Continuous Eligibility Policies And CHIP Structure Affected Children's Coverage Loss During Medicaid Unwinding

Area of Science:

• Health Policy
• Public Health
• Healthcare Access

Background:

• The Families First Coronavirus Response Act (FFCRA) provided continuous enrollment in Medicaid.
• The unwinding of FFCRA provisions in April 2023 allowed states to resume Medicaid eligibility redeterminations.
• Millions of beneficiaries, particularly children, faced potential loss of health coverage.

Purpose of the Study:

• To examine changes in children's Medicaid and Children's Health Insurance Program (CHIP) coverage during the Medicaid unwinding period.
• To analyze how state policies, such as continuous eligibility and CHIP program structure, influenced coverage continuity for children.

Main Methods:

• Utilized Centers for Medicare and Medicaid Services monthly state enrollment data from January 2021 to December 2023.
• Analyzed enrollment changes for children in 49 states and Washington, D.C.
• Compared coverage trends based on states' prior 12-month continuous eligibility policies and CHIP program structures (separate, Medicaid expansion, or combination).

Main Results:

• Substantially lower Medicaid and CHIP enrollment among children was observed during the unwinding period compared to the FFCRA continuous enrollment period.
• Children in states with prior 12-month continuous eligibility policies experienced smaller coverage declines.
• States with separate CHIP or Medicaid expansion CHIP programs demonstrated better coverage continuity for children compared to combination CHIP programs.

Conclusions:

• The unwinding of FFCRA continuous enrollment provisions significantly impacted children's Medicaid and CHIP enrollment.
• State-level policies, including continuous eligibility and specific CHIP program designs, play a crucial role in mitigating coverage losses for children.
• These findings underscore the importance of policy interventions to ensure sustained health coverage for children.