By Margaret A. Murray, CEO, Association for Community Affiliated Plans

October 2021– Success requires persistence in the face of great doubt and, often, repeated failure. It looks like Thomas Edison’s 10,000 unsuccessful attempts to make the lightbulb. The 1,330 times Babe Ruth struck out. The two candy companies Milton Hershey couldn’t keep solvent.

In Washington, D.C., persistence looks like going to Capitol Hill and facing closed doors or, even where doors are open, making your pitch to staff whose minds are visibly elsewhere. Belief in eventual success despite evidence to the contrary has been the story of ACAP’s decade-long effort to pass a law establishing 12 months of continuous Medicaid eligibility for all enrollees.

Since the inception of Medicaid more than 50 years ago, millions of Americans have signed up for Medicaid coverage only to churn off and on the rolls, due to lost paperwork, incorrect phone numbers, or minor and temporary changes in income. Unlike Medicare and the Marketplaces—which don’t look askance at enrollees for twelve full months so long as premiums are paid—Medicaid requires constant validation, resulting in a constant threat of losing access coverage. While established in the name of preventing fraud, waste, and abuse, constant redetermination complicates an already laborious process, adding yet another layer of red tape for enrollees to cut through.

The COVID-19 pandemic laid bare the urgent need to shore up the gaps—but it also provided a blueprint for a solution. Continuous Medicaid eligibility addresses these tears in the fabric, ensuring steady access to care for enrollees and alleviating the administrative burden created by churn.

Congress put a temporary stop to Medicaid churn in 2020 when it ended the practice of Medicaid disenrollments for the duration of the COVID-19 public health emergency. So long as the public health emergency continues, so will uninterrupted Medicaid coverage.

Continuous eligibility provided stability and relief for millions of Americans during an unprecedented health crisis. Why cast it aside after? We know it works. Ten years of advocacy have seen incremental legislative changes. States have the option to extend twelve months of continuous Medicaid eligibility for children and, as of the passage of the American Rescue Plan Act earlier this year, to pregnant and postpartum people.

Fear of catching COVID led millions of Americans to avoid clinics or hospitals, delaying essential care, from vaccinations to chronic care management to needed surgery. We expect pent-up demand to explode as the health care environment stabilizes. To cut off coverage to people who need it now – and who will continue to need it after the pandemic—will be devastating.

The idea of 12-month continuous eligibility for children and pregnant or postpartum mothers is one of the many proposals Congress is considering as part of its budget reconciliation bill. This would promote stable coverage once the public health emergency formally comes to an end.

For many, it would be a game-changer – no longer would seasonal or hourly workers count their hours to stay under a threshold so their kids keep their health insurance. Pregnant moms wouldn’t show up for a prenatal checkup to find they had been dropped from the Medicaid rolls because they had missed a phone call or a postcard in the mail.

They say that fortune favors the bold, and chance favors the prepared mind. The idea of 12-month continuous eligibility seemed an audacious goal when ACAP first proposed it more than a decade ago. But our unswerving belief in its necessity – and our persistence in talking with elected representatives on Capitol Hill over years and years – has made what was audacious a few years ago well within the bounds of possibility today.

After all, persistence in the face of long odds can pay off. Just ask Milton Hershey—his third try at launching a candy company turned out pretty well.


About the Author

Margaret A. Murray is Chief Executive Officer of the Association for Community Affiliated Plans, a national trade organization whose 78 member Safety Net Health Plans provide health coverage to more than 20 million Americans. For more information, visit or follow @safetynetplans on Twitter.

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