Congress Can Help Prevent Health Coverage Disruptions and Lock in Recent Gains

According to the most recent Census data, the uninsured rate has fallen to a record low. One major reason: Temporary prohibition on the termination of Medicaid coverage for most enrollees under a federally declared public emergency (PHE). But this “continuous coverage” requirement will phase out when the PHE ends, likely next year. When Congress begins to work on the end-of-the-year legislation, policies that protect or bolster health coverage, especially for low-income individuals, should be a top priority.

Medicaid’s continuous coverage provision has helped keep people, including millions of children, insured despite the economic and social disruption caused by the COVID-19 pandemic. Continuous coverage is a requirement. prevent the churn on and off Medicaid coverage that often happens as people’s income fluctuates, or if they can’t meet paperwork requirements that are often part of eligibility checks. Churn harms Medicaid enrollees, disrupting their access to medications and other needed care, and it’s also administratively burdensome for states, providers, and health plans. ResearchIt also shows that paper requirements and other requirements are not the only ones. administrative burdensPeople lose coverage often and are unable to reenroll with Medicaid or other programs for which they may be eligible.

Congress should take the lessons learned from the past two year and create policies to reduce coverage disruptions once the continuous coverage requirement is over. This could help to stem the tide of a crisis. widely anticipated coverage lossesSecure broad coverage for the future, giving people more access to life-saving financial protection and health care. To advance health equity, policies that help maintain record low levels of uninsured people are also important. The uninsured rate fell by a staggering 5% to a record lowIn 2021, Black people will make up a majority of the population. These gains should be maintained by policymakers.

These policies should be included in year-end legislation by Congress to reduce coverage disruptions and loss and to lock in coverage gains.

  • Increase coverage for postpartum to 12 months The American Rescue Plan recognized the importance of uninterrupted coverage after childbirth and gave states the option to extend postpartum coverage for 12 more months instead of the 60 required by law. To date, 33 states and the District of ColumbiaSeveral people have either taken up the option or announced plans to do so. The American Rescue Plan coverage option is only available until March 2027.

    To help reduce the maternal and infant mortality crisisCongress should make it a permanent law to increase mandatory pregnancy coverage from 60 to one year after the birth. Doing so could eliminate the risk of coverage disruptions in all states, but it’s particularly important in the 12 states that have not expanded Medicaid, as postpartum people with very low incomes often lose Medicaid coverage 60 days after giving birth in non-expansion states. This could be addressed by requiring full-year coverage for all postpartum women in all states. maternal health equityBlack women are especially vulnerable to postpartum coverage. somewhat likelierWhite people are more likely to experience life-threatening complications during the late postpartum period (between six and one year after childbirth) that those who are not white.

  • Continuous eligibility is required for children. Even before the PHE continuous coverage requirement, states had the option to provide “continuous eligibility” to children, meaning that children remain eligible for Medicaid (or the Children’s Health Insurance Program, or CHIP) for a 12-month period regardless of changes in their family’s income. Some of these options were available as of January 2022. 32 states(including D.C.), provided twelve-month continuous eligibility for children aged under 19 in Medicaid or CHIP.

    Continuous coverage for children increases access to preventive care and decreases the proportion of children without coverage or with unmet medical need. research shows. It also reduces the administrative burden and administrative cost for states. It is a great tool for reducing administrative burden and administrative costs for states. evidence Congress should force all states to provide continuous eligibility for children. This is a strong argument. It would be very beneficial. help advance health equityBy ensuring continuity of coverage for children of low-income families, who are at disproportionate risk of suffering from health disparities,

  • In order to ensure continuous eligibility for adults, you should at least offer a state plan option. Continuous 12-month eligibility can help prevent coverage losses among adults, too, and could further help children since adult enrollment is positively correlated with children’s enrollment. At a minimum, Congress should permit — if not require — states to provide 12 months continuous eligibility to adults without seeking federal approval through a Section 1115 demonstration, or waiver. As of earlier in the year four statesTo authorize continuous eligibility for adults, the Section 1115 demonstration programs had been used. Last week, two more states — Massachusetts and Oregon — received approval to provide continuous eligibility to some or all adults (along with groundbreakingContinuous eligibility for children up to age 5 in Oregon. Even if Congress doesn’t require it, more states would adopt this important policy if Congress gives states a permanent state plan option to adopt continuous coverage for adults.
  • Additional funding should be provided for Puerto Rico and other U.S. territories Territories. Without Congress taking action this year, Puerto Rico’s more than 1,000,000 residents who rely upon Medicaid for their healthcare could be without. face deep cuts to eligibility, benefits, and already low provider payments. Puerto Rico has the same uninsured rate as the United States. droppedBetween 2019 and 2021, the rate dropped from 7.8 percent down to 5.7 percent. This drop may be partially due to the increased Medicaid funding and the continuous coverage requirement. Given the unique funding challenges in the territories, providing Puerto Rico and other territories with the funding they need to avoid cutting eligibility is critical to maintaining coverage; that’s particularly true for Puerto Rico to help prevent people from losing coverage as residents recover from the destruction and dislocation caused by Hurricane Fiona.

Congress can help to maintain recent gains in health coverage by passing policies such as postpartum coverage, continuous eligible and funding for Puerto Rico. As policymakers negotiate the year-end spending bill, they should also consider other policies — such as a permanent reauthorization of CHIP and inclusion of the proposed Medicaid Reentry Act — that also could help people with low incomes gain, retain, or access the coverage they need.