MedicaidCoverageHigh impact
Update: Medicaid and CHPlus Continuous Eligibility for Children up to Age Six
EmblemHealth·Pediatrics·Provider News
Effective date
Jul 1, 2026
We identified it
Jul 17, 2026
Summary
Effective July 1, 2026, Medicaid and CHPlus will discontinue continuous eligibility for children birth through age 6, requiring annual coverage renewals instead. Children will lose coverage if renewal is not completed. This represents a significant change to enrollment verification workflows for pediatric patients, as continuous eligibility is being eliminated for this age group while remaining in place for members under 19.
Action Required
By June 1, 2026: Billing team must implement coverage verification workflow changes for all Medicaid and CHPlus patients ages birth through 6. (1) Update billing system to flag these patients for annual eligibility verification rather than assuming continuous coverage. (2) Train front desk staff to request updated insurance cards/eligibility confirmation at each visit for this age group. (3) Implement patient notification system to remind families of renewal deadlines to prevent coverage lapses. (4) Update encounter forms and check-in procedures to capture renewal status. (5) Establish protocol to hold claims for 24-48 hours if eligibility verification cannot be confirmed, preventing claim rejections due to coverage termination. Failure to verify eligibility will result in denied claims and potential patient balance responsibility if coverage has lapsed.