Approaches to Medicaid, CHIP Expansion Expected to Differ

Janice Simmons, for HealthLeaders Media , July 27, 2009

The major health reform bills working their way through the House and under development in the Senate would expand Medicaid and provide new options for families whose children are eligible for each state's Children's Health Insurance Program (CHIP), according to a new policy brief from the Robert Wood Johnson Foundation.

However, each establishes--or is expected to establish--"different income eligibility limits, allows for different approaches for private insurance coverage, and specifies different arrangements for how the federal government will share the costs," the briefs' researchers note.

In the House, the bill (HR 3200) introduced earlier this month would expand Medicaid to all individuals with incomes up to 133% of the federal poverty level. The cost of covering this new group would be fully paid for by the federal government. (The Congressional Budget Office has estimated that the cost of Medicaid and CHIP provisions would run $438 billion over 10 years.) In addition:

  • No state could reduce the eligibility levels or benefits in place for Medicaid beneficiaries as of June 30, 2009. This "maintenance of effort" provision would mean that new federal dollars to help expand Medicaid would go mainly to states that have had "less generous eligibility levels and benefits in the past," the report said.
  • Medicaid would cover all newborns for up to 60 days if they did not have coverage from other sources.
  • Adults without dependent children who become newly eligible for Medicaid could instead sign up for private coverage through a health insurance exchange--if they were enrolled in "qualified health coverage" at least 6 months before they became eligible for Medicaid.
  • To expand the number of primary care providers willing to care for Medicaid populations, payment rates for primary care services would be increased with new federal funding.


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