Continuous Eligibility
Effective January 1, 2024, states are required to provide 12 months of continuous eligibility (CE) for children under the age of 19 in Medicaid and the Children’s Health Insurance Program (CHIP). Section 5112 of the Consolidated Appropriations Act, 2023 (CAA, 2023) amended titles 1902(e)(12) and 2107(e)(1) of the Social Security Act to add this requirement. Previously, states had the option to provide children with 12 months of continuous coverage under CHIP and Medicaid.
Final Rule
In November 2024, we published the Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Final Rule. This final rule amends the Medicaid and CHIP regulations to codify the requirements of the CAA, 2023. Specifically, this rule finalized the requirement to provide 12 months of continuous eligibility for children under the age of 19 enrolled in Medicaid and CHIP. This rule also finalized a policy removing the previous options of applying continuous eligibility to a subgroup of enrollees or limiting continuous eligibility periods to less than 12 months. This rule also removed failure to pay premiums as an optional exception to continuous eligibility in CHIP.