States Embracing Multi-year Medicaid Eligibility for Children: Racial Equity and Anti-Poverty Policy in Action

By Suzanne Wikle

4 min read.

Many states across the country are embracing multi-year continuous coverage for young children insured by Medicaid. This is an important policy for supporting the health and well-being of children. But less attention has been paid to the positive impact this policy has on coverage for kids of color, in particular, and how the policy reduces administrative burdens for people experiencing poverty.

Multi-year continuous coverage means that once children are enrolled in Medicaid, they remain eligible, regardless of changes in their families’ income, until the end of their eligibility period. For example, several states have asked the Centers for Medicare and Medicaid Services (CMS) for permission to provide multi-year continuous eligibility for children through age six. This means that when children younger than six are enrolled in Medicaid, they will remain eligible until their sixth birthday. After they turn six, their family would need to complete the renewal process to determine if the child is still eligible and may stay enrolled. For babies enrolled in Medicaid shortly after their birth, this policy means they would have the assurance of affordable health insurance for the first six years of their life, without interruption.

Continuous Coverage and Racial Equity
Providing multiple years of continuous eligibility eliminates a lot of administrative burdens, such as navigating bureaucratic paperwork and waiting to hear if additional information needs to be submitted, for up to six years. We know that administrative burdens exacerbate inequity and directly lead to procedural disenrollments, so any reduction in these burdens is a step in the right direction.

More than two-thirds of children enrolled in Medicaid are Black, Hispanic, Asian American, American Indian or Alaska Native, or multiracial. Between that and the fact that administrative burdens are more likely to lead to coverage loss among people of color, it’s imperative that states take steps to minimize the administrative burden for eligible people to remain on Medicaid. Multi-year continuous coverage is a positive step forward.

As pandemic-era protections that kept people continuously enrolled in Medicaid have ended over the past year, we have a better sense of the impact of administrative burden. States resumed Medicaid renewals about a year ago and more than 4.5 million children have lost Medicaid coverage. But that doesn’t mean those children aren’t still eligible for Medicaid. There are two reasons someone may lose coverage: they are found ineligible for Medicaid or they are disenrolled for procedural reasons, meaning their paperwork was not completed and an assessment of ongoing eligibility was not made.

While we don’t have data that tell us the number of child-specific procedural disenrollments, we do know that 70 percent of total disenrollments across the country have been for procedural reasons. We also know that applications are increasing in many states, suggesting that people who were procedurally disenrolled are re-applying and likely still eligible.

Louisiana provides one snapshot of data because it is publishing unwinding and churn data by age. Children in the state accounted for 32 percent of closed cases and nearly 50 percent of people who “churned” back onto Medicaid. Multi-year continuous eligibility policies will help reduce this cycle of procedural disenrollments and churning back onto Medicaid. It’s a smart move for children and for the state.

Multi-year Eligibility Aids Anti-Poverty Work

Nearly half of all children insured by Medicaid are in families living below the poverty line. More than 60 percent of families earn less than 138 percent of the federal poverty level. These rates are higher for all minority groups. Multi-year continuous eligibility policies are important for anti-poverty policy work for two reasons.

First, these policies significantly reduce administrative burden, which in turn eliminates a small part of the mental load of poverty. When families are struggling to make ends meet, put food on the table, or pay rent, it’s easy to miss an envelope with the paperwork for Medicaid renewals. Taking that off the “to-do” list allows families to focus on other pressing needs.

Second, families will not have to decide between a better-paying job and losing Medicaid for their young children. Continuous eligibility means that children remain eligible even if their family begins to earn more money, which may put them over the eligibility criteria. This allows families to prioritize their income for other expenses that come with young children, such as child care.

Looking Ahead

We expect to see more approvals from CMS for states asking to implement multi-year continuous eligibility and more states looking to adopt this promising policy. For the more than 30 million kids insured by Medicaid, this is a concrete action states can carry out to ensure young children are more likely to receive all their developmental check-ups, while also taking positive steps to decrease inequities and help families.

NOTE: A previous version of this blog post incorrectly characterized the percentage of Medicaid disenrollments due to procedural reasons as consisting only of children. The percentage includes both children and adults, and the post was corrected on April 8, 2024, to reflect this information.