At Georgetown CCF we have been thinking about a day when no child in the United States is uninsured since our inception 19 years ago. Substantial progress has been made over the past two decades with some ups and downs along the way. However, as the recent Medicaid unwinding made abundantly clear, this day will not come until the many kinks in Medicaid and CHIP enrollment and retention policies become a thing of the past. These red tape glitches often affect children who remain eligible.

A few weeks ago the Keep Kids Covered Act was introduced by Representative Kathy Castor (D-FL) and Rep. Caraveo (D-CO), a pediatrician, to require that all states cover children enrolled in Medicaid and CHIP continuously birth to age 6 with renewals every two years after that. This is not a complicated idea, and state leaders in a dozen states have already moved down this path with most focusing on protecting preschool-aged children from losing coverage. One challenge children face is that their access to uninterrupted coverage depends on where they live. Medicaid and CHIP are run by governors with varying degrees of commitment to their health and well-being with flexibility on how children enroll. In contrast, Medicare, which ensures that 99% of seniors have coverage is run directly by the federal government. There is no confusion about the Medicare rules – once you are 65 everyone knows it’s time to sign up for Medicare.

At Georgetown CCF we have been thinking about this idea for most of our 20-year history. Our founding director Cindy Mann first wrote about this idea in 2009. This proposal would build on the 12 months of continuous eligibility protection for all children that took effect in January 2024.

Specifically, the Keep Kids Covered Act would require states to implement:

• Continuous eligibility for all children from birth to age 6, including deemed newborns. Any child under the age of 6 who enrolled in Medicaid or CHIP will stay enrolled until age 6, regardless of any changes in family circumstances.
• Twenty-four months of continuous eligibility for children ages 6 to 19.

Well before the pandemic, the child health policy community knew that more than half of uninsured children nationally were eligible but unenrolled in Medicaid or CHIP. During the public health emergency, children were protected from losing coverage due to red-tape but when states began the unwinding process, many children fell through the cracks – particularly in states that did not prioritize child health coverage. Gaps in coverage expose families to large medical bills – when children fall on the playground or break a bone on the soccer field. And common, chronic conditions like asthma worsen when families can not order expensive prescription drugs like inhalers and children show up in the emergency room.

Children need consistent access to health care, especially in their early years when frequent screenings, vaccinations, and well child checkups are so critical to their development and school readiness. And despite efforts to streamline and simplify eligibility processes and improve retention, many children covered by Medicaid and the Children’s Health Insurance Program (CHIP) experience gaps in coverage due to administrative burden. Our long-standing concern about eligible children losing coverage during renewal was exacerbated during the unwinding of the Medicaid continuous coverage provision over the past year or so when our worst fears about eligible children falling through the cracks became a reality for far too many families.

Stable coverage allows children to access needed well-child visits, which are more frequent in the months and years following a birth to closely track progress toward developmental milestones. These check-ups are key to identifying any delays or conditions that may need to be addressed as early as possible through additional services such as early intervention, home visiting, or family therapy. Impaired vision or hearing, social emotional conditions like autism or ADHD, or early family stressors, can create major barriers to school readiness if they are left unaddressed. Of course, the peace of mind and added economic security that uninterrupted coverage can give to parents also play a major role in families’ overall health and success.

But the benefits of strong and stable coverage extend well beyond kindergarten. Medicaid coverage in pregnancy and childhood is associated with better health, educational and earnings outcomes in adulthood. The Congressional Budget Office has estimated the significant long-term fiscal benefits of each additional year of Medicaid for children because they have higher earnings and greater labor productivity as adults.

This new bill elevates the conversation about how best to keep children covered following the historic unwinding– especially for children at the earliest stages of development. It offers a common-sense, research-backed policy change that can help to move the United States down the path to a day no child will be uninsured.

For more on the Keep Kids Covered Act, see this fact sheet, and news articles here and here.