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Monday, January 30, 2012

Medicaid and the State Children’s Health Insurance Program (CHIP) Provisions in ACA: Summary and Timeline

Evelyne P. Baumrucker
Analyst in Health Care Financing

Cliff Binder
Analyst in Health Care Financing

Elicia J. Herz
Specialist in Health Care Financing

Elayne J. Heisler
Analyst in Health Services

The President signed into law H.R. 3590, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), on March 23, 2010. Seven days later, a second bill, H.R. 4872, was signed into law by the President to modify ACA. This second law, the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152), was signed into law on March 30, 2010. Together these measures constitute what is referred to as the health care reform law, which makes many significant changes to the private and public markets for health insurance, as well as modifies aspects of the publicly financed health care delivery system. It represents the most significant reform to the Medicaid program since its establishment in 1965. This report details some of the major changes to the Medicaid and CHIP programs and provides a timeline of effective dates for these provisions.

In general, the Medicaid law (1) raises Medicaid income eligibility levels for certain people up to 133% of the federal poverty level, (2) adds both mandatory and optional benefits to Medicaid, (3) increases the federal matching payments for certain groups of beneficiaries and for particular services provided, (4) provides new requirements and incentives for states to improve quality of care and encourage more use of preventive services, and (5) makes a number of other Medicaid program changes. Regarding CHIP, the law includes a new requirement for states to maintain their current program structures through FY2019 and extends additional CHIP funding through FY2015.

To help explain the most important Medicaid and CHIP changes, provision descriptions are grouped into the following six major issue areas: eligibility, benefits, financing, program integrity, demonstrations and grant funding, and miscellaneous. Appendix A provides a detailed implementation timeline of the Medicaid and CHIP provisions. Appendix B is a crosswalk between the provision titles and the amending sections of P.L. 111-148 and P.L. 111-152 for all of the Medicaid and CHIP provisions. Finally, Appendix B is a list of abbreviations used in this report and their definitions. This report reflects the Medicaid and CHIP provisions at the time of ACA’s enactment and will not be updated to capture subsequent program guidance, public notices, or rulemaking.

Date of Report: January 18, 2012
Number of Pages: 112
Order Number: R41210
Price: $29.95

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