New rule ensures continued Medicaid coverage for children for a year

Children whose health care is covered by Medicaid will be guaranteed coverage for 12 months under a new federal requirement that took effect Jan. 1, the state health department announced Thursday.

“This policy change ensures Wisconsin children will continue to get the care they need when they need it,” said Kirsten Johnson, secretary-designee of the Wisconsin Department of Health Services (DHS), in a department statement.

The Consolidated Appropriations Act that Congress passed in December 2022 included the new requirement. In Wisconsin, the rule covers most new and existing patients under the age of 19 who are covered by BadgerCare Plus and other Medicaid programs.

The change is aimed at keeping access to health care stable for children so that they aren’t kicked off of Medicaid if their family income increases or they no longer meet certain other rules for the program, according to DHS.

“Families will have peace of mind knowing their kids can get wellness checks, vaccines and more to stay healthy,” Johnson said.

The federally mandated chain “tackles, head on, the past issue of ‘churn,’ children rolling in and out of eligibility due to fluctuating family income or circumstances, disrupting continuity of coverage and care,” said Brynne McBride, CEO of ABC for Health, which advocates on health care for low- and moderate-income people.

“It also supports a broader objective: insurance works better when there are more people in it — and children are not only important to insure [so they have] a healthy start and healthy outcomes, but they are relatively inexpensive to cover,” McBride added.

“I think this has the potential to be huge for protecting coverage for children,” said William Parke-Sutherland, health policy analyst for Kids Forward. The organization analyzes policy to help low-income families in Wisconsin.

“We know that three out of four children who lose coverage for procedural reasons are still eligible,” Parke-Sutherland said. “Hopefully this will eliminate one of those barriers. Children won’t be losing coverage because parents make a little bit more money and one month versus another.”

Both McBride and Parke-Sutherland said it will be important for the word to get out to families of children who are covered under the new rule so that they know their children can maintain coverage for a full 12 months.

McBride also said that Wisconsin could extend coverage longer than 12 months for children, or expand continuous 12-month coverage to include adults, by seeking a federal waiver.