Significant loss of Medicaid and Children’s Health Insurance Program (CHIP) coverage is often due to inefficient paperwork, overly burdensome reporting requirements, or temporary fluctuations in income. Five states already offer continuous eligibility for 12 months to all or some adults, and other states are implementing policies to ensure that eligible enrollees retain their coverage.
Now, a group of nearly 190 organizations representing health care consumers, payers, and providers has sent a joint letter to Congressional and committee leaders urging them to support continued 12-month eligibility for adults enrolled in Medicaid and CHIP.
The joint letter urges Congress to enact the Medicaid and CHIP Coverage Stabilization Act, H.R. 5434 and S. 3138.
Medicaid and CHIP provide critical health coverage to more than 80 million Americans, including children, pregnant women, people with disabilities, seniors, and low-income adults. Millions of enrollees lose this safety net coverage within a year (even though they often remain eligible) and re-enroll within months.
There is ample evidence of the benefits of continued eligibility in Medicaid and CHIP, including improved health outcomes, lower avoidable administrative costs and relief for providers from having to double-check that their patients maintain coverage, the organizations say.
“The staggering disenrollment rate during the Medicaid rollback only increases the urgency to implement strong state policies to keep people covered. Communities of color are especially vulnerable to being caught in the cracks of coverage,” Anthony Wright, incoming executive director of Families USA, said in a statement. “Coverage gaps can be the difference between life and death, as people caught in the gap have poorer access to treatments, delay necessary care, and end up in the emergency department more often. Congress must pass the Medicaid and CHIP Coverage Stabilization Act and work to ensure more equitable access to stable, continued coverage for our nation’s adults.”
“We are grateful for Congress’s work in passing nationwide 12-month continuous eligibility for all children in Medicaid and CHIP through the Consolidated Appropriations Act of 2023,” Jennifer McGuigan Babcock, senior vice president of Medicaid policy at the Association of Community Affiliated Plans (ACAP), said in a statement. “We are now calling for this protection to be extended to adults. No one should fear losing their access to comprehensive health care due to lack of documentation or fluctuations in income due to working a few extra hours in a given month or taking on an extra shift.”
ACAP represents 82 health plans, which collectively provide health coverage to more than 25 million people.
An example of a state-level initiative is Massachusetts, which will offer 12 months of continuous eligibility for adults and 24 months of continuous eligibility for homeless members age 65 and older. MassHealth has the authority to extend 12 months of continuous eligibility to all adults age 19 and older. Continuous eligibility for children under age 19 began in January 2024, so this amendment extends 12 months of continuous eligibility to all MassHealth members. Continuous eligibility means that members will retain coverage during the designated period even if they experience changes in their circumstances that would otherwise affect eligibility. MassHealth will also extend 24 months of continuous eligibility for homeless members age 65 and older.
Through a new benefits program called the Oregon Health Plan (OHP) Bridge, an estimated 100,000 people will eventually qualify for free health coverage.
Before the COVID-19 pandemic, many adults in Oregon with incomes just above traditional Medicaid limits were uninsured. Additionally, about 34% of members who lost benefits returned to Medicaid within a year due to fluctuating income. OHP Bridge is designed to help people keep their coverage and their same doctors despite short-term fluctuations in income.
