Pennsylvania Expands Continous Medicaid Eligibility for Children and People Leaving Incarceration
Last week, the Centers for Medicare & Medicaid Services (CMS) granted approval for Pennsylvania to offer continuous Medicaid eligibility to children from birth to age 6, as well as to certain individuals transitioning from incarceration for a period of one year following their release. This approval was part of the broader Section 1115 waiver demonstration application, known as “Keystones of Health,” which Pennsylvania submitted to CMS in January. The remaining components of the 1115 application are still awaiting CMS approval.
Continuous eligibility is a critical tool for ensuring that individuals remain enrolled in Medicaid, allowing them to access necessary care without interruption. With this approval, children enrolled in Medicaid will retain their coverage regardless of any changes in circumstances that would typically result in the loss of Medicaid eligibility, until they reach the age of 6. This marks a significant expansion of the current 12 months of continuous coverage for children mandated by law.
Additionally, with this approval, individuals under the age of 64 who are exiting incarceration and meet specific a chronic health condition, serious mental illness, or substance use disorder—will automatically qualify for Medicaid for a full year following their release. Similar to the 0-6 age group, they will maintain coverage regardless of any changes in circumstances during their continuous eligibility period.
There are exceptions to continuous eligibility. Specifically, certain circumstances, such as moving out of Pennsylvania or voluntarily withdrawing from coverage during the continuous eligibility period, will result in a child or formerly incarcerated individual losing their Medicaid coverage.
Having uninterrupted access to healthcare gives people peace of mind and enables them to receive care they need without disruption or the hassle of frequent coverage renewals. Continuous coverage has been shown to benefit children, families, and the economy alike. Research indicates that Medicaid coverage for children, for example, not only improves health during childhood but also has lasting effects into adulthood. In this context, continuous eligibility also reduces the administrative burden on state agencies, such as the Department of Human Services (DHS), which is responsible for Medicaid enrollment and renewals.
Readers will recall that the Centers for Medicare & Medicaid Services (CMS) recently took another significant step toward improving child health by releasing comprehensive guidance on the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements of Medicaid. This guidance encourages states to take active steps to advance EPSDT requirements, ensuring that children have access to a wide range of preventive, diagnostic, and treatment services, including well-child visits, mental health services, as well as dental, vision, and hearing care.
PHLP applauds the Department of Human Services for submitting such a comprehensive waiver amendment application, and CMS for embracing the importance of maintaining access to healthcare during childhood and following incarceration. We will continue to provide updates on the newly approved continuous eligibility provisions as we learn more.
