CCF and its founders have long raised the opportunity to provide multi-year continuous eligibility for young children in Medicaid and CHIP, and have tracked its progress since Oregon and Washington first proposed the policy for children from birth to kindergarten in 2022. (See our latest map and resources to track state progress for children.)

Our CCF colleagues, with KFF, started to track multi-year continuous eligibility (referred to in this blog as “0-6”) in their annual survey of Medicaid agencies last year. This year’s survey, Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies During the Unwinding of Continuous Enrollment and Beyond, details more forward momentum in multi-year continuous eligibility. June’s survey release reaffirmed the 12 states and D.C. moving to adopt multi-year continuous eligibility for young children, including additional multi-year periods for school-aged children as detailed in Table 1 of the survey below.

The growing number of states taking up 0-6 and other continuous eligibility provisions is encouraging for proponents of healthy kids and efficient care. The policy was even highlighted in a recent Washington Post column by Catherine Rampell touting the many child-friendly policies passed in Minnesota under Governor Tim Walz (“Make America Minnesota Already”). States have come out of the unwinding looking for solutions to keep kids covered. Now that all states have implemented the new 12-month continuous eligibility requirement for all children in Medicaid, 0-6 continuous eligibility is a logical next step, ensuring stable coverage in the years before kindergarten when recommended well-child visits, screenings and immunizations are more frequent and could catch possible delays or conditions. The 0-6 period, in particular, is critical for early development and school readiness, ultimately setting children up for the best chances at success. Leveraging policy options like multi-year continuous eligibility to lessen the likelihood of coverage lapses due to procedural and administrative burdens is a strong and common-sense way to support young children during their most rapid period of brain development.

With more and more states looking into multi-year continuous eligibility, State Health and Value Strategies released a new multi-year continuous eligibility toolkit for state leaders by Manatt Health. The toolkit provides federal policy context and outlines populations and policy choices for multi-year continuous eligibility, highlighting state efforts not only on 0-6 continuous eligibility but also for older children and foster care youth. It’s a must read for any state staff, advocates, or others interested in continuous eligibility for young children.

State Implementation Choices will Impact the Success of this Policy

Of course, if unwinding has shown us anything, it’s that policies are not always implemented well, or even correctly. And how can states ensure uninterrupted coverage translates to improved access to quality health care? So far three states have approved section 1115 waivers and are beginning to or have implemented 0-6 continuous eligibility: Oregon, New Mexico, and Washington. Here are some questions we will be exploring as states move forward:

• How will the state conduct outreach and educate families to ensure they are aware of the new policy and can take full advantage of uninterrupted access to care? Who is knowledgeable and responsible at every point of interaction with Medicaid: enrollment, plan selection, well-child visits?
• What will the state track to measure success? Reduced churn on and off coverage, improved access to well child visits, screenings and any needed preventive care (i.e. successful referrals to early intervention based on developmental screenings?)
• With most children served by managed care arrangements, many MCOs stand to benefit financially through additional months of per-member-per-month (PMPM) payment for up to five years straight. What more will the state require of MCOs?? What are their specific outreach and education responsibilities (including those under EPSDT), reporting requirements, and results?

With new state Child Core Set reporting requirements starting this year, renewed federal attention on state EPSDT implementation, and strengthened managed care rules, state implementation and evaluation of multi-year continuous eligibility should be considered carefully from start to finish. Birth-to-kindergarten continuous eligibility holds great potential to help every young child get the care they need, when they need it, well before kindergarten. But the policy’s ultimate success will require sustained state agency leadership and oversight.