A policy dose of 1-2 would earn states a gold star in covering children

As CCF’s Medicaid enrollment tracking for children reached a shocking milestone this week, CMS released a net count of 3 million children as of March 2023 and released a package of documents advising and encouraging states to do more to ensure children don’t slip through the cracks as the pandemic unfolds. – related continuous registration requirement. Given that the researchers estimated that most children would still be eligible for Medicaid or CHIP, one might expect that a smaller number of children would lose coverage. But this is not the case!

However, when you look beyond the national numbers reported by CMS, you find that half of the children who lost coverage live in five states: Texas, Florida, Georgia, Ohio and Arkansas. In fact, Texas accounts for as much as 24 percent of child enrollments based on September 2023 data, according to the secretary’s letter. HHS sent letters to the governors of those states, as well as the smaller states with high child coverage in Idaho, Montana, New Hampshire and South Dakota, noting that the agency takes its oversight role very seriously and will not hesitate to take action to ensure state compliance with federal Medicaid requirements.

In addition to alerting the nine states, CMS issued a bulletin that strengthened federal reform and reporting requirements and highlighted operational strategies that all states can adopt to promote continued coverage for children and youth who are likely to remain eligible for Medicaid or CHIP. The instructions recommend the following:

  • Provide targeted assistance to children and young people with special health care needs;
  • Supports seamless transitions between programs;
  • Increase ex parte renewal rates;
  • Collaborate with managed care plans to increase outreach and renewal;
  • Eliminate or suspend premiums or enrollment fees and remove lock-out periods after non-payment;
  • Delay or suspend removal proceedings;
  • Enhance outreach to families and strengthen partnerships with family-serving agencies and community-based organizations.

But what really caught my eye was CMS encouraging states to take advantage of children’s multi-year continuous eligibility. through Section 1115 protest authorities, as Oregon, Washington and New Mexico have done, and eight other states are quickly following suit. In fact, we propose a 1-2 punch to help states deal with the ongoing operational challenges of relaxing and protecting children at the same time.

Hit 1 would take advantage of the available paragraph (e)(14) exception to advance children’s renewal dates by a year, as provided by CMS, notify when ex parte the housekeeping error was revealed in August. Kentucky and North Carolina were the first states to adopt this option. With children making up 46 percent of all Medicaid enrollees in March 2023, delaying renewal for children would give overburdened systems and eligible workers breathing room to focus on renewing coverage for adults, vulnerable seniors and the disabled.

Hit 2 would introduce multi-year continuous eligibility for children, especially young children in those crucial early years, to protect them from inappropriate coverage terminations, which are particularly acute at renewal, even if they are still eligible. When multi-year continuity comes into effect, children are protected until they reach the upper age limit. For example, Oregon, Washington and New Mexico cover children continuously until their sixth birthday, while Oregon also covers older children for two years instead of the 12-month continuous eligibility that applies to all Medicaid children starting in 2024.

North Carolina is in line to be the first state to utilize the 1-2 punch. As noted above, the state has already received permission to move up renewal dates for 12-month-old children. And in its pending § 1115 authorization application with CMS, the state proposes to implement multi-year continuous eligibility for children under 6 later in 2024.

As we close out 2023, governors and state leaders should think about the negative consequences of children losing the health insurance they need to thrive. The long-term benefits of childhood Medicaid coverage are well documented, including better health, higher education, higher earnings, and less disability later in life. Covering young children from birth to school is particularly important when trying to address developmental delays that can hinder school performance and increase special education costs. Every child should have the opportunity to succeed and governors can earn a gold star (not to mention winning the favor of the electorate) on enhancing the protection of children’s health care. The country has made tremendous progress in reducing the number of uninsured children over the past two decades. Today, governors face a pivotal moment when state choices will either lead to more uninsured children or states will move to a new normal where children can get care without their parents tripping over red tape.

Editors note: There is a lag in CMS reporting of state-level data, which explains the differences in CCF enrollment tracking, which shows a decline of 3 million children compared to CMS’ reported decline of 2.2 million children by September 2023. CCF tracking includes more current status reported enrollment data.

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Image Source : ccf.georgetown.edu

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