A Step Toward Guaranteeing Health Coverage of Children
David R. Jones, La Nueva Mayoria / The New Majority
In less than a year, 1.4 million New Yorkers have lost their Medicaid coverage, and 45 percent of those who lost it did so because of administrative burdens, not because they were ineligible. Shockingly, even with this extremely high administrative disenrollment rate, New York ranks second in the nation for the fewest number of administrative disenrollments. How can this be? The fact is, everytime we ask individuals and families to fill out insurance paperwork, they lose coverage.
The good news is that a new law enacted as part of the state’s fiscal year 2025 budget, and awaiting federal approval, will at least insulate children under the age of six from the threat of administrative disenrollments in our state’s Medicaid and Child Health Plus (CHIP) programs.
New York has been a national leader when it comes to improving access to healthcare coverage. Our innovative universal children’s health insurance program was a model for adopting the federal CHIP program. We are also one of only two states in the country that took advantage of a provision in the Affordable Care Act (ACA) to establish a Basic Health Plan (the Essential Plan) that covers over 1.3 million low-income adults. And our New York State of Health Marketplace features a real-time eligibility rules engine that is a model for the country, responsible for enrolling nearly seven million New Yorkers in coverage.
Despite all these incredible achievements, New Yorkers continue to be churned off of public health insurance coverage. The stakes for children are very high with nearly half of all children in the state getting access to coverage through Medicaid and Child Health Plus.
Children coverage is important for a myriad of reasons: it ensures access to pediatric care such as well child visits, immunizations, pharmacy benefits, and specialty care; it promotes health equity; and it stabilizes family finances.
There is also a strong fiscal argument for keeping children enrolled as it helps stop churn among Medicaid and Child Health Plus enrollees. Churn means enrollees cycling on and off their coverage during a short period of time, typically during the renewal process. It’s well documented that churn results in higher administrative and healthcare costs in our healthcare system.
Between 2020 and 2023, a federal rule required the state to maintain continuous coverage for their residents with public insurance during the Covid-19 Public Health Emergency. Before the pandemic, we would see thousands of people, including children, losing their coverage due to administrative issues. These bureaucratic disenrollments essentially stopped during this pandemic moratorium. The benefits of continuous coverage were dramatic for children. The percent of uninsured children in New York fell to an all-time low of just 1.2 percent.
Fast forward to 2024, we know we must deal with the consequences of the lifting of this moratorium that prevented disenrollment for public health insurance enrollees. At the very least, the state should guarantee that children are able to continuously access healthcare without experiencing unexpected gaps in insurance coverage.
A bill (A.8146 /S.7747) sponsored by Assemblymember Jessica Gonzalez-Rojas and State Senator Samra Brouk goes a long way toward this goal by guaranteeing continuous health insurance coverage to children under the age of six in the State-administered Medicaid and Child Health Plus programs.
This bill, which was successfully included in this year’s state budget, now authorizes New York to follow the path of several other states that have secured or requested federal 1115 waiver applications. These applications seek permission from the federal government to allow children who qualify for Medicaid and Child Health Plus to stay enrolled until the age of six. Oregon has been approved to do this, and Washington and New Mexico have similar applications pending before the federal government.
Our state elected officials did the right thing by including A.8146/S.7747 in the budget. This would benefit the children, families, and our entire health care system. It’s now the federal government’s turn to show they also care about children’s health by approving the state’s 1115 waiver application.