Medicaid and CHIP: Changes Made by the Reconciliation Act of 2010 to the Patient Protection and Affordable Care Act (PPACA,H.R. 3590, P.L. 111-148)

Evelyne P. Baumrucker, Coordinator
Analyst in Health Care Financing

Cliff Binder, Coordinator
Analyst in Health Care Financing

Julie Stone
Specialist in Health Care Financing

Elicia J. Herz
Specialist in Health Care Financing

On March 23, 2010, the President signed into law H.R. 3590, the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148), as passed by the Senate on December 24, 2009, and the House on March 21, 2010. This new law will, among other changes, make several significant statutory changes affecting Medicaid and the Children's Health Insurance Program (CHIP). 

On March 21, 2010, the House passed an amendment in the nature of a substitute to H.R. 4872, the Health Care and Education Reconciliation Act of 2010 (hereafter referred to as the reconciliation bill). The reconciliation bill would make amendments to PPACA and is now before the Senate for consideration. 

The reconciliation bill includes two titles: (1) Coverage, Medicare, Medicaid, and Revenues, and (2) Education and Health. Title I contains provisions related to health care and revenues, including modifications made by reconciliation bill to P.L. 111-148. Title II includes amendments to the Higher Education Act of 1965, which authorizes most of the federal programs involving postsecondary education, and other health amendments. 

This report provides a brief summary of P.L. 111-148 followed by a discussion of the modifications that would be made to the Medicaid and CHIP provisions contained in the reconciliation bill. This report reflects legislative changes contained in the reconciliation bill published by the House Committee on Rules on March 18, 2010. Selected highlights of the Medicaid and CHIP changes that would be made by the reconciliation bill include provisions that 

• increase primary care physician payment rates for selected patient treatments; 

• revise the definition of the average manufacturer price (AMP) to help make AMP more closely reflect the manufacturers' average prices; 

• delay the effective date of the Community First Choice Option; 

• change state FMAP rates for newly eligible populations, and changes income counting rules for certain populations; 

• provide an increase in the territories' spending rate caps beginning with the second quarter of FY2011; 

• provide additional program integrity funding through indexing of the Medicaid Integrity Program for fiscal years beginning with FY2010; and 

• modify Medicaid Disproportionate Share Hospital (DSH) payment reductions. 


Date of Report: March 25, 2010
Number of Pages: 16
Order Number: R41125
Price: $29.95

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