Children's health cover may not reach back more than two months
What the document says“provide that such assistance is not made available to such individual for items and services included under the State child health plan (or waiver of such plan) that are furnished before the second month preceding the month in which such individual made application”
The section adds a new clause (vi) to section 2102(b)(1)(B) of the Social Security Act so that where a State chooses to give child health or pregnancy-related assistance for a period before the month of application, it may not cover items and services given before the second month preceding that month. The changes apply to applications made on or after the first day of the first quarter beginning after December 31, 2026, and $10,000,000 is appropriated for fiscal year 2026 to the Administrator of the Centers for Medicare & Medicaid Services, to remain available until expended.
What the document actually says“provide that such assistance is not made available to such individual for items and services included under the State child health plan (or waiver of such plan) that are furnished before the second month preceding the month in which such individual made application”
Cover may not reach care given too early. The cut-off is two months before the claim.
A state may still choose to reach back at all. This only caps how far. The change reaches claims made from 2027.
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