Paths to Coverage for Kids: Public Sector Coverage

Medicaid and the Children’s Health Insurance Program (CHIP) are the most significant source of public coverage for low-income children and their families. Together these programs provide coverage to 27.4 million children and youth and have helped reduce the number of uninsured children to 7.2 million in 2012.1 With the help of the ACA’s new eligibility and renewal policies, Medicaid and CHIP will continue to be key sources of coverage for children and youth. Some key ACA provisions that apply to both Medicaid and CHIP and will impact children include:

  • Maintenance of Effort: States are required to maintain existing Medicaid and CHIP eligibility levels for children through September 30, 2019. This means that states must maintain the enrollment and eligibility practices that were in place as of March 23, 2010 when the ACA was signed into law, or risk losing their federal Medicaid matching funds.
  • Simplified and Coordinated Enrollment and Renewal Processes: The ACA envisions that eligibility and renewal determinations for Medicaid, CHIP, and the marketplaces will occur through a streamlined “no wrong door” eligibility and enrollment process by using federal and state data sources to provide real-time eligibility decisions.
  • Modified Adjusted Gross Income (MAGI): MAGI is a new method for determining a family’s income for the purpose of determining eligibility in coverage programs. The change is intended to make enrollment simpler and faster, and to be standardized across Medicaid, CHIP, and the marketplaces.
    • Elimination of income disregards: Under MAGI, income disregards (other than the 5 percent across the board disregard) will be eliminated. The final federal rule (Federal Register Vol. 77 No. 57) requires that a child who becomes ineligible for Medicaid directly as a result of the elimination of income disregards be assured coverage through a state’s separate-CHIP program. For states that don’t have a separate-CHIP program this will mean establishing a temporary program, which states can choose to design and operate to be the same as its existing Medicaid expansion program. An April 2013 frequently asked questions bulletin from the Centers for Medicare and Medicaid Services outlines options for states to implement this provision.

NASHP Resources

Public Insurance Programs and Children with Special Health Care Needs: A Tutorial of the Basics of Medicaid and CHIPThis NASHP and Catalyst Center tutorial gives a broad overview of Medicaid and CHIP programs and the changes they are undergoing as a result of health care reform.

Other Resources

Fact Sheet on Maintenance of Effort Requirements Under the ACAThis Fact Sheet from Families USA summarizes maintenance of effort requirements under the ACA.

Medicaid and Children’s Health insurance Program Provisions in the New Health Reform Law: This Kaiser Family Foundation brief summarizes key provisions in the ACA related to Medicaid and CHIP.

1The Kaiser Family Foundation, Health Insurance Coverage of Low Income Children 0-18 (Under 200% FPL) (2011-2012). Accessed March 10, 2014.