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Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2018: Findings from a 50-State Survey

March 20, 2018

This 16th annual 50-state survey provides data on Medicaid and the Children's Health Insurance Program (CHIP) eligibility, enrollment, renewal and cost sharing policies as of January 2018. It takes stock of how the programs have evolved as the fifth year of implementation of the Affordable Care Act (ACA) begins, discusses policy changes made during 2017, and looks ahead to issues that may affect state policies moving forward. It is based on a survey of state Medicaid and CHIP officials conducted by the Kaiser Family Foundation and the Georgetown University Center for Children and Families.Key FindingsMedicaid and CHIP provide a robust base of coverage for low-income children. All but two states cover children with incomes up to at least 200% of the federal poverty level (FPL, $41,560 per year for a family of three in 2018), including 19 states that cover children with incomes at or above 300% FPL. The ten-year extension of federal funding for CHIP approved by Congress provides states stable funding to maintain children's coverage and continues protections for children's coverage moving forward.There have been major gains in Medicaid eligibility for parents and other adults under the Affordable Care Act (ACA) Medicaid expansion, but eligibility remains limited in the 19 states that have not implemented the expansion. Among non-expansion states, the median eligibility level for parents is 43% FPL ($8,935 for a family of three in 2018) and other adults generally are ineligible. Alabama and Texas have the lowest parent eligibility limits at 18% FPL or $3,740 per year for a family of three. Additional states may expand Medicaid for adults in the coming year, which would reduce the number of poor uninsured adults who fall into the coverage gap. States moving forward with expansion may seek waivers to add requirements or restrictions for adults as a condition of expanding.Through significant investments of time and resources, most states have transformed their Medicaid and CHIP enrollment and renewal processes to provide a modernized, streamlined experience as outlined in the ACA. With these processes, a growing number of states are processing real-time eligibility determinations and automated renewals through electronic data matches with trusted data sources. Looking ahead, waivers and other proposed changes for adults, including premiums and cost sharing, work requirements, and lockout periods, require complex documentation and costly administrative processes that run counter to the simplified enrollment and renewal processes states have implemented under the ACA.

Measuring and Improving Health Care Quality for Children in Medicaid and CHIP: A Primer for Child Health Stakeholders

March 16, 2016

A large body of evidence shows that, compared to low-income uninsured children, Medicaid has been highly successful in providing children with a usual source of care and regular well-child care while significantly reducing unmet or delayed needs for medical care, dental care, and prescription drugs due to costs. Nonetheless, quality improvement centers on the notion that systematic and continuous actions lead to measurable improvement in health care services and health status. To this end, health care quality improvement efforts in Medicaid and the Children's Health Insurance Program (CHIP) have accelerated significantly in the past several years largely due to the CHIP Reauthorization Act of 2009 (CHIPRA) and the Affordable Care Act of 2010 (ACA). In May 2015, the Centers for Medicaid and Medicare Services (CMS) also proposed a major modernization of federal rules regarding Medicaid managed care. If enacted, the regulations will have sweeping implications for state quality strategies that extend to all health care delivery mechanisms, including fee-for-service. Provisions in the new rules call for transparency and for states to engage stakeholders in planning and implementation.Given the acceleration in health care quality improvement and opportunities for stakeholder engagement, this brief is intended as a primer for child health policy and advocacy organizations that want to focus their efforts beyond coverage to ensure that every child enrolled in Medicaid and CHIP receives high quality health care. The goal is to help stakeholders better understand the current state of quality measurement and improvement, specifically as it pertains to children enrolled in Medicaid and CHIP. It covers a brief history of health care quality efforts, explains the basics of quality measurement and improvement, discusses the challenges in data collection and analysis, and describes how quality improvement initiatives work. Importantly, it discusses the key roles that child health policy and advocacy organizations can play in making sure that our public coverage programs for children deliver high quality health care that advances health outcomes and strives for continuous improvement.

Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies as of January 2016: Findings from a 50-State Survey

January 19, 2016

January 2016 marks the end of the second full year of implementation of the Affordable Care Act's (ACA) key coverage provisions. This 14th annual 50-state survey of Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing policies provides a point-in-time snapshot of policies as of January 2016 and identifies changes in policies that occurred during 2015. Coverage is driven by two key elements -- eligibility levels determine who may qualify for coverage, and enrollment and renewal processes influence the extent to which eligible individuals are enrolled and remain enrolled over time. This report provides a detailed overview of current state policies in these areas, which have undergone significant change as a result of the ACA.Together, the findings show that, during 2015, states continued to implement the major technological upgrades and streamlined enrollment and renewal processes triggered by the ACA. These changes are helping to connect eligible individuals to Medicaid coverage more quickly and easily and to keep eligible people enrolled as well as contributing to increased administrative efficiencies. However, implementation varies across states, and lingering challenges remain. The findings illustrate that the program continues to be a central source of coverage for low-income children and pregnant women nationwide and show the growth in Medicaid's role for low-income adults through the ACA Medicaid expansion.

Performing Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011-2012

January 18, 2012

Analyzes findings on state trends in maintaining or expanding eligibility for public coverage and improving enrollment and renewal procedures. Highlights some states' expansion of Medicaid eligibility and the use of technology to achieve efficiencies.

Holding Steady, Looking Ahead: Annual Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost Sharing Practices in Medicaid and CHIP, 2010-2011

January 11, 2011

Analyzes findings on state trends in maintaining or expanding eligibility for public coverage and improving enrollment and renewal procedures. Highlights the challenges of developing the Web-based eligibility systems required under healthcare reform.