Analysis: Oregon is guaranteeing kids won’t get kicked off Medicaid until at least age 6

Oregon is testing out a new concept in Medicaid: keep children continuously enrolled in the safety net program until they turn 6 years old.

The first-of-its-kind idea, to be piloted over five years, is designed to stop children from getting kicked off their health coverage during years crucial to their development. Federal health officials signed off last week on the program, which more states could emulate in the coming months.

“We have near universal health insurance coverage for senior citizens in this country,” said Bruce Lesley, the president of the First Focus on Children, an advocacy group. “Where we really would like to get with kids is that the public programs should basically assume coverage unless someone says, ‘No, I have private coverage.’ ”

Oregon’s pilot program comes at a critical moment for safety net coverage. Millions of children are at risk of losing their Medicaid coverage when the public health emergency for the coronavirus ends. Such a notion is already fueling a push in Congress to include policies in a year-end deal that would further maintain coverage for kids.

The details

The idea of continuous enrollment for kids isn’t new – it’s one advocates and some Democrats have been pushing for years. Over half of states have a requirement that kids can’t be kicked off their coverage for 12 months, even if a family’s income changes.

The point is to avoid a temporary loss of health coverage, known as churn. It occurs frequently in Medicaid and the Children’s Health Insurance Program, and is essentially when people cycle on and off the programs in a short period of time, and can happen when a person’s income fluctuates, for instance.

Roughly 11.2% of children with full benefits are disenrolled and then subsequently re-enrolled within one year, according to the Kaiser Family Foundation.

Now, Oregon is pioneering a new approach. The state will soon allow children to remain on Medicaid until their sixth birthday. After that, children 6 years old and older, as well as adults, can stay enrolled for two years at a time, regardless of changes in their finances or other family circumstances.

Will other states follow suit? Joan Alker, the executive director of Georgetown’s Center for Children and Families, said she’s “cautiously optimistic,” and some states have already begun to propose such policies.

• Washington state asked the federal Medicaid agency this summer for permission to cover children with Medicaid for the first six years of their lives.
• New Mexico has drafted an application that would also provide continuous Medicaid enrollment up to age 6.
• California lawmakers asked state officials to seek sign-off from the federal government to continuously cover children with Medi-Cal until they turn 5.

Challenges loom

Amid the coronavirus pandemic, Congress offered states a deal. They could get enhanced funding for their Medicaid programs from the federal government if they pledged not to remove anyone from the program’s rolls until the public health emergency ended.

States are already bracing for the complex process of determining who is still eligible for the programs when the public health emergency is over. Children and young adults are expected to be disproportionately impacted, with the Department of Health and Human Services predicting that 5.3 million could lose their Medicaid or CHIP coverage.

That’s already spurring advocates to push Congress to pass policies to keep kids covered in a year-end spending deal. A requirement that children can’t lose their coverage for a continuous 12 months was originally included in Democrats’ sweeping social spending bill but was ultimately left on the cutting room floor when the legislation was narrowed. And such a policy is a top priority for key party leaders, such as House Energy and Commerce Chair Rep. Frank Pallone Jr., D-N.J.

“We’re hoping that people recognize that when the public health emergency ends, there’s going to be a lot of kids kicked off,” Lesley said. “Having 12-month continuous (coverage) would really help – not completely eliminate that – but it would help mitigate the loss of coverage for lots of kids.”