MACPAC staff presented a draft chapter for the June 2026 report to Congress and six recommendations to improve coverage transitions for CYSHCN. These recommendations reflect prior input from the Commission. The chapter begins with background on the Medicaid-covered CYSHCN population and their transitions from child to adult Medicaid coverage and the federal requirements for Medicaid redeterminations and transitions between Section 1915(c) home- and community-based services waivers. The chapter includes findings on the state role in facilitating the transition to adult Medicaid coverage and key challenges beneficiaries experience with the process. Finally, the chapter presents the six recommendations, the rationale for the recommendations, and implications for federal spending, states, enrollees, plans, and providers.
The draft recommendations direct (1) the Centers for Medicare & Medicaid Services to require states to send advance notice to CYSHCN aging out of child eligibility; (2) states to provide up to 30 days for beneficiaries to respond to requests for information in eligibility redeterminations; (3) CMS to coordinate with the Social Security Administration (SSA) on model notice language; (4) states to adopt the state option for Medicaid coverage for CYSHCN not otherwise eligible and enrolled; (5) Congress to amend the statute to implement 12-month continuous eligibility for CYSHCN; and (6) CMS to issue guidance to states on supporting CYSHCN transitions to adult coverage.