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.

 
 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. 

• Federal Health Reform webpage

• Health Reform 2011 State Legislative Tracking Database - latest listings, with summaries and status for about 600 measures filed so far this year. Includes a "Medicaid" search option.   Publiished March 15, 2011.
• "Putting Reform into Medicaid and Medicaid into Reform: A Two‐Way Street" - Slide presentataion by Director Cynthia Mann of CMS at NCSL's Spring Forum, April 2010.

• NCSL’s Medicaid web page

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. 

• NCSL’s Children’s Health Insurance web page

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: