Before the new year slips from memory, I wanted to take stock of a few good things happening for kids covered by Medicaid and CHIP this year. Amidst all the dismal news about how nearly 4 million children have lost their coverage during the unwinding – many remain eligible but lost coverage due to red tape and administrative barriers – there are positive policy changes to love in 2024.
12-Month and Multi-Year Continuous Eligibility for Children
At the top of our list of 2024 policy changes to love is 12-month continuous eligibility for all children in Medicaid and CHIP. No longer does the peace of mind that your child is covered for a full year depend on where you live or whether your kids are covered in Medicaid or CHIP. No longer will a temporary loss of income or an unexpected expense (like a major car repair) result in disenrollment for nonpayment of premium. Once a child is enrolled, they remain eligible unless they move out of state or request voluntary disenrollment.
What we love even more is that a dozen states are now in various phases of seeking approval and implementing multi-year continuous eligibility with Oregon and Washington state leading the way. Most multi-year initiatives focus on young children (0-6 or 0-3) during the formative years of development; however, Illinois is also seeking 2-year continuous eligibility for all children, while Oregon will provide 2-year continuous eligibility to children and youth ages 6-18.
Phasing In Coverage for all Former Foster Youth to Age 26
One of the most popular provisions of the Affordable Care Act (ACA) – allowing young adults to stay on their parent’s health plan until age 26 – would neglect a vulnerable group were it not for another ACA provision extending Medicaid to former foster youth. Unlike other young adults, youth transitioning out of the foster care system do not have families to fall back on. The ACA protects these youth by allowing them to retain Medicaid until age 26, a pivotal time as they transition to adulthood and independence.
Like other aspects of the ACA’s expansion of coverage, the former foster youth group became effective on January 1, 2014. While the intent of the law is clear and the provision seems straightforward, the way the law was constructed has posed certain implementation barriers. In the 2018 SUPPORT Act, Congress made a technical correction to fix the statutory language, but the fix phases in by age and the issue will not be completely resolved until 2030. However, states have the option to seek Section 1115 waiver authority to align coverage for all former foster youth regardless of the state in which they were in foster care when they aged out. Accelerating alignment of eligibility for all former foster youth provides critical access to services as these youth, who often have higher health care needs than their peers, become young adults. What really warms our heart is that a quarter of states already cover all former foster youth as Minnesota has proposed in a recent amendment to its 1115 waiver.
Mandatory Reporting of All Quality Measures in the Child Core Set
At CCF, we love data and there are few things to love more about Medicaid than transparency and accountability. 2024 marks the first year states will be required to report the full set of all of the Child Core Set of Health Care Quality Measures, as well as the Behavioral Health Measures in the Adult Core Set and all of the measures in the Health Home Core Set. In the proposed mandatory reporting rules, CMS suggested that the Secretary had discretion to determine a subset of core measures that would be mandatory. However, in the final regulations, CMS agreed with CCF and other stakeholders that, by statute, all states are subject to mandatory reporting of all core measures. In December, CMS also released additional guidance on mandatory reporting of the core sets. This reporting and transparency requirement will allow fair comparisons of states and will hopefully lead to improved performance.
While voluntary reporting on child core measures has improved over time with at least 45 states reporting 15 measures of the 25 core measures in 2022. However, only two measures that are calculated by CMS on behalf of states – live births weighing less than 2,500 grams and low risk cesarean delivery – are reported for all states. Look for publication of mandatory core measures in the fall of 2025, after states report on the 2024 core set based generally on calendar year 2023 utilization data by December 31, 2024.
As we celebrate these policy gains, we are excited to see how Medicaid continues to improve child health in 2024 as states work to improve access to care, advance school-based health services, and address the social needs of families that are so critical to overall health and wellbeing.
[Editor’s Note – State reporting on child core set measures can be found on CCF’s state data hub here.]
