CHA News Article

Report Outlines Findings From 50-State Survey on Medicaid,CHIP Policies

The Kaiser Family Foundation has released a report titled Modern Era Medicaid: Findings from a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP as of January 2015. The report provides a snapshot of state Medicaid and Children’s Health Insurance Program (CHIP) policies in place one year after key Affordable Care Act (ACA) Medicaid provisions took place, including the Medicaid expansion to low-income adults and new rules for streamlined enrollment and renewal processes that coordinate across insurance affordability programs (including Medicaid, CHIP and the health insurance marketplaces). The report finds there have been significant gains in coverage opportunities for low-income adults, most notably with increased eligibility levels for parents and childless adults in states that have expanded Medicaid.

Other key findings from the report reveal:


  • As of Jan. 1, 28 states set their Medicaid income eligibility levels for parents and other adults to at least 138 percent of the federal poverty level, reflecting their implementation of the ACA Medicaid expansion.
  • Eligibility levels remain very limited for adults in the 23 states not adopting the Medicaid expansion at this time.
  • Medicaid and CHIP coverage for children and pregnant women remains strong.
  • Although eligibility levels for adults markedly increased over pre-ACA standards as a result of the Medicaid expansion, they remain well below those of children and pregnant women.

Progress toward streamlined enrollment and renewal processes

  • States have achieved major progress implementing the modernized and streamlined enrollment and renewal processes under the ACA, but work continues in many areas.
  • As of Jan. 1, individuals can apply online for Medicaid at the state level in all but one state, and the majority of states are accepting Medicaid applications by phone.
  • States have established eligibility verification policies that seek to rely on electronic data and minimize paperwork for individuals.
  • A range of additional options facilitates enrollment and renewal of eligible individuals in some states.
  • The way that states integrate their Medicaid and marketplace eligibility determination systems affects coordination across coverage programs.

Premiums and cost-sharing

  • In general, premiums and cost-sharing remain limited in Medicaid and CHIP.

Looking ahead, there is no deadline for states to expand Medicaid, and debate over the adult expansion will continue in some states in 2015. The report acknowledges that, though Medicaid and CHIP coverage for children and pregnant women remains strong across states, without congressional action CHIP funding will not be continued beyond September 2015. If CHIP funding expires, some children may lose coverage and some may face higher premiums and cost-sharing for coverage. The loss of enhanced CHIP funding would also have budgetary implications for states.

The report also finds that on the operational and systems side, many states have achieved significant progress toward realizing the ACA’s vision of a modernized, streamlined enrollment system, but work continues in many areas, including establishing automated renewal processes and enhancing and expanding system functionality.

The full report is attached.