coverage until their child enters kindergarten, according to the expert.
According to a federal estimate that was published in August, roughly 5.3 million children could lose Medicaid coverage if the public health emergency ends next year. Nearly 4 million eligible children would lose coverage for administrative reasons, such as failing to submit paperwork on time, while just around 1.4 million of them would be removed from the rolls because they no longer qualify.
Children are less likely to lose coverage due to minor changes in income since the household income eligibility requirements for Medicaid are typically higher for children than for adults. However, if parents don’t renew the insurance every year or don’t provide the documents a state requests to verify that a family’s income has stayed too low to qualify, the children may lose their eligibility.
In general, Medicaid members must notify the state of any changes to their household income or other factors that can influence their eligibility during the year. Because people’s finances frequently fluctuate, it presents difficulties for Medicaid recipients and state organizations. As a result, if the paperwork is challenging to complete, enrollees risk losing coverage, being forced to transfer between Medicaid and subsidized marketplace coverage on the Affordable Care Act insurance exchanges, or experiencing coverage gaps.
A year of continuous Medicaid eligibility for children is provided in nearly half of the states to solve this issue, regardless of changes in home income. Republicans and Democrats alike govern some of the states in this category, including some that have not expanded Medicaid in accordance with the ACA, such as Alabama and Mississippi.
Oregon provided children with 12 months of continuous eligibility prior to implementing continuous coverage for children up to age 6. However, according to state Medicaid officials, more than 70,000 children under the age of 6—or one-third of those enrolled—moved in and out of Medicaid in 2019 before the epidemic began. According to state authorities who spoke with KHN, 29,000 of those children had coverage lapses longer than six months.
Officials in Oregon predict that the new enrollment strategy, which will cost $177 million after four years, will benefit more than 51,000 kids in 2027.
According to Elizabeth Gharst, a representative for the Oregon Health Authority, which manages the state’s Medicaid program, “the public health emergency has clearly demonstrated the value of having continuous health insurance, particularly for populations that experience health disparities and have had historical barriers to accessing health care.”
Since fewer applications will need to be processed annually thanks to the six-year guarantee, the state will also incur lower administrative expenditures. As children who remain on Medicaid will have access to preventative and primary care services that can lessen the need for treatments connected to delays in seeking care, officials also anticipate that it will lower the medical expenditures associated with the program.
Children from households in Oregon who make up to 300% of the federal poverty threshold, or $83,250 for a family of four, are eligible for Medicaid and CHIP coverage.
The reform will lessen health inequities since it will assist children of color maintain coverage and access to care, according to Lori Coyner, senior Medicaid policy consultant for Oregon.
Oregon received federal clearance in October to become the first state to grant adults and children aged 6 and older two years of continuous eligibility regardless of changes in their household’s income, in addition to extending the time that children are eligible for Medicaid.
KFF predicts that nationwide, 11% of kids enrolled in Medicaid had at least one day of coverage loss in 2019 before having it reinstated. Washington State has 11% as well.
Officials from Medicaid coverage in California, where a continuous-coverage policy is being studied, estimate that of the almost 1.2 million children under the age of 5 who are insured, approximately 64,000, or 6%, were pulled from the rolls and then reenrolled in the same year.
The estimate of the state’s problems, according to Mike Odeh, senior director of health for the California-based advocacy group Children Now, is understated. He estimates that 89,000 kids per year are impacted. The continuing eligibility clause was incorporated by the California Assembly into the budget that was enacted in June. Beginning in 2025, California will provide Medicaid coverage for children from birth through age 5 as long as the state can afford it.
According to the California Medicaid agency, the policy change would cost $68 million for the 2025–2026 fiscal year and $39 million in 2025, assuming a January implementation. The state continues to consider when to get federal approval.
Odeh hopes the state advances quickly. He declared, “We would prefer to see the state pay for children receiving care than paying for paperwork.” Re-enrolling every year, he continued, can be a challenge for low-income families. Odeh stated, “We want them to be healthy and prepared for school.”
Washington state Medicaid officials stated that they have long thought about granting children ongoing eligibility for several years. According to Amy Dobbins, section manager of the Office of Medicaid Eligibility and Policy, “Families on Medicaid are incredibly busy, and the last thing they can think about is renewing their coverage — and so this gets placed to the bottom of their priority list.”
According to her, the covid public health emergency, during which more kids obtained insurance and medical care, only made the case for continuing eligibility stronger.
The National Association of Medicaid Directors’ interim executive director, Dianne Hasselman, expects that some states could be hesitant to follow Oregon’s example. Given that participation in the Medicaid program has already increased dramatically, she added, “State legislators might likewise be apprehensive about increasing Medicaid program enrollment.” Legislators might also be wary of extending coverage to people who already have insurance, such as those from a parent’s job.
Alker stressed that Oregon’s new policy will go into effect — at the end of the public health emergency — just as millions of children lose coverage, even if she was glad to see some states retaining children on Medicaid until age 6.
When the public health emergency fades, states that are unresponsive to the needs of children “would probably witness a large surge in uninsured children,” Alker said. Therefore, quite diverse outcomes are in store.
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