Statement by Georgetown University’s Health Policy Institute’s Center for Children and Families by Jocelyn Guyer, co-director, on February, 25th, 2011

“The Administration today released a clean, straightforward interpretation of the provisions in the Affordable Care Act. This is good news for families seeking to gain solid footing after tough economic times. The Administration’s action protects coverage for children and families by drawing on already-established rules from nearly identical “maintenance-of-effort” provisions included in the Recovery Act. These stop states from cutting children and others off coverage by reducing eligibility or by using “backdoor” strategies to create roadblocks to coverage through red tape and paperwork requirements.”

CCF has evaluated the implications that a repeal of the MoE would have on children and families. The full report is available on our website: click here to view

Background:

The stability protections or maintenance-of-effort provisions included in the Affordable Care Act require states to maintain the eligibility rules that were in place when the law took effect on March 23, 2010. The stability protections cover adults until 2014 and children through 2019. The American Recovery and Reinvestment Act also included stability protections for those insured through Medicaid but did not extend these protections to CHIP beneficiaries.

Today, CMS issued a letter and a frequently asked questions document that outlines how the Administration will work with states to implement the Affordable Care Act’s stability protections. Most notably, the letter indicates CMS will follow rules already established to implement the stability protections included in the Recovery Act unless otherwise noted. These rules preclude states from:

• Eliminating Medicaid for an entire category of people covered at state option;
• Lowering the income threshold for Medicaid coverage, making fewer people eligible;
• Eliminating a state’s CHIP program or scaling back income eligibility thresholds to make fewer children eligible;
• Imposing a new asset test in Medicaid or CHIP;
• Imposing new requirements for families to renew their coverage more frequently; or Imposing a new requirement for families to conduct a face-to-face interview instead of allowing mail-in or on-line applications.

In a few instances, the guidance addresses new issues that arise out of difference between the Recovery Act’s provisions and those included in the Affordable Care Act.

• Option to scale back coverage of adults above 133 percent of the federal poverty level. Congress explicitly gave states with budget deficits this option in the Affordable Care Act, which applies only to adults who are not pregnant or disabled.
• Not requiring states to renew expiring waivers. States that have expanded Medicaid to people using 1115 waivers are not obligated to renew these waivers. CMS already had articulated this policy in a letter to Arizona on February 15th.
• Allowing premium increases consistent with inflation. In a divergence from the Recovery Act rules, states can increase premiums in Medicaid and CHIP to reflect inflation. In explaining the divergence, CMS noted that the stability protections included in the Affordable Care Act are in place for a considerably longer period of time.

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