On Sunday, the Administrator of the federal Centers for Medicare and Medicaid Services (CMS), Dr. Mehmet Oz, appeared on Face the Nation. He was pressed repeatedly on Medicaid cuts by Host Margaret Brennan and responded by emphasizing the need for Medicaid to protect young children, paraphrasing the late Senator Hubert Humphrey in noting that any noble society must.
Dr. OZ: “So I’m trying to save this beautiful program, this noble effort, to help folks giving them a hand up. And as you probably gather, if Medicaid isn’t able to take care of the people for whom it was designed, the young children, the dawn of their life, those are the twilight of their life, the seniors and those who are disabled living in the shadows, as Hubert Humphrey said, then we’re not satisfying the fundamental obligation of a moral government. And this President has said over and over that he believes that it is the wise thing and the noble thing to help those who are vulnerable and every great society does that, we’re going to as well.”
Actions speak louder than words. On July 17th, the federal Centers for Medicare and Medicaid Services (CMS), now run by Dr. Oz, took unilateral action to block states from implementing a groundbreaking new policy designed to do just that – invest in young children and ensure that babies and toddlers have the access to care they need to grow and thrive – and offer peace of mind to their parents about the high costs of medical care during these expensive years of raising children.
Specifically, CMS sent a letter to states on the future (or lack thereof) of continuous eligibility Section 1115 Medicaid demonstrations. In short, the agency will not approve or renew any 1115 demonstrations with more than 12 months of continuous eligibility. The vast majority of these demonstrations are focused on young children so that they do not experience gaps in coverage during this crucial period of development and growth between 0-6.
The end of the first paragraph of the letter reads “This shift in approach reflects the agency’s commitment to preserving these vital programs for the most vulnerable Americans and being good stewards of taxpayer dollars.” Who does Dr. Oz consider “vulnerable Americans” if not babies and toddlers in working families? By cutting off these promising demonstration projects before allowing enough time to determine whether or not they provide a “return on investment” and “protect the most vulnerable” does not live up the moral or fiscal tests articulated by Dr. Oz. It also contradicts the long-touted conservative goal of allowing states to be the laboratories of innovation.
Regular Say Ahhh! readers will recall that eight states have been approved for children to have continuous coverage from birth to age 3 (CO) or age 6 (HI, OR, MN, NC, NM, NY, PA). Oregon, Washington and New Mexico, approved in 2022 and 2023, are well underway. The six remaining states were approved late last year. Ohio closed its state comment period on an 1115 application for children birth to age 4 last spring. in June, Governor DeWine (R-OH), a proponent for many policies to promote children’s health, used his line-item veto to avoid its repeal in Ohio’s budget bill.
The policy has been championed in both red and blue states as an opportunity to boost health and school readiness and is/was under consideration in numerous states. The Tennessee Commission on Children and Youth recommended the policy in its budget recommendations two years ago. Lawmakers in Alaska and Montana debated bills to adopt the policy just this past year, with a bipartisan group passing the measure out of the Montana House. Georgia’s legislatively mandated Comprehensive Health Coverage Commission recommended pursuing 0-6 CE in its report last December.
Regular readers of this blog know that we have been highlighting the benefits of this policy for fifteen years. Decades of experience has shown that states are far more likely to drop eligible children from Medicaid or CHIP rather than keep ineligible children enrolled. Zero-to-six continuous eligibility is a common-sense policy to mitigate coverage losses for the youngest children– at a time when they need regular care. The American Academy of Pediatrics Bright Futures periodicity schedule recommends 15 well-child visits between birth and age 6. These check-ups are more frequent in the earliest months and years of life to check milestones during children’s most rapid period of development. Parents have the peace of mind knowing that as they leave the hospital with their newborn that their baby will be covered until kindergarten. With continuous coverage in place for young children, parents, pediatricians and state officials can spend limited time and energy focused on ensuring that each baby and toddler gets the support and care they need to grow and thrive.
This policy would keep kids covered in their early years even as parents or other family members navigate red tape barriers. Continuous coverage for young children is pro-work — when a parent adds a shift at work one month, a child won’t lose out on coverage due to a small income boost or seasonal fluctuations in income. We already know offering Medicaid coverage to pregnant women and young children impacts their long-term health, educational and economic success well into adulthood and shows returns on investment. The Congressional Budget Office explains the long-term return on investment of children’s Medicaid well.
Where does this Trump/Oz reversal leave states? States with approved demonstration, it appears (the letter could be clearer on this point), can keep the policy standing until their respective 1115 demonstration periods expire—if they even get them off the ground. Pennsylvania officials announced in March the state would postpone implementation of the 0-6 continuous eligibility and other pieces of the demonstration as budget pressures loomed. The CMS change also means Colorado will be forced to halt its planned January 2026 start date even as a new study highlighted the economic and health benefits to the state’s infants and toddlers of continuous coverage. New York’s governor just released new data highlighting that 750,000 babies, toddlers, and preschoolers will be impacted when its current demonstration expires in March 2027.
So, when it comes to Dr. Oz and the Trump Administration, watch what they do – not what they say. An Administration that is committed to protecting the most vulnerable and achieving a strong return on investment would not unravel policies designed to protect the health and well-being of our youngest children.