Amid ongoing state budget pressures, a requirement in the Affordable Care Act (ACA) that states maintain eligibility in Medicaid and CHIP was central in preserving coverage during 2011. In addition, more than half of states (29) made improvements in their programs. Most of these improvements involved greater use of technology to boost program efficiency and make it easier for families to enroll in coverage, but 11 states adopted targeted eligibility expansions, primarily for children.

This annual 50-state survey on eligibility, enrollment, renewal, and cost sharing policies also found that the new enhanced federal funding for technology investments spurred state action to modernize Medicaid eligibility systems. During 2011, more than half of states (29) launched major system improvement projects that will utilize this new funding to make far-reaching changes to their existing eligibility systems and move the enrollment and renewal process into the 21st century.

When the Affordable Care Act of 2010 is fully implemented, it will extend health insurance coverage to many adult Americans who currently lack it. It is not known, however, how the health reform legislation will affect children and parents who would otherwise be uninsured. Based on this analysis, health reform has the potential to cut the number of uninsured children by about 40 percent, from 7.4 million to 4.2 million, and the number of uninsured parents by almost 50 percent, from 12.7 million to 6.6 million. However, the actual impact will depend on increasing the share of children and parents who are enrolled in public coverage and on other implementation outcomes. Most strikingly, if the requirement that states continue their Medicaid and CHIP coverage is rescinded and if Congress does not continue funding CHIP, the uninsurance rate of children could more than double, increasing from 4.2 million to 7.9-9.1 million children. In that case, the uninsurance rate among children would be higher than if the Affordable Care Act had not been adopted.

In this paper, health insurance data from the Census Bureau's annual “American Community Survey” was analyzed in order to get a more accurate depiction of children's coverage. Even though the number of children living in poverty has increased almost 19 percent over a three-year period, the number of children without health insurance declined 14 percent– a true bright spot in an otherwise challenging landscape for America’s children. In 2010, about 8 percent of children were uninsured, as Medicaid and CHIP filled the gap created by the loss of coverage from the private sector. In contrast, adults, for whom Medicaid is not widely available, experienced an uninsurance rate of over 21 percent in 2010. However, progress made in reducing the number of uninsured children varied by state and region. The majority of states in the Northeast and Midwest had uninsured rates below the national average, while the majority of states in the West and South had uninsured rates higher than the national average. Massachusetts lead the country with the lowest percentage of uninsured children (1.5 percent), while Nevada had the highest (17.4 percent). The following issue-brief examines children’s coverage from 2008-2010.

On August 17, 2011, the Obama Administration published three proposed rules in the Federal Register relating to the eligibility and enrollment of individuals into health coverage under the Affordable Care Act (ACA). Taken together, they offer a comprehensive blueprint of how the Administration is proposing to implement the provisions of the ACA aimed at ensuring that all eligible residents of the United States enroll in coverage beginning January 1, 2014. The proposed rules address the expansion of Medicaid up to 133 percent of the federal poverty level (FPL); procedures for evaluating eligibility for Qualified Health Plans (QHPs) provided through Exchanges; eligibility for and enrollment in “affordability programs” (i.e., Medicaid, CHIP, advance premium tax credits and cost-sharing reductions); and the details of how the advance premium tax credits will be calculated and administered. The following memo provides an overview of some of the key implications of the proposed rules for children and families. 

Simplification and alignment of policies for children in Medicaid and CHIP have helped states fill the gap in private insurance and achieve record levels of coverage for 90% of our nation’s children. These lessons are carried forward in the Affordable Care Act’s expansion of coverage through Medicaid and the Exchanges. The ACA envision a customer-friendly, paperless system where coverage options are aligned, enrollment processes are simplified, and technology is used to verify eligibility. The following issue-brief investigates current state efforts to align and simplify coverage for children and parents in Medicaid and how the ACA moves states toward a more coordinated system of family-based coverage.

Presumptive eligibility is a state policy option that gives states the flexibility to train health care providers, schools and other community-based organizations and programs to screen eligibility and temporarily enroll eligible persons in Medicaid and CHIP. Currently 31 states use presumptive eligibility for pregnant women and 16 states enroll children presumptively. The following issue brief examines how the Affordable Care Act (ACA) envisions a broader role for presumptive and highlights the ways in which states have implemented the policy for pregnant women and children.

Sound information on Florida’s Medicaid program is especially timely because of the passage of the Affordable Care Act (ACA), which will move more low-income people into Medicaid by expanding eligibility levels in 2014. The highly politicized nature of the debate about Medicaid and health reform has lead to some exaggerated state estimates of Florida’s cost for the expansion. In this policy brief, Georgetown researchers provide a more reasonable set of estimates of the impact of the Affordable Care Act on Florida's Medicaid program.

The Patient Protection and Affordable Care Act (ACA) requires states to set-up health insurance exchanges. Once up and running, exchanges are expected to connect approximately 29 million people to coverage. Their design should help individuals and small businesses shop for and purchase health insurance, access premium and cost-sharing subsidies, and facilitate health plan competition based on price and quality. Two states established exchanges before the passage of health reform: Massachusetts in 2006 and Utah in 2008. The experiences in Massachusetts and Utah highlight the diverse approaches states may take to creating their own exchanges.

March 23, 2011 marked the one-year anniversary of the signing of the Affordable Care Act (ACA). There have been early wins for children and their families, even though many of the major provisions do not go into effect until January 2014. The following issue brief highlights families from across the country that are already benefiting from provisions in health reform, including young adult coverage and the elimination of denying insurance to children with pre-existig conditions.

The stability in Medicaid and CHIP can be directly attributed to the short-term fiscal relief and the federal requirements that states maintain their eligibility rules and enrollment procedures until broader health reform is implemented. If the stability provisions are rescinded, states could eliminate Medicaid for anyone who is covered at state option, as well as cut eligibility, shut down enrollment or even entirely abolish its CHIP program. This issue brief describes the Medicaid and CHIP stability protections, identifies who is most at risk of losing coverage if the protections are weakened or eliminated, and discusses the policy implications.

Families could turn to Medicaid and CHIP because in 2010, nearly all states "held steady." This annual 50-state survey of Medicaid and CHIP eligibility rules, enrollment and renewal procedures and cost sharing practices found that 49 states, including DC, held steady or made targeted improvements in their Medicaid and CHIP eligibility rules and enrollment procedures. In addition, a total of 13 states expanded eligibility, largely for children, and 14 states made improvements in enrollment and renewal processes to reduce burdens on families and streamline administrative processes.

September 23rd marks the six-month anniversary of the passage of the Patient Protection and Affordable Care Act (ACA). It also ushers in a new set of insurance reforms that will enable more children and families to obtain and keep their health care coverage. This brief describes the changes as well as a number of strategies to ensure that these policies work most effectively.

A key feature of the Patient Protection and Affordable Care Act (ACA) is state-based “exchanges.” These new health insurance marketplaces are designed to provide uninsured (and in some cases underinsured) individuals and small businesses with the ability to purchase affordable health insurance coverage for themselves and their employees respectively. States that establish and operate exchanges will do so within federal guidelines, although states will have the flexibility to make a number of distinctive design choices.

Under health reform, Medicaid eligibility will be expanded to reach nearly everyone under age 65 with income below 133 percent of the federal poverty level. As a result, millions of uninsured adults, including many with very low income and significant health needs, will become eligible for the program. This brief provides details of the benefit and cost-sharing rules that will govern the coverage available to these newly eligible adults Medicaid beneficiaries, and it identifies key considerations for state policymakers making Medicaid benefit design choices.

The Patient Protection and Affordable Care Act (PPACA) includes a much-discussed requirement that people secure health insurance coverage for themselves and their children. This "individual responsibility requirement" is an essential element of the new law, which will play a vital role in increasing the number of people with health insurance and make it possible to adopt a broad range of popular insurance reforms. This document provides policymakers and advocates with a detailed explanation of why the requirement was included in the new law and how it will work.

Under health care reform, the federal government is tasked with establishing the framework under which many provisions of the law are implemented. Within this framework, though, state policymakers will make many key decisions and serve as critical partners in the implementation process. States must begin planning soon for the bulk of reforms that go into effect in 2014.

Under health reform, Medicaid will be expanded to cover nearly all people under age 65 with incomes below 133 percent of the federal poverty line. This issue brief examines how the federal government and the states are expected to split responsibility for financing the expanded Medicaid coverage. For any given state, the share financed by the federal government will vary based on factors such as the state's Medicaid "matching rate," coverage decisions prior to the enactment of health reform, and the rate at which eligible people participate in its Medicaid program.

While many of the sweeping changes to insurance industry practices and other major provisions do not go into effect until January 1, 2014, there are some important early wins in health reform for children and their families. This issue brief reviews those early wins in some detail.

On March 23, 2010, President Obama signed into law the Congress-approved health care reform bill (H.R. 3590). The House also passed a set of amendments (H.R. 4782) that primarily incorporate changes included in President's health reform proposal. The Senate will vote on the changes before sending to the President for his final signature. This fact sheet describes the key Medicaid, CHIP, and low-income provisions in the combined bills.

The Patient Protection and Affordable Care Act (PPACA) requires that states maintain their current eligibility standards for Medicaid and the CHIP. These maintenance-of-eligibility (MOE) requirements apply to adults until the major components of health reform go into effect on January 1, 2014, and to children until September 30, 2019. This set of question and answers reviews how the MOEs are structured in the PPACA.

This fact sheet provides a description of the key Medicaid, CHIP, and low-income provisions in the health reform proposal released by President Obama on February 22, 2010.

The country has made significant progress covering children. Health reform has the potential to build upon this success by opening new doorways so that all children have quality and affordable health insurance and providing coverage options to their parents and the other adults in their lives. This fact sheet provides basic information on the coverage pathways for children and their families in the current health reform bills (HR 3962 and HR 3590) as passed by the House and Senate.

This fact sheet provides a description of the key Medicaid, CHIP, and low-income provisions in the health reform bill approved by the Senate on December 24, 2009.

This fact sheet provides a description of the key Medicaid, CHIP, and low-income provisions in the merged health reform bill released by the Senate on November 18, 2009.

This survey shows that families are still reeling from the recession, feeling pessimistic about the future, and struggling to afford health care. Health care costs are squeezing families financially, forcing them to make hard choices. For this reason, their goal for health care reform is overwhelmingly to make health care more affordable and to lower premiums and copayments that people must pay for their insurance coverage.

This fact sheet provides a description of the key Medicaid, CHIP, and low-income provisions in the merged health reform bill released by the House and amended on November 3, 2009.

This one-page fact sheet provides a brief overview of children's access to care in Medicaid.

This report provides a first look at state activity after the passage of CHIPRA and the availability of increased Medicaid funding in the economic stimulus package. It finds that despite unprecedented fiscal challenges, all but a few states held steady on children's health coverage, and twenty-three states took steps to move forward. This progress on children's coverage has important implications as the nation moves forward with health reform.

Because they are growing and developing, children have a distinct set of health care needs that evolve over time and differ from those of adults. Moreover, while as a group children are relatively healthy, one in seven has special health care needs. Given that under reform, many children will be covered through private plans and some children who are currently covered through public programs may be shifted to private plans, it is particularly important to consider how well private plans might meet children’s health care needs.

This side-by-side compares the House bill (H.R. 3200) as approved by the three committees of jurisdiction and the Senate HELP Committee bill. It focuses primarily on the provisions affecting children and low-income populations.

As drafted, the HELP Committee’s legislation would extend coverage to millions of Americans and take major steps toward transforming the health care delivery system. However, the legislation, as of June 9, 2009, lacks details on some key areas that must be addressed in order to fully evaluate its implications, particularly for children.This brief provides a summary of the Affordable Health Choices Act, an analysis of its implications for children, and a chart outlining key provisions of the legislation.

The nation has made significant progress in covering children, but nine million children still lack insurance and many more are at risk of not receiving the health care services that they need to develop and grow properly. To address these issues, children will need to be an integral part of the much larger health reform debate now underway. This report provides a blueprint of what children and families need from health reform, including an overview of where the remaining gaps are for children’s coverage, and recommendations on the key challenges that must be addressed in order to complete the puzzle.

Health care reform is once again a front and center issue. While the policy debates are just beginning, broad consensus exists that a newly reformed system ought to build on the components of the current system, including the Medicaid program. This means that a central question underlying health care reform is: How can each of those components work together to meet national health care reform goals? This question raises many important issues, including how to best build on and strengthen the Medicaid program.