Today the Biden Administration announced the final federal regulation “Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes” which, among other things, eliminates outdated red tape barriers to coverage for children insured through the Children’s Health Insurance Program (CHIP) that have been in place since its inception in 1997. It is high time to get rid of these policies that place additional burdens on families earning about $36,000 to $66,000 per year (for a family of three) in separate state CHIP programs.
I am so pleased to see that CHIP waiting periods – a forced period of uninsurance that doesn’t exist elsewhere in our insurance system – are finally gone. Goodbye and good riddance. Along with the elimination of “lockouts” for nonpayment of premiums and protection from annual and lifetime dollar limits, this federal regulation ensures that children in working families don’t face more onerous and unfair rules than everyone else. All children deserve a healthy childhood and the opportunity to reach their full potential. This regulation will make a meaningful contribution to achieving that goal by putting an end to this barrier to health coverage for children in low- and moderate-income families.
More than ten years ago, on the eve of the implementation of the Affordable Care Act, CCF and other child health leaders urged then-Secretary Sebelius to eliminate CHIP waiting periods. At the time we wrote, “This policy should be a relic of the past in a world where all Americans, especially children, are expected to have timely access to uninterrupted health care.” Many states have removed this barrier to coverage but 13 states still have waiting periods in place.
Lockouts for non-payment of premiums are another unique and punitive policy facing children in 12 states that force children to be uninsured for a period of time if a family misses a premium payment. Lockouts penalize children when their families experience a financial setback like a major car repair that causes them to miss a premium payment. The new federal regulation will work in concert with the new 12 months continuous eligibility guarantee for all children covered by Medicaid and CHIP to create meaningful change so that children don’t experience pernicious gaps in coverage. (We’ve explained the new premium rules related to continuous eligibility here.)
Finally, while Medicaid has never permitted lifetime or annual limits, the Affordable Care Act eliminated lifetime limits and annual limits for just about everyone else and now this protection will extend to separate CHIP programs. While no states currently impose aggregate lifetime or annual dollar limits in separate state CHIP programs (though some did so in the past), the Department of Health and Human Services reports that a number of states place lifetime or annual dollar limits on specific CHIP benefits – especially dental care.
Many families are facing gaps in coverage today due to the Medicaid unwinding. Gaps force children to go without needed care including prescriptions and timely well-child visits, and expose families to large medical bills. Today’s action by the Biden Administration is a critical step towards building a future where all children have health coverage and access to the care they need.
