CMS Orders States to Provide Continuous Coverage for Kids in Medicaid, CHIP

CMS is reminding state health officials of the upcoming continuous coverage requirements for children in Medicaid and the Children’s Health Insurance Program (CHIP).

Provisions in the Consolidated Appropriations Act of 2023 amended the Social Security Act to require states to provide 12 months of continuous eligibility for children under 19 who receive coverage through Medicaid and CHIP starting January 1, 2024.

CMS sent a letter to all 50 states, Washington, DC, and US territories detailing guidance on implementing the requirement.

“Children should always have access to healthcare services. No exceptions. Thanks to the actions taken by the Biden-Harris Administration, states must provide all children with Medicaid and CHIP continuous coverage for 12 months,” HHS Secretary Xavier Becerra said in the press release. “This important action will ensure children have access to the preventative and primary care they need to be healthy and thrive. We will continue to support children and their families, whenever and however it is needed.”

Currently, states have the option to provide 12 months of continuous coverage for kids under 19 in Medicaid and CHIP. Within these state plan options, states can set a younger age limit or a shorter continuous eligibility period.

A child’s eligibility cannot end during a continuous eligibility period unless they reach age 19 or a lower age set by the state, they request a voluntary termination, they are no longer a resident of the state, the agency determines eligibility was granted improperly due to errors or fraud, or the child is deceased.

Under Section 5112 of the Consolidated Appropriations Act, the requirement was amended to require 12 months of continuous coverage in all states, with exceptions for children who reach age 19 or cease to be state residents.

Starting January 1, 2024, states with continuous eligibility periods of less than 12 months must extend the period to a full year.

States can also request section 1115 demonstration authority under the Social Security Act to extend continuous coverage for children beyond 12 months and implement continuous coverage policies for adult Medicaid beneficiaries.

Ensuring children receive 12 months of continuous health insurance coverage can help promote access to preventive and primary care, the CMS announcement said. According to data from the Commonwealth Fund, children who are disenrolled for all or part of the year are more likely to have fair or poor health status compared to those with continuous coverage throughout the year.

Additionally, continuous coverage for children has been associated with reduced financial barriers to care for low-income families and improved health equity. Continuous coverage policies can also enable providers to develop more consistent relationships with patients and help families avoid emergency room visits, the press release indicated.

Expanding continuous coverage eligibility to adults can also come with benefits, such as lower uninsurance, cost savings, and better health outcomes, research found.