Yesterday, CMS approved a set of another five state 1115 waiver demonstration applications to adopt multi-year continuous eligibility for children in Medicaid. Four states (Hawaii, Minnesota, New York and Pennsylvania) were approved to adopt continuous eligibility for children in Medicaid from birth to age 6; Colorado was approved to implement for children up to age 3. Hawaii was also approved to extend 24-month continuous eligibility to children ages 6 to 19, as in Oregon. Some of these states also extended 12-months of continuous eligibility to adults, who do not have the same 12-month continuous coverage requirement that children now enjoy in every state: Minnesota will extend implement 12 months of continuous eligibility for adults ages 19 to 21 and Colorado and Pennsylvania will do the same for adults 19 to 65 transition from incarcerated settings.
This new policy, in various stages of consideration in a dozen states, offers state policymakers a positive solution to Medicaid enrollment challenges exposed by the unwinding, which will have the effect offsetting coverage losses seen during unwinding in the past year-plus. Unwinding continuous coverage protections exposed our fear that Medicaid enrollees, especially children, continue to be vulnerable to the long-standing administrative barriers in place in Medicaid and CHIP eligibility and enrollment systems. Most children who have lost coverage were disenrolled for administrative reasons, not because of a determination that they were ineligible. This is not new– we’ve long known that most uninsured children are eligible but not enrolled for Medicaid or CHIP. These states follow the path of Oregon, Washington, and New Mexico Medicaid programs, which were already approved to keep young children covered without interruption until kindergarten so they can access the care they need to show up to school ready to learn.
Our colleagues at the Urban Institute just put out a helpful piece to aid states in implementation of the new policy: Multiyear Continuous Eligibility in Medicaid and CHIP: Five Keys to Maximizing Positive Benefits for Children and their Families.
But following the results of last week’s election, the looming question remains: What will a second Trump Administration mean for more states moving forward on multi-year continuous eligibility?? Will CMS continue to approve additional multi-year continuous eligibility waivers? Would CMS move to rescind existing approvals and prevent states from implementing multi-year continuous eligibility (or continuing to provide multi-year continuous eligibility)? It’s wholly unclear at this point. But we do know that any steps to roll back multi-year continuous eligibility would result in fewer eligible young children enrolled and more children who are uninsured and going without needed care. Research shows that Medicaid in childhood, especially for the youngest children, produces long-term benefits including better health and financial health in adulthood and greater educational attainment.
But what else could get in states’ way? The bigger and more important question today, unfortunately, is what does the incoming Administration and Congress mean for Medicaid overall? Unfortunately, we already have some sense of where things are likely to go. My colleague Edwin Park previewed what a possible Trump Administration and new leadership in Congress could mean, now said aloud by Senator Cornyn. Draconian Medicaid cuts and radical financing changes, either through block grants or per capita caps, are at the top of their list. We’ve seen these proposals many times before, but only need to look back to 2017 as Medicaid cuts were tied in with the failed ACA repeal bills. We wrote then about the harms for children and families: Jeopardizing the guarantee of coverage and benefits (including EPSDT) and adding state budgetary pressure to other critical child and family programs.
Apropos to recent history we know all too well, these proposals would put families and states at further risk during financial downturns, weaken states’ abilities to respond to public health crises, and tie states’ hands when health care costs go up.
Despite the plan for the incoming administration and Congress, Americans, and specifically voters, value Medicaid. CCF’s Joan Alker and Mike Perry of Perry Undem recently highlighted results of voter focus groups on Medicaid. Medicaid remains popular, especially when we remind our leaders who it covers and its core importance. They write:
At a time when the high cost of living is a key concern for many voters, Medicaid’s role is more important than ever. Medicaid has always been a popular program with the American public but it has never been more popular. There is ideological opposition to Medicaid among some politicians, but the American public has never been conflicted about Medicaid.
Medicaid provides health insurance to millions of children, pregnant women, people with disabilities, parents, seniors and many other Americans. While states can (and we hope will!) continue to make important progress for children and families, like 0-6 continuous eligibility, the federal Medicaid proposals we are likely to see next year would threaten the overall program. Now is the time to remind our friends, communities and other stakeholders of Medicaid’s broad reach and value and what could be at risk, and why policymakers should reject deep, damaging cuts to Medicaid.
