Building upon its commitment to expand health care coverage and ensure continuity of care, today the Biden-Harris Administration, through the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS), approved five section 1115 demonstration amendments. These amendments will authorize Colorado, Hawaii, Minnesota, New York, and Pennsylvania to provide additional years of continuous eligibility for children beyond the minimum 12 months required by law, and will newly provide continuous eligibility to individuals leaving incarceration in Colorado and Pennsylvania.
“Throughout the Biden-Harris Administration, HHS has worked to help more Americans secure – and keep – health care coverage. It’s critical to prevent loss or unnecessary interruptions in coverage so Americans, especially our children, can see a doctor when they need to,” said HHS Secretary Xavier Becerra. “Earlier this year, the Biden-Harris Administration implemented 12-month continuous coverage for children nationwide. Today, we are proud to partner with five states to broaden coverage protection and give families the peace of mind they need to stay healthy and well.”
“CMS is committed to expanding health care coverage — and that means ensuring that no one, especially children, falls through the cracks,” said CMS Administrator Chiquita Brooks-LaSure. “I applaud these states for guaranteeing continuous eligibility for children and addressing the often-overlooked needs of people leaving carceral settings. I urge additional states to follow in these footsteps.”
Providing eligible people with continuous eligibility ensures that people enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) can have peace of mind, knowing that they, or their children, will maintain uninterrupted access to care. Continuous eligibility means that individuals are assured that they are able to maintain health insurance, regardless of changes in circumstances that may make someone ineligible, such as a change in income. This continuous eligibility is especially critical for children to continue to receive health services they need, without interruption or having to renew their coverage frequently. Continuous eligibility also helps states by reducing the administrative burden on state agencies that conduct Medicaid and CHIP enrollment and renewals.
Specifically, today’s approvals include:
- In Colorado, continuous eligibility for children in Medicaid and CHIP until the child’s 3rd birthday, and 12 months of continuous eligibility for individuals aged 19 up through age 64 who are leaving incarceration.
- In Hawaii, continuous eligibility for children until the child’s 6th birthday, and 24 months of continuous eligibility for children aged six up to age 19.
- In Minnesota, continuous eligibility for children until the child’s 6th birthday, and 12 months of continuous eligibility for individuals aged 19 up to age 21.
- In New York, continuous eligibility for children in Medicaid and CHIP until the child’s 6th birthday.
- In Pennsylvania, continuous eligibility for children until the child’s 6th birthday, and 12 months of continuous eligibility for individuals aged 19 up through age 64 leaving incarceration, who meet certain high-risk criteria.
Over the last two years, CMS has approved broad expansions of continuous eligibility for different populations using section 1115 demonstrations to advance uninterrupted health coverage. These section 1115 demonstrations allow states to provide continuous eligibility for longer durations of time than they could under their Medicaid or CHIP state plans. CMS has previously approved nine other states’ requests for continuous eligibility for different populations: Kansas, Massachusetts, Montana, New Jersey, New Mexico, New York, Oregon, Utah, and Washington.
Today’s approval is just one example of how the Biden-Administration has taken action to strengthen coverage and access for children. Thanks to the Consolidated Appropriations Act, 2023, all states are now required to provide 12 months of continuous eligibility for children under the age of 19 in Medicaid and CHIP. In a 2024 report published by the Assistant Secretary for Planning and Evaluation, it was estimated that with this change, 17 million children could gain new protections from coverage disruption. Additionally, this past September, CMS released comprehensive guidance on Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements, which outline how eligible children and youth are entitled to a comprehensive array of prevention, diagnostic, and treatment services — including well-child visits, mental health services, dental, vision, and hearing services.
Continuous coverage is good for children, families, and the economy. Research shows that Medicaid coverage for children has been found to enhance health not only during childhood, but also in adulthood. Medicaid eligibility for children has also been found to improve educational outcomes, which along with better health contributes to higher rates of employment and earnings as adults. This, in turn, generates increased tax revenues and reduced spending on public assistance programs.
For additional information about each state’s section 1115 demonstration amendment approval, please visit the approvals on Medicaid.gov:
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