CMS Directive: Affected States
This directive policy has the potential to affect two groups of states:
- States that have recently adopted legislation to expand coverage to children above 250% of the FPL but had not received federal approval prior to the directive; or
- States that already cover children above 250 percent of the FPL prior to the directive, and must comply with the directive's requirements by August 2008.
States with Planned Expansions
State |
Eligibility on 8/17/07 |
Planned Expansion |
Status |
| Illinois |
200% |
300% |
Implemented expansion in July 2006; coverage from 200-300% of the FPL is state-funded. Prior to directive, the state planned to seek federal funds for the expansion. |
| Indiana |
200% |
300% |
CMS approved the expansion on 5/9/08 to children only to 250% of the FPL (gross income). See the approved state plan. Implementation began 10/1/08. The state is also continuing discussions with CMS regarding fully implementing the expansion to 300% FPL. |
| Iowa |
200% |
300% |
The state passed an expansion in May 2008. The state has not yet submitted a state plan amendment, but plans on implementing the expansion on 7/1/09. |
| Kansas |
200% |
250% |
The state passed an SCHIP expansion in May 2008, but has yet to submit a state plan amendment. The state plans to implement the expansion in two stages; beginning in July 2009, children with family income up to 225% FPL will be eligible for coverage and in 2010, eligibility will increase to 250% FPL. |
| Louisiana |
200% |
300% |
CMS approved expansion on 2/27/08 only to 250% of the FPL (gross income) with a 12-month waiting period. See CMS Stop the Clock Letters and the approved state plan. The state implemented the limited expansion on 6/1/08. |
| Montana |
175% |
250% |
Voters approved a ballot initiative on 11/4/08. The state has not yet submitted a state plan amendment. |
| New York |
250% |
400% |
CMS denied expansion on 9/7/07. On 4/9/08, the state approved use of state funds to cover children from 250% to 400% of the FPL. New York has joined other states in a lawsuit challenging the directive. The lawsuit was dismissed after CMS did not take enforcement action. The state implemented the expansion on 9/1/08. |
| North Carolina |
200% |
250% |
Due to the directive and funding issues, the state is exploring options for expansion. |
| Ohio |
200% |
300% |
Due to the directive, the state submitted a state plan amendment on 2/5/08 limiting the expansion to 250% of the FPL. The state previously submitted a proposal to expand up to 300% of the FPL but it was
denied on 12/20/07 for federal matching issues. Approval was granted for the expansion to 300% when the administration did not act within the required timeline. |
| Oklahoma |
185% |
300% |
Due to the directive, the state planned to limit premium assistance coverage up to 250% of the FPL through an 1115 waiver. The state received a Stop the Clock Letter on 5/20/08, with questions concerning its use of income disregards to determine eligibility. |
| Washington |
250% |
300% |
Implementation is scheduled to begin in January 2009; no state plan amendment has yet been filed. The state has joined other states in a lawsuit challenging the directive. The lawsuit was dismissed after CMS did not take enforcement action. Implementation to 300% began February 23, 2009. |
| West Virginia |
200% |
300% |
Implemented a limited expansion to 220% of the FPL in January 2007, in part due to the directive. The state submitted a state plan amendment in September 2008 to expand coverage to 250% of the FPL, with enrollment beginning 1/1/09. |
| Wisconsin |
185% |
300% |
CMS approved expansion to 250% of the FPL; coverage from 250-300% FPL is state-funded. Implementation began 2/1/08. |
States with Approved Expansions Prior to Directive
| State |
Current Eligibility |
Date of CMS Approval [1] |
Compliance Status |
| California [2] |
250% |
11/23/99 |
To be determined. |
| Connecticut |
300% |
4/27/98 |
To be determined. |
| District of Columbia |
300% |
3/15/07 |
Because DC is a Medicaid expansion state, they are not affected by the directive. [3] |
| Hawaii |
300% |
1/30/06 |
To be determined. |
| Maryland |
300% |
11/7/00 [4] |
To be determined. |
| Massachusetts |
300% |
7/20/06 |
To be determined. |
| Minnesota |
275% |
4/27/95 |
To be determined. |
| Missouri |
300% |
4/29/98 |
To be determined. |
| New Hampshire |
300% |
9/15/98 |
To be determined. |
| New Jersey |
350% |
8/3/99 |
To be determined. |
| Pennsylvania |
300% |
2/20/07 |
To be determined. |
| Rhode Island [2] |
250% |
5/8/98 |
Approved by CMS on May 9, 2008. Premium assistance program accepted as an alternative strategy to one-year waiting period. |
| Tennessee [2] |
250% |
1/18/07 |
Due to the directive, the state no longer applies disregards in determining income eligibility. |
| Vermont |
300% |
12/15/98 |
To be determined. |
| Washington [2] |
250% |
9/8/99 |
To be determined. |
Notes:
[1] Date reflects original CMS approval of current income eligibility level as noted.
[2] These states have eligibility levels set at 250% of the FPL but allow some deductions and disregards when calculating income and therefore effectively cover some children with family income above 250% of the FPL.
[3] Ohio is also a Medicaid expansion state, but they delayed implementation of their eligibility expansion due to the directive.
[4] Maryland implemented an enrollment freeze for children between 200% and 300% FPL fromJuly 2003 to July 2004.