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Tuesday, August 20, 2013

States Should Implement or Expand Continuous Eligibility to Prevent Disruptions in Health Coverage for Kids

Sophia Kortchmar

Staff Writer

As states gear up for full implementation of the Affordable Care Act, more children than ever will be able to get health coverage through Medicaid, the Children’s Health Insurance Program (CHIP), or their states’ health insurance marketplaces. But many of these children are predicted to experience mid-year changes in eligibility (caused by shifts in household income), which could mean that they have to switch health insurance programs. When children move between health coverage programs or in and out of coverage multiple times a year—a process called “churning”—their health can suffer. States can address this problem by adopting or expanding 12-month continuous eligibility policies.

 Eligibility for Medicaid and CHIP is tied to family income, so a change in household earnings can trigger a change in eligibility. But income fluctuations throughout the year are common for many families, especially those with lower incomes, who are most likely to have children who qualify for Medicaid or CHIP. Twelve-month continuous eligibility policies allow states to waive the federal requirement for families to immediately act on reported income changes that would affect children’s eligibility for Medicaid or CHIP. These policies would allow children to keep coverage for a full year regardless of shifts in income.

 According to a recent study from the Government Accountability Office, nearly one in three children in states without continuous eligibility is expected to experience a change in household income that would affect eligibility for health coverage under full implementation of the Affordable Care Act.

 Switching health insurance programs causes gaps in coverage and care while applications are processed and while families figure out the coverage they have under new insurance plans and whether or not they can keep seeing the same health care provider. This disruption can have a negative effect on children’s health and states’ budgets. This is especially true when the income shift is temporary, and kids are moved out of—and then right back into—a public insurance program within a couple of months. When this happens, children have multiple disruptions in care, and states have the expense of closing and reopening cases, sometimes many times a year.

 Continuous eligibility policies are one important way states can proactively address this issue and help children maintain continuous health coverage. States are currently upgrading and changing eligibility and enrollment practices in preparation for full implementation of the health care law. That make this a good time to push your state to adopt these policies if it hasn’t already. States will also benefit from continuous eligibility policies because frequent transitions in and out of coverage are costly for states.

 Check the map below to see if your state has comprehensive continuous eligibility policies. If it doesn’t, urge your state to adopt full continuous eligibility. These policies are a big step toward ensuring that kids have access to high-quality health care at all times.

 For a more complete discussion of continuous eligibility and more arguments for why states should take it up, see Families USA’s new piece, Continuous Eligibility Can Prevent Disruptions in Health Coverage for Children