CMS implores states to keep children on Medicaid and CHIP

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In a letter to state health officials late last week, the U.S. Department of Health and Human Services, through the Centers for Medicare and Medicaid Services, reiterated that states must provide 12 months of continuous coverage for children under the age of 19 on Medicaid and the Children's Health Insurance Program (CHIP), beginning January 1, 2024.

The administration said it's committed to ensuring eligible children enrolled in Medicaid and CHIP have uninterrupted coverage over the course of a year. 

"Children should always have access to healthcare services," said HHS Secretary Xavier Becerra. "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."

WHAT'S THE IMPACT?

According to HHS, ensuring 12 months of uninterrupted health coverage for children promotes access to appropriate preventive and primary care, necessary treatment for healthcare needs that may arise, and continuity of care.

Research published in Medical Care Research and Review shows that children who are disenrolled for all or part of the year are more likely to have only fair or poor health status compared to children who have health coverage continuously throughout the year.

A separate analysis from the Commonwealth Fund found that continuous coverage for children has been shown to reduce financial barriers to care for low-income families, promote health equity and provide states with better tools to hold health plans accountable for quality care and improved health outcomes.

Stable coverage also enables healthcare professionals to develop relationships with children and their parents, track a child's health and development, and help a family avoid expensive emergency room visits, HHS said, adding that when families maintain coverage year-round, it reduces the administrative burden on state agencies due to repeated eligibility reviews and reenrollment after a gap in coverage.

The letter provides background on the importance of continuous coverage in preventing interruptions that can impede access, and describes policies related to implementing continuous coverage for children as required by the Consolidated Appropriations Act of 2023. The letter also reminds states that they may request section 1115 demonstration authority under the Social Security Act to extend the continuous coverage period for children beyond 12 months, and to adopt continuous coverage for adults eligible for Medicaid.

THE LARGER TREND

CMS proposed new standards and requirements for Medicaid or CHIP services, including ones for in-home and community-based services, in April. Among other standards, the proposed rule would establish national maximum standards for certain appointment wait times for Medicaid or CHIP managed care enrollees and require disclosure of provider payment rates in both fee-for-service and managed care.

Last week, the agency said half a million children and families will regain their Medicaid and CHIP coverage that was lost due to improper disenrollment. At least 7.1 million Medicaid enrollees had been disenrolled as of September 20, based on data from 48 states and the District of Columbia, according to KFF's Enrollment and Unwinding Tracker.

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com