CMS is instructing states to ensure uninterrupted 12-month coverage for children in Medicaid and CHIP, as mandated by the Consolidated Appropriations Act of 2023. This directive, effective from January 1, 2024, aims to enhance access to primary care. States with shorter eligibility periods must extend them, and they have the option to expand continuous coverage to adult Medicaid beneficiaries. This move is expected to promote better healthcare outcomes, reduce financial barriers, and strengthen patient-provider relationships.
The Centers for Medicare & Medicaid Services (CMS) has issued a directive to state health officials, emphasizing the need to ensure uninterrupted coverage for children in Medicaid and the Children’s Health Insurance Program (CHIP). This directive comes in light of recent changes made by the Consolidated Appropriations Act of 2023, which amended the Social Security Act to mandate that states provide a continuous 12-month eligibility period for children under 19 receiving Medicaid and CHIP benefits, effective January 1, 2024.
CMS has communicated this requirement to all 50 states, Washington, DC, and US territories, providing them with guidance on its implementation. Health and Human Services (HHS) Secretary Xavier Becerra underscored the importance of this measure, stating that all children should have unfettered access to healthcare services. This action aims to guarantee that children can avail themselves of essential preventive and primary care, promoting their well-being. HHS remains committed to supporting children and their families in their healthcare needs.
Previously, states had the discretion to offer 12 months of continuous coverage for children under 19 in Medicaid and CHIP. However, they could set shorter periods or apply age restrictions within their state plans. The new requirement stipulates that a child’s eligibility cannot be terminated during this 12-month period unless they reach age 19, request voluntary termination, cease to be a state resident, are deemed ineligible due to errors or fraud, or pass away.
Effective January 1, 2024, states with eligibility periods shorter than 12 months must extend them to the full year. States also have the option to seek section 1115 demonstration authority under the Social Security Act to extend continuous coverage beyond 12 months for children and implement similar policies for adult Medicaid beneficiaries.
Ensuring that children maintain 12 months of uninterrupted health insurance coverage has several benefits, including improved access to preventive and primary care. Data from the Commonwealth Fund suggests that children who experience interruptions in coverage are more likely to have fair or poor health status compared to those with continuous coverage throughout the year. Additionally, continuous coverage for children can reduce financial barriers to care for low-income families, enhance health equity, facilitate stronger patient-provider relationships, and reduce reliance on emergency room visits.
Extending the concept of continuous coverage to adults can also yield positive outcomes, including reduced rates of uninsurance, cost savings, and improved overall health results, as supported by research findings.
