COUNCIL OF THE DISTRICT OF COLUMBIA
The John A. Wilson Building
1350 Pennsylvania Avenue, nw
Washington, D.C. 20004
Statement of Introduction
Childhood Continuous Coverage Act of 2023
July 10, 2023
Today, along with Councilmembers Charles Allen, Janeese Lewis George, Brianne K. Nadeau,
Zachary Parker, Brooke Pinto, and Robert C. White, Jr., I am introducing the Childhood
Continuous Coverage Act of 2023. This bill will require that any child enrolled in Medicaid, the
Children’s Health Insurance Program (CHIP), or the Immigrant Children’s Program during the
ages of zero to five years old will not face a redetermination or risk losing coverage under the
program until the end of the month in which they turn six years old.
During the COVID public health emergency, all Medicaid enrollees were continuously enrolled.
The District similarly implemented continuous enrollment for participants in the DC HealthCare
Alliance program. Anyone who enrolled in Medicaid or the Alliance could not lose that coverage
until the redetermination process resumed. Redeterminations of eligibility resumed for Alliance
enrollees on July 1, 2022 and for Medicaid enrollees on April 1, 2023 and will continue through
June of 2024. In the early months of recertifications, the District has seen thousands of
individuals removed from the Medicaid roles, and nationally, more than a million individuals
have lost their Medicaid coverage due to the recertification process. For many, the lost in
coverage was not due to ineligibility, but due to paperwork.
This bill is intended to remove the worry and stress associated with the potential of losing health
insurance coverage for children by ensuring that no children enrolled in Medicaid, CHIP, or the
Immigrant Children’s Program would be removed from the program before they turn six years
old. These protections produce a broad spectrum of benefits across the health care sector.
Continuous enrollment promotes health equity by limiting gaps in coverage for low-income
children who frequently experience health disparities. Additionally, continuous coverage
improves access to health care services including preventive services, assists with care
coordination, and allows for consistent treatment over time for chronic conditions.
Consider, for example, the 2023 recommended immunizations for children from birth through
age 6 years old from the Centers for Disease Control and Prevention and the American Academy
of Pediatrics, which includes more than 25 immunizations over the first 6 years of life.
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The
costs of these recommended immunizations are covered under Medicaid, CHIP, and the
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Centers for Disease Control and Prevention, Recommended Vaccinations for Infants and Children: Birth
through 6 years, United States, 2023, Feb. 10, 2023, available at:
https://www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html.
Christina Henderson Committee Member
Councilmember, At-Large Hospital and Health Equity
Chairperson, Committee on Health Judiciary and Public Safety
Transportation and the Environment
COUNCIL OF THE DISTRICT OF COLUMBIA
The John A. Wilson Building
1350 Pennsylvania Avenue, nw
Washington, D.C. 20004
Immigrant Children’s Program. Providing continuous coverage will prevent instances of enrolled
children missing immunizations due to fluctuations in insurance coverage.
Continuous coverage can also reduce the administrative burden on the Medicaid program
associated with enrollees cycling on and off Medicaid due to the volatility of income. An
analysis of national data from 2005 to 2010 estimated that the administrative cost of disenrolling
and reenrolling an individual in Medicaid coverage within a year is between $400 and $600.
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This bill would eliminate some of this churn.
Oregon was the first state to have a multi-year continuous coverage waiver approved for young
children in September of 2022. New Mexico and Washington have filed similar 1115 waiver
applications, and California passed a law requiring continuous enrollment for children up to age
five subject to federal approval and state funding.
The District has long prided itself on having among the very lowest rates of uninsurance in the
country. This bill will help protect that performance going forward and will focus its attention on
the most vulnerable population of young children whose families have lower incomes.
Parenthood and guardianship come with a plethora of stresses and concerns about the wellbeing
and development of the child. This bill will alleviate one of those stresses by guaranteeing that
any child that qualifies for one of the District’s medical assistance programs will not lose that
coverage until they have at least reached the age of six years old.
I look forward to working with my colleagues to move this legislation forward and improve the
health and wellbeing for District of Columbia children.
2
Swartz, Katherine, et al. "Reducing Medicaid churning: extending eligibility for twelve months or to end
of calendar year is most effective." Health Affairs 34.7 (2015): 1180-1187. 1
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Councilmember Brianne K. Nadeau Councilmember Christina Henderson 2
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Councilmember Charles Allen Councilmember Brooke Pinto 6
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Councilmember Zachary Parker Councilmember Robert C. White, Jr. 10
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Councilmember Janeese Lewis George 14
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A BILL 16
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IN THE COUNCIL OF THE DISTRICT OF COLUMBIA 20
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To establish continuous coverage for children ages 0 to 6 years under Medicaid and the 25
Immigrant Children’s Program. 26
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BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this 28
act may be cited as the “Childhood Continuous Coverage Act of 2023”. 29
Sec. 2. Definitions. 30
For the purposes of this act, the term: 31
(1) “CHIP” means the Children’s Health Insurance Program authorized by Title 32
XXI of the Social Security Act, approved August 5, 1997 (Pub.L. No. 105-33; 42 U.S.C. § 33
1397aa et seq.) and section 2203 of the Service Improvement and Fiscal Year 2000 Budget 34
Support Act of 2009 (D.C. Law 13-38; D.C. Official Code §1-307.05). 35 2
(2) “Immigrant Children’s Program” means the medical assistance program 36
established pursuant to section 2202 of the Service Improvement and Fiscal Year 2000 Budget 37
Support Act of 1999 (D.C. Official Code § 1-307.03(b)), for immigrant children not eligible for 38
coverage under Medicaid. 39
(2) “Medicaid” means the medical assistance programs authorized by Title XIX 40
of the Social Security Act, approved July 30, 1965 (79 Stat. 343; 42 U.S.C. § 1396 et seq.), and 41
by section 1 of An Act To enable the District of Columbia to receive Federal financial assistance 42
under title XIX of the Social Security Act for a medical assistance program, and for other 43
purposes, approved December 27, 1967 (81 Stat. 744; D.C. Official Code § 1-307.02), and 44
administered by the Department. 45
Sec. 3. Childhood continuous eligibility requirements. 46
(a) (1) Individuals ages 0 through 5 years, excluding individuals eligible for Medicaid 47
based on the home and community-based services waiver under 42 CFR 435.217, who enroll in 48
Medicaid or CHIP shall qualify for continuous eligibility until the end of the month in which 49
their sixth birthday falls. 50
(2) The Mayor shall apply for any waivers and exemptions from federal statutes 51
and regulations, or for any amendments to the District’s Medicaid State Plan, necessary to 52
provide the continuous coverage described in this section 53
(3) Continuous eligibility shall begin upon approval of a relevant demonstration 54
waiver by the Centers for Medicare & Medicaid Services or inclusion in the District’s Medicaid 55
State Plan. 56 3
(b) Individuals ages 0 through 5 years who enroll in the Immigrant Children’s Program 57
shall qualify for continuous eligibility until the end of the month in which their sixth birthday 58
falls. 59
(c) An individual’s continuous eligibility period under this section shall be redetermined 60
or terminated if: 61
(1) The individual is no longer a resident of the District; 62
(2) The individual’s legal guardian requests termination of eligibility; 63
(3) The individual dies; or 64
(4) The Department determines that eligibility was erroneously granted at the 65
most recent determination, redetermination, or renewal of eligibility because of agency error, 66
fraud, abuse, or perjury. 67
Sec. 5. Fiscal impact statement. 68
The Council adopts the fiscal impact statement in the committee report as the fiscal 69
impact statement required by section 4a of the General Legislative Procedures Act of 1975, 70
approved October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-301.47a). 71
Sec. 6. Effective date. 72
This act shall take effect after approval by the Mayor (or in the event of veto by the 73
Mayor, action by the Council to override the veto), a 30-day period of congressional review as 74
provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December 75
24, 1973 (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)), and publication in the District of 76
Columbia Register. 77