A new study by researchers at George Washington University found that children who are guaranteed continuous Medicaid eligibility are less likely to experience gaps in insurance coverage, but it's unclear if they had better health outcomes.
Twenty-four states offered 12-month continuous eligibility for children in Medicaid, which helps ensure that kids don't lose coverage because of income changes and paperwork burdens, during the study period of 2016 to 2018. Researchers compared health measures for children under 18 in those states to those among children in states that don't offer continuous eligibility.
The working paper was commissioned by the Association for Community Affiliated Plans, a trade group representing 77 safety-net insurance plans that called on Congress to maintain 12-month continuous eligibility requirements after the COVID-19 public health emergency ends.
Congress' second COVID-19 relief package, the Families First Coronavirus Response Act, increased states' federal Medicaid matching funds during the COVID public health emergency, on the condition that states would not terminate enrollees' Medicaid coverage through the end of the public health emergency unless an individual voluntarily terminates coverage, moves out of state or dies.
"Continuous Medicaid eligibility would close some of the gaps in our insurance system and assure better access to care for a longer period," ACAP CEO Margaret Murray said in a statement. "Given that so many people have avoided the doctor's office in the midst of the pandemic, the real need may not come until after the pandemic subsides."
The study found that 7.8% of kids in states with continuous eligibility were currently uninsured, compared with 11.7% of kids in states without continuous eligibility. Of those in states with the policy, 11% were uninsured all of part of a past year, compared with 15.9% in states without the policy. And while 1.5% of kids in states with continuous eligibility experienced a gap in coverage due to application problems, 3% experienced such issues in states without the policy.
The study also pointed out "marginally significant" findings, which did not meet the criteria for statistical significance. It found that 4.2% of kids in states with continuous eligibility reported an unmet need for healthcare, while 5.6% in states without that protection had an unmet need. Researchers wrote that the continuous eligibility policy may lower the number of children without a preventive care visit by about one-tenth and increase the likelihood of having seen a specialist in the past year by one-eighth.
Having continuous eligibility was not significantly associated with a child's reported health status, percentage of emergency department visits, unmet needs for specialty care, or missed school days. The findings were based on data for about 17,600 children with family incomes below 138% of the federal poverty level from the National Survey on Children's Health for 2016 to 2018.
Researchers concluded that more generous Medicaid eligibility policies could increase low-income children's access to care. Experts expect Medicaid enrollment to grow this year as a result of COVID-19 and the associated economic downturn. According to an analysis published last week by Georgetown University's Center for Children and Families, Medicaid enrollment has grown 5.8% across 15 states over the past three months. Child enrollment has grown 5.5% across nine states that have reported data. Data are limited to the states that have publicly reported Medicaid enrollment; federal data for all states won't be available until July, according to the analysis.
The current public health emergency declaration expires in July, but the HHS secretary can renew it in 90-day increments. House Democrats' opening bid for the next phase of COVID-19 relief legislation would increase the federal matching rate and extend it through at least June 30, 2021.