Health Reform and Medicaid/CHIP Overview
Medicaid is currently a public health coverage program for low-income children, their parents, the elderly and people with disabilities. Jointly financed by the states and the federal government, Medicaid pays for health and long-term care services for more than 55 million people, accounting for roughly one sixth of the nation’s health care spending and almost half of all funds spent on long-term care. States have considerable flexibility in determining eligibility policy; therefore, eligibility varies widely state-to-state.
In 2014, the Patient Protection and Affordable Care Act will expand Medicaid to most people with incomes up to 133 percent of the federal poverty guidelines ($14,404 for an individual and $29,326 for a family of four in 2009). This will remove the state-by-state variability for the lowest income people in the nation and will, for the first time, require states to extend eligibility to childless adults. The new federal law will provide federal financing (FMAP) for all newly eligible individuals according to the following schedule: 100 percent FMAP for 2014 to 2016; 95 percent FMAP for 2017; 94 percent FMAP for 2018; and 90 percent FMAP for 2020 and beyond.
Federal Health Law and the Supreme Court
On June 28, 2012 the U.S. Supreme Court upheld most provisions of the Patient Protection and Affordable Care Act, but rejected the portion of the law that would have penalized states that did not comply with the expanded eligibility requirements for Medicaid. The law called for cutting off all Medicaid funding to states that did not go along with the expanded eligibility provision. NCSL will continue to update and analyze the law and its effects on states.
For NCSL’s updated summary and analysis of the Court’s decision and its effects see: U.S. Supreme Court and Federal Health Law
The new federal law provides for other changes to state Medicaid programs. The following are a list of online resources related to federal health reform, Medicaid and CHIP.
The Children’s Health Insurance Program (CHIP)
The Children's Health Insurance Program (CHIP, formerly SCHIP) has allocated about $20 billion over 10 years to help states insure low-income children who are ineligible for Medicaid but cannot afford private insurance. States receive an enhanced federal match (greater than the state's Medicaid match) to provide for this coverage. Each state is entitled to a specific allotment of federal funds each year.
Among many provisions, the new federal health reform law:
Extends the authorization of the CHIP program for an additional two years, through Sept. 30, 2015.
Requires states, upon enactment (March 23, 2010), to maintain current income eligibility levels for CHIP through Sept. 30, 2019. States are prohibited from implementing eligibility standards, methodologies or procedures that are more restrictive than those in place as of March 23, 2010, with the exception of waiting lists for enrolling children in CHIP.
For more information contact NCSL Staff: