The Center for Medicaid and CHIP Services (CMCS) serves as the focal point for all national program policies and operations related to Medicaid, the Children's Health Insurance Program (CHIP), and the Basic Health Program (BHP). These critical health coverage programs serve millions of families, children, pregnant women, adults without children, and also seniors and people living with disabilities.
Authorized by Title XIX of the Social Security Act, Medicaid was signed into law in 1965 alongside Medicare. All states, the District of Columbia, and the U.S. territories have Medicaid programs designed to provide health coverage for low-income people. Although the Federal government establishes certain parameters for all states to follow, each state administers their Medicaid program differently, resulting in variations in Medicaid coverage across the country.
Children's Health Insurance Program
The Children's Health Insurance Program (CHIP) was signed into law in 1997 and provides federal matching funds to states to provide health coverage to children in families with incomes too high to qualify for Medicaid, but who can't afford private coverage. All states have expanded children's coverage significantly through their CHIP programs, with nearly every state providing coverage for children up to at least 200 percent of the Federal Poverty Level (FPL).
Basic Health Program
The Basic Health Program was enacted by the Affordable Care Act and provides states the option to establish health benefits cover programs for low-income residents who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace, providing affordable coverage and better continuity of care for people whose income fluctuates above and below Medicaid and CHIP levels.
Affordable Care Act
Beginning in 2014, the Affordable Care Act provides states the authority to expand Medicaid eligibility to individuals under age 65 in families with incomes below 133 percent of the Federal Poverty Level (FPL) and standardizes the rules for determining eligibility and providing benefits through Medicaid, CHIP and the health insurance Marketplace.
|Affordable Care Act Provisions||Description|
|Eligibility||Fills in current gaps in coverage for the poorest Americans by creating a minimum Medicaid income eligibility level across the country.|
|Financing||Beginning in 2014 coverage for the newly eligible adults will be fully funded by the federal government for three years. It will phase down to 90% by 2020.|
|Information Technology Systems and Data||Policy and financing structure designed to provide states with tools needed to achieve the immediate and substantial investment in information technology systems that is needed in order to ensure that Medicaid systems will be in place in time for the January 1, 2014 launch date or the new Affordable Insurance Exchanges as well as the expansion of Medicaid eligibility.|
|Coordination with Affordable Insurance Exchanges||This system enables individuals and families to apply for coverage using a single application and have their eligibility determined for all insurance affordability programs through one simple process.|
|Benefits||People newly eligible for Medicaid will receive a benchmark benefit or benchmark equivalent package that includes the minimum essential benefits provided in the Affordable Insurance Exchanges.|
|Community-Based Long-Term Services and Supports||Includes a number of program and funding improvements to help ensure that people can receive long-term care services and supports in their home or the community.|
|Quality of Care and Delivery Systems||Improvements will be made in the quality or care and the manner in which that care is delivered while at the same time reducing costs.|
|Prevention||Promotes prevention, wellness and public health and supports health promotion efforts at the local, state and federal levels.|
|Children's Health Insurance Program (CHIP)||Extends funding for the Children's Health Insurance Program (CHIP) through FY 2015 and continues the authority for the program through 2019.|
|Dual Eligibles||A new office will be created within the Centers for Medicare & Medicaid Services to coordinate care for individuals who are eligible for both Medicaid and Medicare ("dual eligibles" or Medicare-Medicaid enrollees)|
|Provider Payments||States will receive 100% federal matching funds for the increase in payments.|
|Program Transparency||Promotes transparency about Medicaid policies and programs including establishing meaningful opportunities for public involvement in the development of state and federal Medicaid waivers.|
|Program Integrity||Includes numerous provisions designed to increase program integrity in Medicaid, including terminating providers from Medicaid that have been terminated in other programs, suspending Medicaid payments based on pending investigations or credible allegations of fraud, and preventing inappropriate payment or claims under Medicaid.|