Earlier this month, we released an analysis of uninsurance trends that found that young children were becoming uninsured at a faster rate than their school-aged peers. The trend is alarming and predates the massive declines we are seeing in child Medicaid enrollment since President Trump took office and before H.R. 1 Medicaid cuts and policy changes hit.
How can we protect the youngest children from erroneously losing coverage during a tumultuous period, you may ask? Young children are more likely to live in poverty compared to older children, making them, in turn, more likely to rely on Medicaid for health insurance. Huge damage has been inflicted by the Trump Administration’s anti-immigrant agenda that will be hard to undo; our colleagues will have more to say in the future on what to do to address the loss of coverage of citizen children in mixed-status immigrant families.
A key goal should also be reducing red tape – and ensuring that government is working for families rather than forcing young families to struggle to keep their babies covered. Coming out of unwinding of the pandemic era continuous coverage protection, more and more states sought to keep children connected to health coverage with multi-year continuous eligibility policies. By early 2025, nine states had secured federal approval to implement continuous eligibility for young children birth to ages 3 or 6 through Section 1115 demonstrations, with others, like Ohio, poised to submit proposals.
Last July, the Trump Administration shut the door on this promising approach that protected young children from losing health coverage during a critical time of life. CMS sent a letter to state Medicaid agencies announcing that new approvals or renewals of this innovative strategy would be halted immediately. The letter explained the rationale behind the radical shift this way: “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.”
Hmmm. We thought babies and toddlers were among the most vulnerable Americans, but I guess we will just have to agree to disagree on what constitutes “most vulnerable”.
Federal waiver authority that allowed implementation of 0-6 continuous eligibility will expire in New York and Oregon next year right as new work reporting requirements, which will affect many parents, will go into effect. It will expire in Washington in 2028 and in Hawaii, North Carolina and New Mexico in 2029.
If CMS officials had checked with child development experts, such as pediatricians, or budget experts, such as CBO, before making the rash decision to end multi-year continuous eligibility for children, they would have learned that this policy does protect the most vulnerable Americans, promotes healthy child development, reduces red tape, and is a smart investment that saves taxpayers money over the long term.
What Can States and Children’s Advocates Do to Protect Eligible, Young Children from Losing Coverage?
Children are guaranteed a full 12 months of continuous coverage in Medicaid and CHIP by federal law. Since states are under tremendous pressure to implement the largest changes and cuts in Medicaid’s history, it will take many voices to help sound the alarm that young children need the attention of overextended state officials to prevent them from falling through the cracks. State leaders should:
- Monitor and enforce the implementation of children’s 12 months of continuous coverage. Right now, this means taking steps to protect children from losing coverage during implementation of the work reporting requirement mandate by ensuring children’s eligibility redeterminations happen on their own cycle, separate from adults in the family that may be more frequent. States must do a better job of educating parents that most of them should be exempt from the new work rules.
- Conduct robust education and outreach focused on eligible children by providing tools and engaging trusted messengers across community-based organizations, health care providers, educators, PTAs, child care providers, faith leaders and others who can help families realize that children are likely to remain eligible for Medicaid or CHIP, even if others in their family are disenrolled, and how to keep their children connected to coverage.
- Document the implementation of innovative strategies to keep eligible children enrolled (such as multi-year continuous coverage in the seven states implementing the policy) to identify lessons learned and opportunities to extend it to other states. Examine whether the policy shielded young children from significant coverage losses during H.R.1 implementation.
No child living in the United States should be uninsured. Yet we are moving in the wrong direction, especially for babies, toddlers and preschoolers. Even as massive cuts and program changes threaten stable coverage for every Medicaid enrollee, leaders must double down on efforts to keep eligible children connected to uninterrupted coverage.