During the COVID-19 public health emergency (PHE), states implemented numerous Medicaid and Children’s Health Insurance Program (CHIP) policies and operational processes that helped to maintain coverage and support access to needed physical and behavioral health services for children and adolescents. The continuous enrollment requirement ended on March 31, 2023, and many states have begun to process pending renewals. The unwinding of the federal continuous coverage enrollment (from this point forward referred to as “unwinding”) requires states to redetermine Medicaid eligibility for more than 90 million beneficiaries, which will result in a high risk of eligible individuals losing Medicaid or CHIP coverage due to administrative or procedural reasons.
The PHE’s conclusion and subsequent loss of flexible access and coverage policies is particularly important when considering the scale of Medicaid—covering 42 percent of all births and over 40 million children nationwide—and the disproportionate coverage of children of color, with more than one in two Hispanic or Latino/a children, American Indian or Alaska Native, Black, other, or multi-racial children enrolled in Medicaid. In addition, the racial and ethnic disparities that exist among children enrolled in Medicaid and CHIP have been further exacerbated by decades of systemic discrimination and the COVID-19 pandemic, with Black and Brown children more likely—compared to white children—to experience higher rates of infant mortality, mental health emergency department visits, substance use, asthma and obesity.
As state Medicaid and CHIP agencies prepare for the end of the PHE, there is an opportunity to make permanent and build upon the temporary policies that were adopted during the PHE in order to improve continuity of coverage and access to health care services. The Lucile Packard Foundation for Children’s Health and Manatt Health partnered to publish a three-part series focused on improving access to Medicaid, CHIP and Marketplace coverage and care at the end of the PHE. These three articles focus on:
- The importance of continuity of coverage for all children and how other states have leveraged State Plan Amendments and/or 1115 demonstrations to implement continuous enrollment policies;
- How working with community-based organizations (CBOs) and individuals with lived experience can help support continuity of coverage, including how states can partner and engage with CBOs now to support Medicaid/CHIP enrollees post-PHE; and
- How to permanently expand state policies to maintain access to Medicaid-covered pediatric telehealth services after the PHE concludes.