Innovation in Medicaid: Multiyear Continuous Eligibility for Young Children

Session Submission Type: Roundtable

Abstract

Millions of eligible children disenroll from Medicaid and the Children’s Health Insurance Program (CHIP) due to system glitches or administrative hurdles each year only to soon reenroll, leading to discontinuities in care. Several states are implementing an innovative policy, multiyear continuous eligibility (CE), through waivers, aiming to reduce young children’s coverage gaps by providing uninterrupted Medicaid/CHIP coverage for children from birth through their third, fifth, or sixth birthday regardless of changes in family income. CE implementation began in July 2023 in Oregon and Washington and January 2024 in New Mexico, and additional waivers were approved by the Centers for Medicare & Medicaid Services in late 2024 in Colorado, Hawaii, Minnesota, New York, North Carolina, and Pennsylvania. These waivers build on the new federal requirement for one-year continuous eligibility for children up to age 19.  

Continuous Medicaid/CHIP eligibility is expected to improve continuity of health insurance coverage and care at a critical stage in child development when children require frequent preventive screenings and vaccinations. Other potential benefits include reductions in parents’ stress, worry, and financial burdens; increases in kindergarten readiness; and ultimately improvements in the longer-term health and wellbeing of children and their families. Since Medicaid and CHIP are important coverage sources for children of color, children in rural areas, and children with special health care needs, CE policies could also reduce disparities in access to care and health outcomes. States adopting CE policies could also benefit from reduced administrative burden and more efficient health care spending in the long run. CE may be especially important in maintaining children’s coverage if contractions in federal Medicaid funding result in reductions in parents’ Medicaid eligibility and coverage. 

Drawing on insights from Medicaid officials in two states with CE and an expert on pediatric health care quality, this panel will discuss factors that motivated decisions to adopt the policy, how specific design and implementation choices are expected to shape impacts, insights from early implementation, and challenges with measuring impacts of the policy. It will provide practitioner and researcher perspectives about effects on child and family wellbeing as well as strategies states that are yet to implement could take to achieve successful implementation and impacts. 

Jennifer Haley, MA, (Principal Research Associate, Urban Institute, Health Policy Division) will serve as the panel’s Moderator and provide framing for the panel discussion drawing on ongoing studies of early experiences in implementing states, identifying steps for maximizing positive benefits of CE policies for children and their families and developing strategies for evaluating CE policy impacts. Emma Sandoe, PhD, MPH, (Medicaid Director, Oregon Health Authority) and Mich’l P. Needham (Chief Policy Officer and Director of Strategy, Policy and Innovation, Washington Health Care Authority) will discuss their states’ motivations for seeking CE waivers, insights on implementation of the policy and challenges they have faced, and early evidence of the policy’s impacts on coverage retention among young children. Colleen Reuland, MS, (Director, Oregon Pediatric Improvement Partnership) will discuss how to leverage CE for promoting heathy development of young children. 

Policy Area

• Health Policy

Secondary Policy Area

• Family and Child Policy

Moderator

• Jennifer Haley, Urban Institute

Organizer

• Jennifer Haley, Urban Institute

Speakers

• Emma Sandoe

• Mich’l Needham, WA St Health Care Authority