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The recent legislative approval for continuous child health coverage offers an innovative approach to reducing administrative costs and improving children’s health. If fully implemented, it will make it easier for busy families to keep their young children healthy.
The Ohio Department of Medicaid (ODM) is applying for a Section 1115 waiver to implement continuous Medicaid eligibility for children covered by Medicaid and the Children’s Health Insurance Program (CHIP) will receive coverage through the end of the month in which their fourth birthday falls. This means that once a child is enrolled in Medicaid, the child will stay covered through this date, regardless of any changes in family income or household circumstances. The goal is to ensure that young children have consistent access to health care during these critical early years.
This means that once a child is enrolled in Medicaid, the child will stay covered through this date, regardless of any changes in family income or household circumstances.
This initiative is designed to prevent gaps in coverage that can leave kids without necessary medical care. Right now, families often must navigate frequent income checks and eligibility reviews, which can lead to interruptions in coverage. By guaranteeing continuous eligibility, Ohio Medicaid hopes to reduce administrative burdens and ensure that children receive uninterrupted preventive care, vaccinations, and other essential health services. Research has shown that stable health care access in early childhood leads to better long-term health outcomes, so this change could have a lasting positive impact.
Specific goals of this 1115 Demonstration waiver include:
- Providing continuous Medicaid enrollment to children through age three regardless of changes in circumstances that would otherwise cause a loss of eligibility;
- Minimizing coverage gaps to help maintain consistent access to care, including early childhood screenings, primary and preventive services, and treatment;
- Decreasing the need for higher-cost services associated with delaying care;
- Easing the stress and burden on families and caregivers as they navigate Medicaid coverage; and
- Reducing administrative costs associated with application processing and churn
A notice for public comment opened for the five-year waiver on February 21, 2025, and closes on April 2, 2025.
Currently, Ohio’s Medicaid program covers children in families earning up to 200 percent of the federal poverty level, but eligibility can fluctuate based on financial changes. The proposed Section 1115 waiver would strengthen support for families by eliminating the risk of losing coverage during a child’s first three years. This is a time when regular doctor’s visits and early interventions are especially important, so maintaining stable health care access will make a lifelong impact for children. Continuous eligibility for children through age three is an important move toward improving children’s health and well-being across Ohio.
A notice for public comment opened for the five-year waiver on February 21, 2025, and closes on April 2, 2025.
