Despite difficult economic times, forty-nine states maintained or invested in expansions or improvements in their eligibility and enrollment policies for their Medicaid and Children’s Health Insurance Programs (CHIP) in 2010. That’s the headline coming out of the tenth annual Kaiser Commission on Medicaid and Uninsured state survey of Medicaid and CHIP eligibility rules, conducted this year with the Georgetown University Center for Children and Families. Without Medicaid and CHIP’s stability, many more children and families would have likely become uninsured, adding to the more than fifty million Americans currently without health insurance coverage.

Why were Medicaid and CHIP eligibility policies so stable? Well, primarily because provisions in the American Recovery and Reinvestment Act of 2009 required states to maintain their Medicaid eligibility rules and enrollment procedures as a condition of receiving a boost in funding from a temporary increase in the federal Medicaid matching rate. It’s also worth noting here that the Affordable Care Act (ACA) includes a similar requirement to maintain both Medicaid and CHIP eligibility rules and procedures for children until 2019 (and for adults until 2014 when the ACA makes subsidies to purchase coverage available).

Additional key findings from the report include:

  • — Thirteen states implemented targeted Medicaid and CHIP eligibility expansions for children, pregnant women, and adults in 2010. Most of these expansions were aimed at providing coverage to uninsured children and some produced state savings because states were able to draw down federal matching funds to help pay for coverage that was previously paid for solely with state dollars.
  • — Three states (Colorado, Kansas, and Oregon) increased Medicaid and CHIP income eligibility levels for children. Twenty-five states now cover children in families with income at least up to 250 percent of the federal poverty level (FPL), or $45,775 for a family of three in 2010.
  • — Six states (Delaware, Minnesota, Montana, Nebraska, North Carolina, and Wisconsin) took advantage of the option to cover lawfully residing immigrant children and pregnant women during their first five years residing in the country. As of the end of 2010, this means that twenty-one states have eliminated this barrier for children.
  • — While meaningful progress continues to be made in expanding coverage for children, parent eligibility for Medicaid and CHIP continues to lag far behind. Only Colorado expanded eligibility for parents in 2010. Thirty-three states do not cover parents up to 100 percent of the FPL. This was $18,310 in 2010 for a family of three.
  • — Low-income adults without dependent children remain ineligible for Medicaid in the vast majority of states. Just seven states (Arizona, Connecticut, Delaware, the District of Columbia, Hawaii, New York, and Vermont) provide Medicaid or (Medicaid-like) benefits to adults without dependent children.
  • — States have moved forward with making improvements to their Medicaid and CHIP enrollment and renewal procedures in 2010. For example, twenty-nine states took advantage of the Children’s Health Insurance Program Reauthorization Act of 2009 option to verify citizenship by using an electronic data match with the Social Security Administration.
  • — States continued to focus on making technological improvements to their Medicaid and CHIP systems in 2010. For instance, every state posts its Medicaid application online. However, only thirty-two states accept the electronic submission of the application.
Looking back at 2010, this report reminds us of the importance of keeping Medicaid and CHIP strong in order to ensure that coverage remains available during the most difficult times. Going forward, the report paints a clear picture of the work that still lies ahead to continue to make the promise of the ACA a reality for our children and families.

—Patrick M. Tigue, Children’s Health Care Coordinator New England Alliance for Children’s Health