2024 Survey of Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies Shows Gains in Child and Maternal Health Coverage

Highlights of the 2024 Survey of Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies, conducted by KFF and Georgetown CCF, were presented in a webinar today featuring federal and state officials from North Carolina and Ohio. This marks the 22nd annual report on state policies for eligibility, enrollment, and renewal processes, which this year includes lessons learned during the unwinding of the Medicaid continuous enrollment requirement as many states come to the end of the process.

The survey highlights state experiences during the unwinding of the pandemic-era Medicaid continuous enrollment requirement after a three-year pause on disenrollments. Despite the demands of the unwinding, 13 states expanded income eligibility or immigrant coverage for children and pregnancy in the past year, as shown in this table. Two states – North Carolina and South Dakota – also implemented Medicaid expansion for adults.

Nine of the 30 states charging premiums or enrollment fees for children when we last collected the data in 2020 have eliminated premiums permanently. Premiums continue to be suspended temporarily or indefinitely suspend in four additional states. After Congress enacted legislation requiring states to provide 12-months continuous eligibility to children, CMS issued guidance indicating that exceptions to 12-month continuous eligibility, such as moving out of state or requesting voluntary disenrollment, do not include disenrollment for nonpayment. This may be impacting state decisions regarding premiums, as noted by Arizona officials in this KFF Health News article. The report shows that 8 states continue to apply lockout periods that prevent children from re-enrolling for up to 90 days following disenrollment for nonpayment; a punitive policy that states will need to eliminate by June 2025.

A focus of this year’s survey was to gather insights on states’ experience during the unwinding. More than half of the states indicated that workforce challenges had a significant or moderate impact on their ability to manage the workload. States were asked about changes to the renewal process that they plan to keep after the unwinding period ends, which include improved ex parte processes, increased outreach to enrollees, engagement of managed care and community partners, enhanced online functionality, revised renewal notices, and extended renewal response times.

States also want to keep some of the flexibilities allowed under section 1902(e)(14) waivers during the unwinding. At the top of their list, states wanted to continue to accept updated contact information from the USPS or the National Change of Address Database and managed care organizations, which are in place with the Eligibility and Enrollment rules that took effect June 3, 2024. They are also hopeful that flexibilities to allow ex parte renewals based on SNAP/TANF eligibility or for individuals with $0 income or income under 100% FPL can be adopted as state options going forward.

When asked about their successes during the unwinding, states cited improved outreach and enrollee communication and enhanced stakeholder engagement. On the flip side, challenges included changing/unclear federal guidance, workforce shortages, workload volume and system limitations.

The report includes 26 tables with 50-state data and is a rich source of eligibility, enrollment, and renewal policies in effect. You can find it here.