ACHA Advocacy Committee Seeks Member Feedback on Medicaid Portability Across State Lines

Ensuring all college students have access to affordable healthcare is a critical component of student success, especially during a time when many young people and emerging adults in America face a mental health crisis spurred on by a global pandemic, economic challenges, and international conflicts. ACHA remains concerned about continued healthcare and mental health services for Medicaid-enrolled college students attending college out of state.

Students who depend on Medicaid or the Children’s Health Insurance Program (CHIP) to cover medical expenses often face barriers if going to college out of state. These barriers are due to these students’ inability to get reimbursement for medical expenses by state-run programs when those expenses are incurred in a different state.

With the passage of the Patient Protection and Affordable Care Act (ACA), the percentage of undergraduate students covered by Medicaid increased from 9% to 17% in Medicaid expansion states. State laws that restrict Medicaid reimbursements for patients with out-of-state residency complicate continued care for individuals enrolled in Medicaid who choose to attend college away from home.

One solution for college students regardless of residency is enrolling in their college’s student health insurance and benefits plan (SHIBP), which can follow a student across state lines. While convenient for coverage, not all colleges offer SHIBPs and SHIBPs often have more out-of-pocket costs than Medicaid. Another solution is reapplying for Medicaid in the new state. This option would require students to change their residency to meet residency requirements, which can be timely (up to 6 months) and costly (rent) to demonstrate and may not be the long-term plans of the student. Additionally, they would lose coverage when “visiting” home on breaks. Also, during the application period, students would lose coverage. Note: Once approved for enrollment in a new state, Retroactive Medicaid will cover up to three months preceding the reapplication date if eligibility requirements in the previous state were established.

To explore what might be done to help address the issue of continued healthcare for Medicaid-enrolled college students with out-of-state residency, ACHA has met with the Democratic staff of the House Energy and Commerce Committee. During these talks, ACHA discussed reciprocal agreements between states and whether they could apply to college students and health center providers. While the Committee was familiar with Medicaid portability as an issue for military families and state agreements in place for eligible service member families, the Committee was less familiar with college students facing similar problems and asked if ACHA has any examples of agreements applicable to college students.

We’re looking for your input and experiences with students enrolled in Medicaid. Our Advocacy Committee is asking for you to share any information you have on college students from out of state who are enrolled in Medicaid, any reimbursement arrangements you are aware of, or anything else that might help inform Congress on this issue, even if anecdotal. Please email such information to advocacy@acha.org.

ACHA will keep you informed of our progress as we continue working with Congress on a solution for guaranteeing continued care for Medicaid-enrolled college students across state lines. Your continued engagement helps us better advocate on issues important to you and college health centers across the country, so we encourage you to email us to add your voice to our work.