Americans should not have to choose between their jobs and their health. They shouldn't have to worry whether a few hours of overtime will keep them out of a safety net program intended to keep them healthy. And that goes double for the parents of children.
But a twisted set of bureaucratic rules actually punish parents for working harder by taking away health care for their children. Right now, Congress has the opportunity to fix that problem and create incentives and opportunities for working Americans.
Medicaid doesn't operate like other forms of health insurance. Every year, millions of people enroll in Medicaid and are removed because of complex enrollment rules, only to then turn around and reapply. This bureaucratic merry-go-round is called Medicaid churn, and it can happen for a multitude of reasons. Coverage can be interrupted by minor fluctuations in income, a move to another area, failure to submit periodic reports, or missing a renewal deadline by a day or two. If a parent works a few extra hours of overtime, their children can lose health coverage. If a parent gets paid irregularly because they work in the "gig economy," their children can lose health coverage.
Fixing Medicaid churn would have positive effects on both our public finances and our public health. Research shows that continuous eligibility policies are cost-effective and significantly improve the continuity of children's enrollment in Medicaid. Monthly per-person costs decrease over time; the longer the coverage, the greater the savings.
Under Medicaid, the average monthly cost for a child enrolled for 12 months was $107, compared to $163 for a child enrolled for only one month and $147 for a child enrolled for only six months. States with continuous eligibility policies have fewer administrative costs, because there is less need to repeatedly review eligibility, terminate children, and then re-enroll them, and increased preventive care, which in turn reduces expensive acute and emergency care.
Our state is fortunate. Thanks to Oregon's good decision-making, our state has provided 12 months of continuous eligibility for children for years and is considering expanding eligibility for up to five years as part of its proposed Medicaid 1115 waiver. With 42% of Oregon kids on Oregon Health Plan, the state is proposing this expansion because it has the potential to improve health outcomes for Oregonians for years to come.
The benefits of such a program have been clearly measured. Children living in our state and others with 12-month continuous eligibility are less likely to be uninsured and to have a gap in coverage in the previous year. Twenty-four states have adopted 12-month continuous eligibility for children in Medicaid, plus 26 of 35 separate CHIP programs. In the remaining states without such policies, children frequently lose coverage between annual renewals, for a variety of reasons.
A health care leader and steward of Medicaid funds, I can't stand by and see countless children lose coverage when there is such an easy fix.
Early in the COVID-19 pandemic, Congress passed the Families First Coronavirus Response Act, which requires all states receiving enhanced Medicaid funding to provide continuous Medicaid coverage to all enrollees. As a result, eligibility churn in Medicaid has been brought to a temporary halt, providing security to tens of millions of people.
One of the 117th Congress's first acts this year was to allow states to provide continuous Medicaid and CHIP coverage to all pregnant and postpartum individuals, under the American Rescue Plan Act.
But more needs to be done. If passed, the House budget reconciliation package would eliminate churn for kids by requiring 12 months of continuous eligibility for children on Medicaid and CHIP. This measure must be included in the final budget package that is send to President Biden.
The vote on budget reconciliation is the most consequential health care vote since the Affordable Care Act was saved by a single vote in the Senate in 2017.
A child can't have continuous access to health care without continuous eligibility for their parents' insurance. Private insurance and Medicare don't work this way. Medicaid shouldn't either. Congress should fix this discrepancy once and for all.
Eric C. Hunter is president and chief executive officer of CareOregon, the largest provider of Oregon Health Plan services.
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