By NextBestFitContinuous eligibility (12-month or multi-year) in Medicaid and CHIP
Once enrolled, people keep coverage for at least 12 months (or until age 6 for children) regardless of income changes.
Cheap interim fix for Medicaid churn before the transition.
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This path
Continuous eligibility (12-month or multi-year) in Medicaid and CHIP
Creates or worsens
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Require 12-month continuous eligibility for adults in Medicaid and multi-year eligibility for children up to age 6
- Use automated renewals with tax and benefit data (ex parte renewals)
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- People lose coverage when their life changes (churn)
Keeping Medicaid and CHIP coverage through income changes reduces paperwork for states and families and is inexpensive and quick to implement. It does not prevent gaps between employer and individual coverage.
- About $1 trillion a year in administrative cost
Continuous eligibility reduces enrollment paperwork for states and families.
What it creates or worsens
- Directs benefits or burdens imperfectly
Continuous eligibility can keep people covered after they become ineligible.
Who's affected
Who gains
- People whose job, income, or home changes
- People lose coverage when their life changes (churn): They lose coverage when income, job, or address changes.
- People with ongoing or specialist care needs
- People lose coverage when their life changes (churn): Treatment is interrupted when coverage lapses mid-course.
- Low- and middle-income households
- People lose coverage when their life changes (churn): Keeping Medicaid and CHIP coverage through income changes reduces paperwork for states and families and is inexpensive and quick to implement. It does not prevent gaps between employer and individual coverage.
- Doctors, nurses, and other clinicians
- About $1 trillion a year in administrative cost: Time goes to billing and insurer rules instead of patients.
- People with employer coverage
- About $1 trillion a year in administrative cost: Premiums pay for the administration.
- Taxpayers and public budgets
- About $1 trillion a year in administrative cost: Public programs pay for it too.
Who loses
- Health insurers, brokers, and their shareholders
- People lose coverage when their life changes (churn): Insurers avoid the long-term costs of members who leave.
- About $1 trillion a year in administrative cost: Insurers, billing firms, and clearinghouses earn from the complexity.
- Taxpayers and public budgets
- People lose coverage when their life changes (churn): Budgets save money when eligible people fall off.
- Insurance and billing workers
- About $1 trillion a year in administrative cost: Their jobs exist because of the complexity.
Where it has been tried
- Oregon, Washington: Multi-year continuous eligibility for young children under Medicaid waivers.
- Oregon: By December 2024, 80.5% of Oregon Medicaid members completing renewal kept benefits; most adults then received two years of continuous eligibility.Sources: Oregon Health Authority (2024)