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New requirement to protect children’s health care coverage takes effect

February 1, 2024

States now are required to provide 12-month continuous eligibility for all children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).

This long sought-after AAP priority marks important progress toward protecting children’s access to health care and comes as millions of children have lost coverage while states continue to navigate the Medicaid unwinding process.

How we got here

Congress passed the continuous eligibility requirement as part of its sweeping, bipartisan federal government spending package at the end of 2022. The deal set January 2024 as the requirement’s start date.

Before the new requirement took effect, about half of states already had 12-month continuous eligibility in place.

What it means

Under the new requirement, all states must provide children enrolled in Medicaid and CHIP with a full year of eligibility for the programs, regardless of changes in family circumstances. This policy change helps ensure children do not experience disruptions in their health care coverage over the span of the year or face unnecessary administrative barriers to stay enrolled in the program.

The Academy has long advocated for continuous eligibility so families have peace of mind that children will keep their coverage and can continue to receive the care and services they need to be healthy.

Notably, this new requirement went into effect as the Medicaid unwinding continues to play out across the country. Unwinding refers to the process states are undertaking to redetermine individuals’ Medicaid eligibility after pandemic-era continuous coverage protection ended. Through this process, more than 3 million children have lost their health care coverage. Many of them are eligible for the program but have been unenrolled for procedural reasons, such as missed paperwork or data systems glitches.

While the new continuous eligibility requirement will not prevent children from losing coverage during the Medicaid unwinding, it creates a long-term best practice that ensures children enrolled in the programs do not experience unnecessary disruptions in care.

On the horizon

While 12-month continuous coverage is a critical first step, the Academy called for multiyear continuous coverage in its latest policy statement, which outlines bold reforms to Medicaid and CHIP.

Specifically, the AAP calls for required continuous eligibility of children enrolled in Medicaid and CHIP starting at the newborn stage through age 6, and a minimum period of two-year continuous eligibility without renewal requirement for individuals ages 6 through 26.

Recognizing the benefits of continuous coverage, several states have taken promising steps in this direction. At press time, 10 states have moved toward multiyear continuous eligibility, with Oregon and Washington being the first two states with waivers approved by the Centers for Medicare & Medicaid Services to provide this eligibility through age 6.

AAP chapters have played a leading role, urging their states to advance these innovative policies to protect children’s health care coverage.

As 2024 continues, the Academy will continue its multipronged approach at the federal and state levels to advance children’s access to health care, protect against coverage losses and promote enrollment for those who have lost coverage.

Pediatrician videos highlight importance of firearm violence prevention research

The AAP recently released a series of videos featuring pediatricians speaking about the importance of continued federal investment in firearm violence prevention research.

One video features Emily Lieberman, M.D., FAAP, (pictured here) speaking about her experiences as a survivor of the 2022 Fourth of July parade mass shooting in Highland Park, Ill., and her ongoing advocacy to protect children from gun violence. Watch the videos at


Federal emergency services program for children due to be reauthorized

The Academy is advocating for the Emergency Medical Services for Children (EMSC) Program to be reauthorized for five years, which for 40 years has worked to ensure that emergency medical systems are prepared to meet the needs of children.

It is the only federal program specifically focused on children’s unique health needs during emergencies.

Every five years, lawmakers reauthorize the program so it can continue to serve children and help ensure access to timely and effective emergency services no matter where they live, go to school or travel. It is due to be reauthorized this year in Congress. As of press time, AAP-endorsed, bipartisan legislation to reauthorize the program was introduced in the U.S. House of Representatives. The Academy is urging its swift passage.

Long garnering bipartisan support, the EMSC program aims to improve the quality of emergency medical care for children in several ways.

The EMSC program helps all states and territories expand and improve their capacity to respond to pediatric emergencies through state partnership grants. This funding helps provide pediatric training to paramedics and first responders; equip hospitals and ambulances with appropriate tools, equipment and medication for children; and bolster the emergency systems in place so that children can receive the care they need, when they need it.

The EMSC program also aims to ensure children in rural and tribal communities can receive emergency care. In fact, due to the program, 90% of EMS agencies in the United States have consistent access to online medical direction when treating a pediatric patient, and 85% have offline medical direction that includes protocols inclusive of pediatric patients.

Additionally, the program supports research on pediatric emergency medicine as part of the first and only federally funded network on the topic.

The Academy urges the continuation of the program’s vital work. Significant improvement is needed across emergency medical systems so that they are best equipped and prepared to care for children, especially as the COVID-19 pandemic and surge of pediatric respiratory illnesses exposed and exacerbated existing issues. Late last year, AAP Immediate Past President Sandy L. Chung, M.D., FAAP, joined leaders from the Emergency Nurses Association and the American College of Emergency Physicians in writing an op-ed that was published in MedPage Today about the importance of investing in pediatric readiness.

The Academy will continue to call on lawmakers to support a strong, five-year reauthorization of the EMSC program so children can receive timely emergency medical services designed for their needs.


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