Aligning Eligibility for Children: Moving the Stairstep Kids to Medicaid
Issue Brief
As discussed below, these children will continue to receive the higher CHIP matching rate after they are transferred to Medicaid.
Currently, all children from birth to age 6 with family incomes up to 133% of the FPL are eligible for Medicaid. For CHIP, 46 states and D.C. cover children up to or above 200% of the FPL. The minimum upper income limit in CHIP is 160% of the FPL in North Dakota, and the maximum upper limit in CHIP is 400% of the FPL in New York.
National Federation of Independent Business v. Sebelius, Slip Opinion, Syllabus, at 5.
Letter from Secretary of Health and Human Services Kathleen Sebelius to the Governors (July 10, 2012) http://capsules.kffhealthnews.org/wp-content/uploads/2012/07/Secretary-Sebelius-Letter-to-the-Governors-071012.pdf.
Estimates calculated based on the number of estimated stairstep children moving to CHIP in 2014 was collected from state officials and state advocates and using June 2012 CHIP monthly enrollment data provided to Health Management Associates for the Kaiser Commission on Medicaid and the Uninsured.
Snyder, Laura and Robin Rudowitz. “Premiums and Cost-Sharing in Medicaid: A Review of Research Findings.” Kaiser Commission on Medicaid and the Uninsured, February 2013. http://www.kff.org/medicaid/upload/8417.pdf.
It is important to note that the Centers for Medicare and Medicaid Services (CMS) issued proposed rules on January 22, 2013, that would streamline and simplify Medicaid premium and cost-sharing rules and provide states more flexibility. For a comparison of the current Medicaid cost-sharing rules and the CMS proposed rules, see Snyder, Laura and Robin Rudowitz. “Premiums and Cost-Sharing in Medicaid.” Kaiser Commission on Medicaid and the Uninsured, February 2013.
Georgetown University Center for Children and Families. “Cost Sharing for Children and Families in Medicaid and CHIP,” 2009.
Ibid.
States cannot impose any cost sharing on children in Medicaid below 150 percent of the federal poverty level except in a narrow range of circumstances (e.g., a non-emergency use of the emergency room, only if a Medicaid enrollee has been provided with an appropriate referral to an alternative provider and for certain prescription drugs). At more moderate-income levels, federal rules also exempt some services, such as preventive services for children, from cost sharing.
States can charge premiums through Section 1115 waiver authority.
J. Boylston Herndon, et al., “The Effect of Premium Changes on SCHIP Enrollment Duration,” Health Services Research, 43: 458-477 (September 2007).
Recently, HHS released guidance to states confirming that through Section 1115 waiver authority, states may implement 12-month continuous eligibility for parents, which will further align family coverage.
States have the option to implement continuous eligibility, allowing children to maintain Medicaid or CHIP coverage for up to one full year, even if families experience a change in income or family status.
Georgetown University Health Policy Institute Center for Children and Families. “Medicaid Provides Needed Access to Care,” February 2013.
Public Law 111-152. Health Care and Education Reconciliation Act of 2010 (HCERA), enacted on March 30, 2010.
“Medicaid Financing: An Overview of the Federal Medicaid Matching Rate (FMAP).” Kaiser Commission on Medicaid and the Uninsured, September 2012.
Section 2101(a) of the Patient and Protection and Affordable Care, P.L. 111-148 includes a provision that will increase each state’s CHIP FMAP by 23 percentage points on October 1, 2015. However CHIP funding expires in 2015 and must be renewed by Congress; so it is unclear if this increase will go into effect.
Federal Register / Vol. 77, No. 57 / Friday, March 23, 2012 / Rules and Regulations / Page 17149. Available at https://www.federalregister.gov/articles/2012/03/23/2012-6560/medicaid-programeligiblity-changes-under-the-affordable-care-act-of-2010.
Center for Medicaid and CHIP Services Informational Bulletin, Questions and Answers: Medicaid and the Affordable Care Act, Feb. 6, 2013, available at http://medicaid.gov/State-Resource-Center/FAQ-Medicaid-and-CHIP-Affordable-Care-Act-ACA-Implementation/Downloads/ACA-FAQ-BHP.pdf.
States will likely see savings through this continuation of enhanced FMAP in 2014.
Public Consulting Group. “State of Utah Medicaid Expansion Assessment. Impact Analysis 2014-2023.” http://health.utah.gov/documents/PCGUtahMedicaidExpansionAnalysis.pdf.
Social Services Estimating Conference. Estimates Related to the Affordable Care Act: Title XIX (Medicaid). http://www.fdhc.state.fl.us/medicaid/pdffiles/Estimates_as_requested_by_House_Staff.pdf. December 20, 2012
The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) allowed states to use tools to implement ELE. States can use eligibility determinations from other public need-based programs, such as Supplemental Nutrition Assistance Program, or Head Start to streamline enrollment.
States have the option to keep children covered in Medicaid and CHIP for 12 months, regardless of whether their family income changes in that time frame.
The Centers for Medicare and Medicaid Services (CMS) granted federal approval for the Department of Health Care Services (DHCS) to begin the transition via the Bridge to Reform 1115 Demonstration Waiver.
The HFP transition will occur in four phases in 2013:
Phase 1A: Children enrolled in a HFP plan that is also a Medi-Cal managed care plan.
Phase 1B: Additional children enrolled in a HFP plan that is also a Medi-Cal managed care plan, in their county of residence.
Phase 1C: Remaining children enrolled in a HFP health plan that is also a Medi-Cal managed care plan, in their county of residence.
Phase 2: Children enrolled in a HFP plan that is a subcontractor of a Medi-Cal managed care plan, in their county of residence.
Phase 3: Children enrolled in a HFP plan that is not a Medi-Cal managed care plan and does not contract with a Medi-Cal managed care plan.
Phase 4: Children enrolled in the HFP residing in a county that is not currently a Medi-Cal managed care county.
