Covid-19 Exposed Many Inequities for Latino Families, Adopting Continuous Eligibility Would Repair Cracks and Protect More Latino Kids from Losing Medicaid/CHIP

COVID-19 underscores the need for universal access to health care and exposes the coverage inequities in our system today. Latino children are more likely to be uninsured than their non-Latino peers, and this coverage gap widened in recent years.

A new report from CCF and UnidosUS shows that because Latino children are more likely to be covered by Medicaid and CHIP, adopting Medicaid/CHIP policies that remove barriers to participation would narrow inequities in health coverage and access. The report highlights one proven strategy in particular – 12-month continuous coverage.

Under 12-month continuous eligibility, a child is guaranteed a full year of coverage (even if income fluctuates) unless the child requests disenrollment, reaches adulthood, or moves out of state. This policy has proven effective in reducing the rate of churn – when beneficiaries lose coverage and re-enroll within a year. Recent research on churn found that Black and Latino beneficiaries are more likely to experience churn compared to non-Hispanic White beneficiaries, creating harmful gaps in coverage. Looking specifically at children, about 10% of all children experience a gap in coverage at some point during the year or are uninsured for the whole year, compared to 14% of Latino children and just over 7% of non-Hispanic White children.

Continuous eligibility policies prevent this from happening by guaranteeing a full year of coverage, helping children access the care they need year-round. Additionally, research shows that continuous eligibility policies are cost-effective: the average monthly per child cost decreases when the coverage period is longer. Maintaining coverage year-round also reduces the administrative burden of repeated eligibility reviews and re-enrollment after a gap in coverage.

Unfortunately, after a flurry of state activity adopting 12-month continuous eligibility for children following the CHIP Reauthorization Act of 2009, recently there’s been little progress. As of 2021, 24 states have adopted continuous coverage for children in Medicaid, plus 26 of 35 separate CHIP programs have done so. Only two states have adopted 12-month continuous eligibility for adults (current law does not allow for a straightforward state plan amendment for adults, states must apply for a section 1115 demonstration project). In the remaining states, children frequently lose coverage between annual renewals, causing harmful gaps in access to care that make it hard for children to receive preventive care such as well-child visits and vaccinations and treatment for chronic conditions, such as asthma, without exposing the family to major financial burdens.

Given the many benefits of continuous coverage, the CCF-UnidosUS report makes two key policy recommendations: continuous eligibility for all children in Medicaid/CHIP and an easier pathway to continuous eligibility for adults in Medicaid. This would help reduce unmet need for specialty care, lead to more preventive care visits, and eliminate unnecessary paperwork barriers. But perhaps most importantly, continuous coverage would advance health equity by promoting continuity of treatment for low-income children who experience disproportionate rates of health disparities.

Read the full report.

Kelly Whitener is an Associate Professor of the Practice at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.