• Description

Under the Affordable Care Act (ACA), the 2016 marketplace open enrollment period for health insurance will last from November 1, 2015–January 31, 2016. The ACA expands important coverage opportunities for women, children, and families through the marketplace and Medicaid expansion. Several studies have shown that when parents have access to coverage, children are less likely to be uninsured.Thus, state Title V maternal and child health (MCH) programs can play an important role in educating women, children and their families about eligibility levels for various health insurance coverage options and potential gaps they may face in gaining coverage. The importance of health reform is seen in the proposed National Performance Measures for Title V, which includes direct and indirect measures for access to healthcare services such as the percentage of children without health insurance. For states that need support in understanding health reform within their state, the MCH National Workforce Center has developed a tool to help states do so.

This fact sheet is designed to assist state MCH programs in understanding insurance affordability programs, not including employer-sponsored coverage. Figures 1 and 2outlinethe federal minimum eligibility levels for each income scenario, including identified and potential gaps ineligibility for MCH populations both with and without Medicaid expansion. Table 1 is designed to be interactive; hyperlinks direct readers to detailed resources. The table highlights the projected minimum or essential health insurance benefits for MCH populations, including children and youth with special health care needs(CYSHCN), for each of the following coverage options or scenarios: Medicaid, Children's HealthInsurance Plan (CHIP), insurance purchased through the health insurance marketplace(exchange), and safety-net services for those remaining uninsured. It is important to note that eligibility for public insurance coverage is limited to those who live in the United States, have satisfactory immigration status, and are not incarcerated.

These charts provide an overview of federal benefit and coverage requirements under the ACA. However, the actual benefits package, cost-sharing, and affordability for families will vary widely depending on the state. These charts will be updated as needed in response to any funding or policy changes as the ACA is implemented.