North Carolina and Hawaii Make 10: States Advancing Medicaid/CHIP Multi-Year Continuous Eligibility for Young Children

It’s hard to keep up with the rapid progress in the number of states seeking federal approval to adopt multi-year continuous coverage for children covered by Medicaid and the Children’s Health Insurance Program (CHIP). Since we last took stock, North Carolina and Hawaii have proposed 1115 waivers to adopt continuous eligibility for children from birth to kindergarten and two-years for children ages 6 and up.

As regular Say Ahhh! readers know, late last year Congress required all states to adopt 12-month continuous eligibility (CE) for all children in Medicaid and CHIP starting in January 2024 as part of the law initiating this year’s unwinding. Now 10 states are working to go further for children, with a concentration on young children in the earliest stages of development. When the 12-month CE requirement was signed into law, only Oregon had secured federal CMS approval for continuous eligibility for young children up to age 6. CMS then approved Washington’s request in April with New Mexico’s waiver application still pending and California working toward a legislatively-required waiver proposal to adopt the measure. Since that time 6 new states have joined the effort adding up to a total of 10 states that have formally adopted or are in the process of seeking approval (see map below).

This policy offers a proactive state opportunity to protect children from losing coverage due to procedural, not eligibility, reasons. The Medicaid continuous coverage unwinding has brought the need for such a policy change into much sharper focus as millions of children are falling through the cracks.

State leaders have championed continuous coverage for young children, in part, as a tool to support school readiness by minimizing coverage gaps in the early developmental period before kindergarten. Not surprisingly, early childhood leaders and advocates have been leading the chorus of voices calling for this policy change alongside child health leaders.

Will more states seek this change in waiver proposals or legislative sessions ahead? Will more states seek this change in waiver proposals or legislative sessions ahead? With a growing body of evidence documenting the long-term benefits of CE and momentum building for this cost-effective policy following the approval of the Oregon waiver last year, we’re bullish.

Elisabeth Wright Burak is a Senior Fellow at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.