Policy Matters Ohio supports the Ohio Department of Medicaid’s proposal for an 1115 waiver for continuous coverage of kids ages 0-3 to support the next generation of Ohio’s economic development. Last year, all states had to provide 12 months of continuous coverage to children in Medicaid as required by the Consolidated Appropriations Act, 2023.[1] This proposed waiver expands continuous eligibility to Ohio kids up to 3 years of age. Access to affordable health insurance has had a powerful influence on the health of Ohio’s children. Research shows that because of Medicaid coverage, children have less severe illnesses, fewer hospitalizations, fewer emergency department visits, and more preventive care than they would have had they not been insured.[2] Medicaid coverage for kids and pregnant people is tied to greater overall economic security, including higher college enrollment rates and wages.[3]
Currently, children in Ohio aren’t getting the care they need. Ohio can and should do a better job of providing care to families and children — particularly those who are covered by and/or eligible for Medicaid. In Ohio, 4.9% of children do not have health insurance.[4] Ohio is 29th in the nation in uninsured children.[5]In small towns and rural areas, 29.5% of children are covered by Medicaid or the Children’s Health Insurance Program (CHIP).[6]
Allowing children with Medicaid to maintain their coverage regardless of household income fluctuations will give children consistent access to the well-child visits, vaccinations, and specialty care they need to start school ready to learn. It will also allow low-income parents to take their kids to the doctor without worrying about whether visits will be covered from one month to the next. According to the department’s own proposal, after five years, the waiver will have increased eligibility by a total of 2,592,678 member months compared to eligibility without the waiver.[7]
Programs that allow for continuous coverage also reduce churn in the system, by preventing children from being kicked off their care and parents having to reapply later due to income fluctuation.[8] Churn costs an average administrative fee of $400-$600 per beneficiary.[9] By investing in children’s continuous eligibility now, state and federal governments will reap the financial benefits for years to come. Research from the Congressional Budget Office in 2023 shows that these returns on investment can offset more than 40% of the costs of the Medicaid program.[10] Less churn means less debt for Ohio families, more stability, and better access to preventive care.
Supporting healthy kids and families is good for parents, kids, and Ohio’s economic growth. We are excited to see the submission of this waiver program and hope to see an expansion up to age 6 in the future.
[1] Early Childhood Continuous Eligibility. First Focus on Children. November 2023.
[2] Hakim, R. B., Boben, P. J., & Bonney, J. B. (2000). Medicaid and the Health of Children. Health care financing review, 22(1), 133–140.
[3] Jeopardizing a Sound Investment: Why Short-Term Cuts to Medicaid Coverage During Pregnancy and Childhood Could Result in Long-Term Harm, the Commonwealth Fund. December 2020.
[4] Georgetown Kids Healthcare Report Card. 2023. See also: The Ohio Department of Medicaid, Testimony to Finance Committee. Feb. 5, 2025.
[5] Georgetown: Kids Health Care Report Card. 2023.
[6] Georgetown (2025) Medicaid’s Role in Small Towns and Rural Areas.
[7] Ohio’s 1115 Waiver Application – Continuous Enrollment through age 3. (p. 8) Feb. 21, 2025. “Member months” = Number of eligible children x Number of months they are eligible.
[8] Wagner, Jennifer and Judith Solomon. Continuous Eligibility Keeps People Insured and Reduces Costs. Center on Budget and Policy Priorities. May 2021.
[9] Swartz, K., Short, P. F., Graefe, D. R., & Uberoi, N. (2015). Reducing Medicaid Churning: Extending Eligibility For Twelve Months Or To End Of Calendar Year Is Most Effective. Health affairs (Project Hope), 34(7), 1180–1187.
[10] Exploring the Effects of Medicaid During Childhood on the Economy and the Budget. Congressional Budget Office. 2023.