During the debate on CHIP, conversations focused a lot on what would happen to kids’ coverage without the program. Now that Congress has extended CHIP funding through 2017, we look to the future. In the near-term, if no new funds are available after 2017, states may eliminate their separate CHIP programs. Further, many Say Ahhh! readers are well aware that states may roll back eligibility thresholds when the maintenance-of-effort (MOE) provision expires in 2019 if it is not continued. Without the MOE, states can’t always be relied on to do the right things for kids. History shows that some states will respond to tough fiscal environments by scaling back coverage for children. We need not look any further than Arizona to know what a difference MOE makes for kids— as the only state in effect not subject to the CHIP MOE, Arizona has dismantled its CHIP program, leaving many families in limbo.
A new study published in Health Affairs explores the impact to children’s coverage if the MOE expires and all states revert to minimum Medicaid and CHIP eligibility thresholds – 138 percent of FPL or $2,310 per months for a family of three in 2015. The study builds on prior work done by researchers at the Urban Institute for MACPAC.
First, the authors estimated how many children up to 400% of FPL would be eligible for ACA programs in 2014 (see pie chart below) and found that of the 57.5 million children:
- 56% are eligible for Medicaid
- 19% are eligible for CHIP
- 3% are eligible for Marketplace subsidies
- 22% are ineligible for Marketplace subsidies
The authors then calculated the breakdown among these groupings if all states eliminated MOE requirements and CHIP funding expired, which would potentially rollback coverage for children eligible for separate CHIP programs and children eligible for Medicaid with incomes above 138% of the FPL, estimating the maximum possible impact on kids. Of the 57.5 million described above half of the children would be eligible for marketplace subsidies (6 million or 10%) or Medicaid (25 million or 44%). The other half (26.5 million or 46%) would be ineligible for marketplace subsidies because of access to ESI (regardless of family glitch) or immigration status. Eliminating the MOE—and, again, assuming every state would revert back to Medicaid minimum levels for kids— would lead to an increase of 14 million children ineligible for public coverage through Medicaid/CHIP or Marketplace subsidies.
The authors also examined other possible outcomes assuming that Medicaid expansion states would continue to maintain Medicaid eligibility levels for children and would not rollback eligibility levels, which would likely be more in line with the variation in state responses to an MOE rollback. In this case, 5.6 million more children would become ineligible for Medicaid, CHIP, and Marketplace subsidies in 2019.
As we look ahead to the near- and longer-term future of children’s coverage, this study is an important reminder that MOE and the CHIP program continue to play vital coverage roles for kids with significant and lasting implications for families.
