States Move Toward Multi-Year Continuous Eligibility for Children in Medicaid

Children need consistent access to health care, especially in their early years when frequent screenings, vaccinations, and well child checkups are so critical to their development and school readiness. And despite efforts to streamline and simplify eligibility processes and improve retention, many children covered by Medicaid (as well as other sources of health insurance) experience gaps in their coverage, often due to administrative barriers. While about half of the states provide 12-month continuous coverage to children in Medicaid, children can still lose coverage at renewal due to family income fluctuations, confusion over renewal requirements, lost mail, and other difficulties in retaining coverage.

The idea of multi-year continuous eligibility isn’t new. In fact, CCF prepared a report for the United Hospital Fund more than a decade ago calling for a state option to provide continuous coverage from birth to age 5. We are now beginning to see traction on this policy priority in a handful of states.


Just this week, the California House and Senate earmarked $1.8 million annually to provide continuous eligibility to children up to age 5. If signed by the Governor, it would make California the first state in the nation to take definitive steps toward multi-year continuous eligibility for young children.


In late April 2021, in its budget bill (Senate Bill 5092, page 189), Washington State lawmakers directed the Washington Health Care Authority to assess the feasibility and fiscal impacts of a Section 1115 Medicaid waiver to extend continuous eligibility for children ages 0 through 5 in Apple Health (Medicaid) as a component of school readiness. Prior to submitting the waiver application, the authority must provide a status update to the governor and legislative fiscal committees no later than September 30, 2021.


The Oregon Health Authority (OHA) released a series of draft concept papers of high-level policy areas under consideration for inclusion in the state’s 2022-2027 1115 Medicaid Demonstration Waiver. In one of four policy papers, which flow from feedback OHA received from stakeholders and the public, the state has proposed 5-year continuous eligibility for children and adolescents. If the state follows through on this prospective policy and receives CMS approval, it would provide multi-year continuous coverage to all children.


Similarly, in Massachusetts, multi-year continuous eligibility would apply to all children if stakeholder recommendations are adopted as the state renews its MassHealth Section 1115 waiver. Last year, the Massachusetts Chapter of the American Academy of Pediatrics supported a multi-sector Child and Adolescent Health Initiative to review how the state’s upcoming waiver renewal can be used to strengthen Medicaid coverage for kids. The initiative’s recommendations include providing all children under age 21 three years of continuous eligibility.

Continuous health insurance coverage produces a broad array of benefits to individuals, states, health plans and providers. It drives more efficient health care spending, improves health status and well-being, mitigates the negative impacts of income volatility, promotes health equity, reduces administrative burden and costs, enhances quality measurement, and strengthens managed care accountability.

In the coming weeks, we’ll be publishing an updated brief on the importance and benefits of continuous eligibility for Medicaid enrollees. It will include recommendations for state options through state plan amendments and/or Section 1115 waivers to expand opportunities to promote continuity of coverage for children, pregnant women, and adults.