Nothing says “long weekend” like a long list of regulations, right? While most of us were still recovering from our Independence Day celebrations, the Centers for Medicaid and Medicare Services (CMS) released a 600-page final rule that includes changes being made to Medicaid and the Children’s Health Insurance Program (CHIP).
These adjustments to current Medicaid and CHIP policy bring the state-administered programs in line with provisions of the Affordable Care Act (ACA). CHIP waiting periods, under which some states require children to remain uninsured for up to 12 months before receiving CHIP benefits, are one topic included in these regulations. Children’s health advocates have been especially concerned about these policies because waiting periods delay kids’ access to needed care and create unnecessary red tape for both families and administrators. That is why Community Catalyst joined 22 other national organizations last February in advocating for the elimination of all CHIP waiting periods.
Unfortunately, the new regulations stop short of prohibiting waiting periods all together. CMS will allow states to impose waiting periods but limits these periods to a wait of up to 90 days for CHIP enrollees who previously were covered by group health plans. (Of the 37 states with CHIP waiting periods, 18 states currently have waiting periods in excess of the 90-day limit.)
Certain children are granted exemptions from any CHIP waiting period. This includes cases where:
- The child recently lost eligibility for Medicaid or another insurance affordability program.
- The child has special health care needs.
- The child lost coverage due to divorce or death of a parent.
- A change in parent’s employment status led to the child losing coverage.
- The parent’s employer stopped covering dependents under an employer-sponsored plan.
- The premium for employer-sponsored coverage exceeds one of several affordability standards.
Waiting periods are intended to prevent “substitution,” when families voluntarily leave employer-sponsored insurance plans in search of less expensive public coverage. There isn’t enough evidence to show that waiting periods accomplish their intended goal, however, and the presence of a waiting period may even discourage eligible families from applying. Some families might temporarily enroll their children in individual plans on the Exchange, creating layers of additional paperwork, and other families will just remain uninsured and hope that their children don’t need care while waiting for CHIP benefits to begin. Requiring children to go without health insurance runs contrary to the spirit of universal coverage envisioned under the ACA.
It is now up to individual states to eliminate this barrier to children’s health care, as New Hampshire, Vermont, and Colorado recently did. As more states move toward shortening their CHIP waiting periods, let’s encourage them to do away with them all together. No child should be forced to go without health care just to prove that they need coverage.
— Ashley Storms, New England Alliance for Children’s Health Intern