Extra Income or Kids’ Health Insurance: Parents Shouldn’t Have to Choose

Medicaid and the Children’s Health Insurance Program, or CHIP, exist to provide health care coverage and care for the millions of people – including children – in the United States with low incomes and limited access to other forms of insurance. Medicaid and CHIP are lifelines for 45 million children. But this lifeline has been only intermittently available thanks to a phenomenon called “churn,” which puts children in harm’s way. Fortunately, Congress has a chance to fix churn for children permanently.

Churn in Medicaid and CHIP occurs when enrollees are kicked off coverage for temporary fluctuations in income, lost mail, or missed phone calls. A child’s health coverage can be interrupted when a parent or guardian works a few extra hours or gets a slight, temporary bump in pay – the kind of thing that happens every day to workers who are paid hourly, or who work in the gig economy. Churn can happen when a month has three paydays instead of two. Or when a paycheck includes a few extra hours of overtime that put a parent above an arbitrary income threshold.

No parent should be forced to choose between earning a little extra money and keeping their children’s health coverage. Churn punishes a child for a parent’s fluctuations in income. Further, it often forces parents to delay needed health care for their children until their income levels off and their coverage resumes — even in the case of a child who is receiving chemotherapy treatment for cancer, or a child who takes to manage their juvenile diabetes.

Before the pandemic, children were enrolled for an average of 10 months of the year. Other studies found that most who lost Medicaid were either still eligible or became eligible again within several months.

Reducing churn increases access to care and is associated with better health for kids. A new study finds that 12-month continuous eligibility for children, if expanded nationwide, would result in substantial increases in access to care for low-income children: 517,000 more children would get needed care. At the same time, continuous eligibility nationwide would be associated with 219,000 more children reported as being in “good,” “very good” or “excellent” health.

This isn’t just an abstract concept – the lack of coverage can harm a family’s health or finances for years to come. Take, for instance, Jon, a security guard who lives in Dallas with his wife and three kids. A few years ago, he had the chance to pick up a couple of extra shifts. He jumped at the chance to earn a little extra money — who wouldn’t? But the state considered his extra shifts a permanent raise and, despite his protests, his children were removed from the Medicaid rolls. During that time, his child spiked a fever and had to go to the emergency room. His family is still paying down the $1,600 bill they incurred that day.

We can’t let churn in Medicaid and CHIP do this to kids and their families. Many states know this and have already joined the fight against churn by enacting some form of continuous eligibility for children.

But Congress can do more. Right now, lawmakers have a rare opportunity to protect kids from losing Medicaid and CHIP coverage. The House budget reconciliation package eliminates churn for kids by requiring 12 months of continuous eligibility for children on Medicaid and CHIP.

In the future, we would like to see Medicaid and CHIP coverage made available for children in families with low incomes until they turn five, to ensure that every child has the care they need to grow up healthy and safe.

But for now, our organizations call on Congress to do the right thing and provide stable, consistent coverage for kids in families with low incomes. They deserve nothing less.


Bruce Lesley is president of First Focus on Children, a bipartisan advocacy organization dedicated to making children and families the priority in federal policy and budget decisions.

Margaret A. Murray is CEO of the Association for Community Affiliated Plans, the organization which represents the nation’s Safety Net Health Plans.

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