Year: 2025
Type: article
Abstract: Medicaid provides health insurance for nearly 4 in 10 children in the United States, but this coverage can be unstable as a result of annual eligibility redetermination requirements.After the continuous Medicaid coverage mandate during the COVID-19 pandemic ended in March 2023, states were required for the first time to publicly report standardized metrics on terminations and renewals resulting from eligibility redeterminations.Our understanding of redeterminations and their contribution to coverage gaps had been constrained by data limitations, but states' reporting practices offered researchers and policymakers key insights into these processes and associated coverage outcomes.This article canvasses some of those insights and suggests how federal reporting requirements could be amended to offer actionable insights into redetermination processes.Background on Medicaid Continuous Coverage Medicaid is a critical source of health insurance for children in the United States, covering nearly 4 in 10 (38.8%) in 2023, second only to employer-based insurance (48.7%). 1 However, coverage through Medicaid and the Children's Health Insurance Program (CHIP) can be disrupted from year to year by annual requirements to ascertain, or to "redetermine," ongoing eligibility for the program.Where enrollees can't have their eligibility automatically renewed based on data states can access (eg, state wage databases), they need to provide information to the state substantiating their eligibility.During the COVID-19 pandemic, as part of a federal law intended to strengthen the safety net, states suspended these redeterminations pursuant to a requirement to keep Medicaid enrollees-children and adults alike-continuously covered until the end of the public health emergency, and they received additional federal funds to do so. 2 With the termination of the continuous enrollment provision effective March 31, 2023, as part of the Consolidated Appropriations Act (CAA) of 2023, 3 early that year states began to roll back Medicaid and CHIP continuous coverage.During the "unwinding" of continuous coverage and resumption of eligibility redeterminations (which typically occur on an annual basis), states were obligated under the act to report metrics on terminations and renewals resulting from Medicaid eligibility redeterminations-the first time that reporting and publishing of such outcomes in any standardized way has been required.3
Source: The AMA Journal of Ethic
Authors: Gabriella Aboulafia, Adrianna McIntyre
Institution: Harvard University
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W4413880164