States Maintained or Expanded Coverage Despite Budgetary Pressures, Report Says

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Nearly all states maintained or expanded eligibility and enrollment rules for Medicaid and the Children's Health Insurance Program in 2010 despite significant budget pressures, according to a report released Jan. 11 by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU).

Researchers at KCMU and the Georgetown University Center for Children and Families surveyed state officials and found that 49 states, including the District of Columbia, maintained their eligibility or enrollment rules or made targeted improvements.

Of the states that made improvements, 13 states expanded eligibility, mostly for children, and 14 improved their enrollment and renewal procedures, according to the report.

The researchers attributed the stability in the eligibility and enrollment rules to the enhanced federal funding for Medicaid included in the American Recovery and Reinvestment Act and maintenance-of-effort (MOE) requirements included in ARRA and the Patient Protection and Affordable Care Act (PPACA). Under the MOE requirements, states lose some or all of their federal funding if they impose stricter eligibility or enrollment rules.

Had states reduced eligibility or made it harder to enroll, more people would have been left without coverage, including those who turn to Medicaid and CHIP during tough economic times, according to the report.

“Millions of Americans families have turned to Medicaid and CHIP as incomes have declined after losing jobs and the health insurance that often goes with them,” Diane Rowland, executive vice president of KFF and executive director of KCMU, said in a statement. “Keeping these programs stable and strong has helped protect children and avoid an even larger increase in the nation's 50 million uninsured, and will be key to ensuring the success of health reform implementation over the next few years.”

The survey found that two states, Arizona and New Jersey, did reduce coverage in areas not subject to the MOE requirements. States also made cuts to benefits and provider reimbursement to deal with increasing costs and budget shortfalls.

Less Coverage for Adults.

Overall, the report said that coverage for children outpaces coverage for adults. Almost all states now cover children with incomes above 200 percent of the federal poverty level (FPL), but the threshold for parental eligibility remains well below the poverty level, and childless adults are largely ineligible for the program.

While PPACA creates a new federal floor for Medicaid eligibility of 133 percent of FPL, many low-income adults will lack access to coverage until the expansion is implemented in 2014, according to the report.

The survey also found that coverage for pregnant women through Medicaid and CHIP remained stable in 2010, with some improvements.

Of the 13 states that expanded eligibility in 2010, most put into place policies that affect children, but the expansions varied in size and scope. However, three states did expand coverage for low-income adults through Medicaid, two of which took advantage of an early option to expand Medicaid, according to the report.

The survey also found that six states adopted an option included in the CHIP Reauthorization Act to provide coverage to legally residing immigrant children without a five-year waiting period, bringing to 21 the total number of states that do so.

CHIPRA options also played a role in streamlining eligibility and enrollment in 2010, such as an option to use an electronic data match with the Social Security Administration to verify a citizenship for applicants. The survey found that 29 states adopted the option for children in Medicaid, 27 adopted it for parents in Medicaid, and 21 adopted it in CHIP.

The 14 states that improved their enrollment and renewal procedures did so by lessening paper documentation burdens, using data from other programs to make eligibility determinations rather than repeating the process, adopting presumptive and continuous eligibility rules, and eliminating asset tests and in-person interview requirements, according to the report.

The survey also looked at how states are using technology to modernize their programs. While states have made some improvements, more work is needed, especially to ensure smooth implementation of PPACA, according to the report.

The report is available at