The passage of the Affordable Care Act represents an historic change in the way health insurance has been handled in the United States. With political discourse about the act continuing to occupy public policy debates and the news media, this collection attempts to shed light on the impact of the policy on citizens and providers as well as examine how the ACA is affecting quality, access, and costs of care.

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The Children’s Health Insurance Program: Why CHIP is Still the Best Deal for Kids

April 18, 2018

CHIP covers those who earn too much to qualify for Medicaid but not enough to be able to purchase health insurance coverage on their own. CHIP's supporters recognized the value of investing in children's coverage to make sure that all children have access to the medical care they need to grow up to become healthy and productive adults.CHIP has a long history of bipartisan support from lawmakers on both sides of the aisle who recognize that providing health coverage for our nation's children is a critical investment in America and its future. If funding for CHIP is not extended beyond FY 2017, the remarkable trend toward universal coverage for children would most certainly be reversed and significant numbers of children would become uninsured.

Percent of Children Covered by Medicaid/CHIP by County, 2012-2016

March 26, 2018

Notes: Children are defined as under 18 years of age. Children with two or more types of coverage are not included in the map. A dash indicates that the percent of children with Medicaid/CHIP coverage in the county are unreported on the map because there are fewer than 10 children residing in the county. Source: Georgetown University Center for Children and Families analysis of the five-year estimates of summary data from the 2016 American Community Survey (ACS). The U.S. Census Bureau publishes ACS summary data on American Fact Finder. Percent estimates were computed.

Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2018: Findings from a 50-State Survey

March 20, 2018

This 16th annual 50-state survey provides data on Medicaid and the Children's Health Insurance Program (CHIP) eligibility, enrollment, renewal and cost sharing policies as of January 2018. It takes stock of how the programs have evolved as the fifth year of implementation of the Affordable Care Act (ACA) begins, discusses policy changes made during 2017, and looks ahead to issues that may affect state policies moving forward. It is based on a survey of state Medicaid and CHIP officials conducted by the Kaiser Family Foundation and the Georgetown University Center for Children and Families.Key FindingsMedicaid and CHIP provide a robust base of coverage for low-income children. All but two states cover children with incomes up to at least 200% of the federal poverty level (FPL, $41,560 per year for a family of three in 2018), including 19 states that cover children with incomes at or above 300% FPL. The ten-year extension of federal funding for CHIP approved by Congress provides states stable funding to maintain children's coverage and continues protections for children's coverage moving forward.There have been major gains in Medicaid eligibility for parents and other adults under the Affordable Care Act (ACA) Medicaid expansion, but eligibility remains limited in the 19 states that have not implemented the expansion. Among non-expansion states, the median eligibility level for parents is 43% FPL ($8,935 for a family of three in 2018) and other adults generally are ineligible. Alabama and Texas have the lowest parent eligibility limits at 18% FPL or $3,740 per year for a family of three. Additional states may expand Medicaid for adults in the coming year, which would reduce the number of poor uninsured adults who fall into the coverage gap. States moving forward with expansion may seek waivers to add requirements or restrictions for adults as a condition of expanding.Through significant investments of time and resources, most states have transformed their Medicaid and CHIP enrollment and renewal processes to provide a modernized, streamlined experience as outlined in the ACA. With these processes, a growing number of states are processing real-time eligibility determinations and automated renewals through electronic data matches with trusted data sources. Looking ahead, waivers and other proposed changes for adults, including premiums and cost sharing, work requirements, and lockout periods, require complex documentation and costly administrative processes that run counter to the simplified enrollment and renewal processes states have implemented under the ACA.

Maternal Depression and Young Adult Mental Health: Key Policy Agenda for Systems that Support Mental Health and Wellness

February 13, 2018

Three million Americans living in poverty are either a mother who has experienced depression or a young adult who has experienced serious psychological distress during the past year. Untreated mental health needs have significant consequences for mothers and young adults as well as their families. This is especially true for low-income people. It is essential to create policy that better meets their mental health needs to ensure their healthy development and long-term success. This report makes the case for CLASP's new foundation-funded effort to strengthen Medicaid, mental health, and human services policy at the federal and state levels to improve outcomes for families and young adults living in poverty. The goals of this initiative are to: (a) develop frameworks for identifying and treating maternal depression among parents of young children as well as improved access to high-quality mental health supports for youth; and (b) help a small number of selected states implement important aspects of the two frameworks. CLASP is uniquely positioned to bridge diverse stakeholders, analyze and identify policy opportunities, and support states interested in advancing this policy agenda. Across numerous fields, policymakers and stakeholders must work together to foster equitable health and economic outcomes for low-income mothers and young adults living in poverty. This work is essential to building systems support all low-income people's mental health and wellness.

What Is the "CHIP Cliff" and How Can Congress Fix It?

January 29, 2018

On January 22, 2018, Congress included a six-year extension of the Children's Health Insurance Program (CHIP) as part of a continuing resolution (CR) to keep the federal government funded on a temporary basis. Funding for CHIP had expired 114 days before, at the close of September 2017. States were continuing to operate their programs with unspent funding from FY 2016 and FY 2017 and a $2.85 billion appropriation from Congress in the CR passed in late December.However, by this past week, states were rapidly running out of any funding. A report by Georgetown's Center for Children and Families had estimated, "If Congress fails to approve long-term funding for CHIP in January, nearly 1.7 million children in separate CHIP programs in 21 states with shortfalls in March 2018 could lose coverage by the end of February 2018."The latest CR is critically important in providing the funding necessary for the next six years to protect the health and well-being of the 9 million children and pregnant women who rely on CHIP for their health coverage, but leaves in place concerns among advocates and states about the long term fiscal health of the program, due to what advocates refer to as a "CHIP cliff."

On the Road to Universal Children's Health Coverage: An Update on the KidsWell Campaign

May 28, 2015

The Patient Protection and Affordable Care Act (ACA), enacted in 2010, held great promise for expanding insurance coverage to millions of uninsured Americans. Starting in 2014, it expanded Medicaid eligibility to low-income adults with family income below 138 percent of the federal poverty level. It also offered premium subsidies to people with income up to four times the poverty level so they could purchase private insurance through federal or state health insurance exchanges. While most of those expected to gain insurance coverage for the first time are adults, children stand to gain as well, since children are more likely to have health care coverage when their parents do too (DeVoe et al. 2015). In 2014, about 3.9 million children were estimated to be eligible but not enrolled in Medicaid or the Children's Health Insurance Program (CHIP), representing roughly two-thirds of all uninsured children (Kaiser Family Foundation 2015). This brief looks at the KidsWell Campaign, a multilevel effort designed to ensure access to health insurance for all children. It summarizes evaluation findings on two research questions: (1) to what extent has state grantees' participation in KidsWell strengthened advocacy networks and capacities so far? and (2) which advocacy activities do grantees believe to be most effective in securing policy advances for children's health care coverage?

Increasing Access to Care

Child Health and Access to Medical Care

May 4, 2015

This article reviews studies that explore the relationship between access to medical care and children's health. The authors find that, on the whole, policies to improve access indeed improve children's health, with the caveat that context plays a big role. Focusing on studies that can plausibly show a causal effect between policies to increase access and better health for children, and starting from an economic framework, they consider both the demand for and supply of health care. On the demand side, they examine what happens when the government expands public insurance programs (such as Medicaid), or when parents are offered financial incentives to take their children to preventive appointments. On the supply side, they look at what happens when public insurance programs increase the payments they offer to health care providers, or when health care providers are placed directly in schools where children spend their days. They also examine how the Affordable Care Act is likely to affect children's access to medical care.

Increasing Access to Care

Rural Children Increasingly Rely on Medicaid and State Child Health Insurance Programs for Health Insurance

September 11, 2014

A new analysis for First Focus by Bill O'Hare shows that children in rural communities are more likely than their urban counterparts to get health care through the Children's Health Insurance Program (CHIP) and Medicaid. With federal funding for CHIP scheduled to end next year, this report illustrates the importance of extending CHIP funding for children in rural America.

KidsWell: Securing Coverage for Children by Advocating for the ACA

June 3, 2014

The expansion of Medicaid eligibility to low income adults and subsidies to purchase private insurance are arguably the most significant provisions of the Affordable Care Act (ACA). To the extent these measures reduce rates of uninsured parents, they could also help to close the gap in children's coverage, 7.2 million of whom were uninsured in 2012 (Finegold 2013). States are on the front-line of ACA implementation: their success in enrolling uninsured parents and their children depends on the effectiveness of state policies and systems for operating one-stop shopping portals, conducting outreach to low income families, helping them apply for insurance, and creating consumer-friendly communication about families' coverage options and their costs. This brief examines how children's advocates in New Mexico and New York have tried to shape state decisions on ACA implementation policies and their achievements to date.

Implications for Medicaid/Medicare; Making the Transition

Federal Health Expenditures on Children on the Eve of Health Reform: A Benchmark for the Future

March 19, 2012

Analyzes trends in federal spending on children's health in 2010, changes over the past fifty years, factors that affect Medicaid and Children's Health Insurance Program coverage under the Affordable Care Act, and implications for federal spending.

Lowering Costs of Care

New Opportunities for Integrating and Improving Health Care for Women, Children, and Their Families

February 8, 2012

Outlines provisions in the Affordable Care Act for integrating healthcare services for low-income women and children to improve outcomes and cut costs. Examines public-private partnerships and other efforts in Colorado, Florida, Ohio, and Vermont.

Improving Quality of Care; Lowering Costs of Care

Addressing Coverage Challenges for Children Under the Affordable Care Act

May 26, 2011

Explores reform implementation issues for ensuring that children in families with varying eligibility for different types of insurance have access to coverage. Estimates the number of such children and examines the implications of specific provisions.

Making the Transition