Senate Health Reform Bill’s Medicaid and CHIP Provisions

The Senate bill is finally out, and Majority Leader Reid is looking to get through a cloture vote on Saturday. The key parts of the bill that we’ve been tracking haven’t changed too much from the Senate Finance version. One change of note, the implementation date for the coverage pieces in the bill was moved from July 1, 2013 to January 1, 2014.

Here is brief reminder of what’s in the bill in terms of Medicaid and CHIP:

  • As in the Finance bill, the new proposal creates a national Medicaid threshold for adults and children at 133% FPL. The newly eligible adults must be given a benchmark benefit plan. The bill also deletes Finance bill provision that would have allowed certain Medicaid adults to go into the Exchange.
  • States must maintain current Medicaid eligibility and enrollment procedures for adults until the Exchanges are operational (with the exception that states with budget deficits can roll back on coverage above 133% FPL).
  • The federal government still will pay a chunk of the costs for newly eligible adults. The new version provides 100% federal funding in 2014, 2015, and 2016. In 2017 and 2018, the percentage picked up by the federal government for the adults will vary, with more support initially provided to states without existing Medicaid expansions. By 2019, the federal share will level out to an increase of 32.3 percentage points for all states.
  • Maintains Medicaid and CHIP coverage for children above 133% FPL through fiscal year 2019. States will receive an increase in the federal match rate for the CHIP-financed kids. However, no funding is provided for CHIP past its current renewal date (September 30, 2013). The bill clarifies that if not funded, children in stand alone CHIP programs can enroll in Exchange coverage and subsidies.
  • Maintains no wrong door and single application process for Exchange subsidies, Medicaid and CHIP.
  • Requires that health plans cover the preventive care and screenings identified in Bright Futures (the American Academy of Pediatrics’ “gold standard” for preventive care).
  • Continues to provide subsidies to people up to 400% FPL but makes some changes to what families are expected to pay at different income levels. While families between 250% and 400% FPL will pay less than in the Finance bill, those with incomes below 250% FPL will pay more. See CBPP’s analysis on this important issue.

It is also worth noting some of what is NOT in the Senate bill including an increase in Medicaid reimbursement rates for primary care services and automatic enrollment of newborns (both in the House bill). And, as noted, there are no funds and other improvements in CHIP past 2013.  We can expect these issues to pop up in the Senate floor debate and/or in conference.

Look out for our new summary of the legislation in the coming days.

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