Beginning January 1, 2024, Pennsylvania’s Medicaid and CHIP eligibility for children under age nineteen will change from “point-in-time” to continuous for twelve months at a time.
Under a new federal requirement, children found eligible for Medicaid or the Children’s Health Insurance Program (CHIP) must receive coverage for a full twelve months (“continuous eligibility”) without interruption, unless the child ages out, moves out of state, or meets another specified exception to the general rule. Pennsylvania currently provides continuous eligibility for pregnant women and children until age four.
Under current policy, which looks at eligibility on a point-in-time basis, a change in a child’s circumstances, such as fluctuation in a parent’s income, can result in a child being disenrolled from Medicaid at any time throughout the year. Under the new continuous eligibility framework, a change in circumstances, absent narrow exceptions, will not result in the child losing Medicaid. Instead, the child’s Medicaid or CHIP coverage would be maintained until their next annual renewal occurs. Regular renewals for Medicaid and CHIP can occur at any time of year; they are not tied to the calendar year. (Remember, Medicaid renewals began again on April 1, 2023, following the end of COVID-era protections that kept most people on Medicaid without needing to renew their coverage.)
Continuous eligibility has been shown to reduce coverage gaps and rates of “churn”, wherein a child loses health insurance coverage and then regains it within a year. Studies have shown that this kind of inconsistent Medicaid coverage leads to children accessing less preventive care and having more emergency room visits. The initiative also aims to improve health outcomes by keeping more kids covered longer. Research shows that fewer disruptions in insurance coverage allow children to access critical preventative health services and necessary treatments that support their healthy development. Ensuring continuous coverage for at least twelve months helps children maintain access to the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Medicaid benefit, which provides comprehensive health care services for children under age 21 who are enrolled in Medicaid, including appropriate preventive, dental, mental health, developmental, and specialty services.
The move to continuous coverage for twelve months at a time should also reduce the administrative burden on state agencies, such as the Department of Human Services (DHS), which is tasked with reviewing and determining eligibility for Medicaid applicants and enrollees.
For more information about the new continuous eligibility rule beginning January 1, see this recent guidance from the Centers for Medicare & Medicaid Services (CMS).