Medicaid and CHIP: Changes Made by the Health Care and Education Reconciliation Act of 2010 (HCERA, P.L. 111-152) to the Patient Protection and Affordable Care Act (PPACA, 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. PPACA will, among other changes, modify Medicaid and the Children's Health Insurance Program (CHIP) statutes. In addition, 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 (HCERA, P.L. 111-152). After being passed by the House, HCERA was subsequently amended and passed by the Senate before being approved again by the House on March 25, 2010. HCERA was signed by the President on March 30, 2010. HCERA, which amends PPACA, combined with PPACA form the health care reform law. 

HCERA includes the following 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 HCERA to PPACA. 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, which include other changes to PPACA. 

This report provides a brief summary of PPACA followed by a discussion of the modifications made to the Medicaid and CHIP provisions by HCERA. This report reflects legislative language in HCERA as passed by the House on March 25, 2010. Selected highlights of the Medicaid and CHIP amendments made by HCERA to PPACA include the following: 

• primary care physician payment rates for selected patient treatments were increased; 

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

• the effective date of the Community First Choice Option was delayed; 

• state FMAP rates for newly eligible populations were changed, as were income counting rules for certain populations; 

• the territories' spending rate caps were increased beginning with the second quarter of FY2011; 

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

• Medicaid Disproportionate Share Hospital (DSH) payment reductions were modified. 


Date of Report: April 1, 2010
Number of Pages: 15
Order Number: R41125
Price: $29.95

Document available electronically as a pdf file or in paper form.
To order, e-mail sales@pennyhill.com or call us at 301-253-0881.