HHS Takes Action to Provide 12 Months of Mandatory Continuous Coverage for Children on Medicaid and CHIP

Letter sent to state health authorities in all 50 states, DC and US territories

Today, as part of its ongoing work to ensure that all Americans have access to health care coverage, the U.S. Department of Health and Human Services, through the Centers for Medicare and Medicaid Services (CMS), sent a letter to authorities state health agencies reinforcing that states must provide 12 months of continuous coverage for children under age 19 in Medicaid and the Children’s Health Insurance Program (CHIP) beginning January 1, 2024. The Biden-Harris administration is committed to using every lever available to protect and expand coverage for children. Today’s action will help ensure that eligible children enrolled in Medicaid and CHIP have uninterrupted coverage throughout a year, helping children maintain access to the health services they need to thrive.

“Children should always have access to health care. No exceptions. Thanks to actions taken by the Biden-Harris administration, states must provide all children with continued Medicaid and CHIP coverage for 12 months,” said HHS Secretary, Xavier Becerra. We will ensure that children have access to the preventative and primary care they need to be healthy and thrive. We will continue to support children and their families, whenever and however necessary.

CMS continues to work to increase access to health services for children to reduce disparities and build a reliable health safety net for all young people, said CMS Administrator Chiquita Brooks-LaSure. Families of children enrolled in Medicaid and CHIP will have peace of mind knowing that their children will have uninterrupted access to health care coverage for a year, regardless of any changes in their family’s financial circumstances.

Ensuring 12 months of uninterrupted health coverage for children promotes access to adequate preventive and primary care, necessary treatment for health care needs that may arise, and continuity of care. Research has shown that children who are not enrolled all or part of the year are more likely to have only fair or poor health status compared to children who have health coverage continuously throughout the year.¹

Continuous coverage for children has been shown to reduce financial barriers to care for low-income families, promote health equity, and provide states with better tools to hold health plans accountable for quality care and better health outcomes.^two Stable coverage also allows healthcare professionals to develop relationships with children and their parents, track the child’s health and development, and help families avoid expensive emergency room visits. Additionally, when families maintain coverage year-round, the administrative burden on state agencies due to repeated eligibility reviews and re-enrollment after a gap in coverage is reduced.

Today’s letter provides information about the importance of continuous coverage in preventing interruptions that impede access to health coverage to support better short- and long-term health outcomes, and outlines policies related to implementing continuous coverage for children, as per required by the Consolidated Appropriations Act of 2023 The letter also reminds states that they may request section 1115 demonstration authority under the Social Security Act to extend the period of continuous coverage for children beyond 12 months and adopt continuous coverage for eligible adults for Medicaid.

For more information and to read the letter to state health officials, visit https://www.medicaid.gov/sites/default/files/2023-09/sho23004.pdf

Final notes

¹ Brantley, E. and Ku, L. (2022). Continued Medicaid eligibility associated with better child health outcomes.Medical Care Research and Review,79(3), 404-413.

^two Park, E., Alker, J., and Corcoran, A. (2020). Putting a Sound Investment at Risk: Why Short-Term Cuts to Medicaid Coverage During Pregnancy and Childhood Could Result in Long-Term Harm. Retrieved from: https://www.commonwealthfund.org/publications/issue-briefs/2020/dec/short-term-cuts-medicaid-long-term damages