Expansion of Public Health Insurance Programs
Treatment of Medicaid
States are required to expand Medicaid to all non-Medicare eligible individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% Federal Poverty Level (FPL) based on modified adjusted gross income. As under current law undocumented immigrants are not eligible for Medicaid. All newly eligible adults will be guaranteed a benchmark benefit package that meets the essential health benefits available through the Exchanges.
The Supreme Court ruling on the constitutionality of the ACA upheld the Medicaid expansion, but limited the ability of Health and Human Services (HHS) to enforce it, thereby making the decision to expand Medicaid optional for states.
To finance the coverage for the newly eligible (those who were not previously eligible for at least
benchmark equivalent coverage, those who were eligible for a capped program but were not enrolled,
or those who were enrolled in state-funded programs), states will receive 100% federal funding for 2014
through 2016, 95% federal financing in 2017, 94% federal financing in 2018, 93% federal financing in
2019, and 90% federal financing for 2020 and subsequent years. States that have already expanded eligibility to adults with incomes up to 100% FPL will receive a phased-in increase in the federal medical assistance percentage (FMAP) for non-pregnant childless adults so that by 2019 they receive the same
federal financing as other states (93% in 2019 and 90% in 2020 and later). States have the option to
expand Medicaid eligibility to childless adults beginning on April 1, 2010, but will receive their regular
FMAP until 2014. In addition, Medicaid payments increase for fee-for-service and managed care for
primary care services provided by primary care doctors (family medicine, general internal medicine or
pediatric medicine) to 100% of the Medicare payment rates for 2013 and 2014. States will receive 100%
federal financing for the increased payment rates. (Effective January 1, 2014)
Treatment of CHIP
States are required to maintain current income eligibility levels for children in Medicaid and the Children’sHealth Insurance Program (CHIP) until 2019 and extend funding for CHIP through 2015. CHIP benefit
package and cost-sharing rules will continue as under current law. States may provide CHIP coverage to children of state employees who are eligible for health benefits if certain conditions are met. Beginning in 2015, states will receive a 23 percentage point increase in the CHIP match rate up to a cap of 100%. CHIP-eligible children who are unable to enroll in the program due to enrollment caps will be eligible for tax credits in the state Exchanges.
