By Joan Alker and Sean Miskell,

As Congress continues to mull over the future of the Children’s Health Insurance Program, we at CCF continue to mull over the policy implications for children of various proposals put forth. As regular readers of Say Ahhh! know, a recently released discussion draft by Senator Hatch, and Reps Upton and Pitts included a repeal of the maintenance-of-effort (MOE) provision included in the Affordable Care Act which holds steady children’s eligibility levels for Medicaid and CHIP.

My colleague Sean Miskell and I have written a new paper on what we can learn from the history of the CHIP program about how states might react to this newfound flexibility. In a perfect world, states would always do right by kids, and children would be able to access the continuous coverage they need to assure healthy development and access to more cost-effective preventive and primary care. But we don’t live in a perfect world – so it is critically important that the MOE be maintained.

Here are our key points:

• Federal protections, notably the Affordable Care Act (ACA)’s ‘maintenance of effort’ provision, have helped bring uninsured rates for kids down to historic lows. Today, the only state in the country not subject to this protection is Arizona – without the MOE, the state virtually eliminated its Children’s Health Insurance Program (CHIP), underscoring the importance of the federal protection in keeping kids coverage off the state negotiating table.
• Even seemingly small changes to eligibility and enrollment procedures can have significant and lasting implications for families and coverage for children.
• Without federal protections on eligibility requirements, history shows that some states will almost certainly respond to tough fiscal environments by scaling back health coverage for children. Federal Actions that cut or fundamentally restructure CHIP would compound the likelihood of state moves to cut children’s coverage.