Beginning January 1, 2014, Medicaid must cover children, ages six to eighteen, with incomes up to 133% of the federal poverty level (FPL) ($31,322 for a family of four in 2013). Today, states must cover children under the age of six in families with incomes of at least 133% of the FPL in Medicaid, while children ages six to eighteen with incomes above 100% of the FPL ($23,550 for a family of four in 2013) may be covered in separate state Children’s Health Insurance Programs or Medicaid at the state’s option. Although many states cover children in Medicaid with income up to 133% of the FPL, due to the change in law, 21 states needed to transition some children from the Children’s Health Insurance Program (CHIP) to Medicaid.
This split source of coverage for children is commonly referred to as “stairstep” eligibility, where different aged children in the same family are being enrolled in different coverage programs with different benefits, provider networks, renewal procedures, etc. When the Affordable Care Act (ACA) was enacted 21 states had stairstep eligibility: Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Kansas, Mississippi, Nevada, New Hampshire, New York, North Carolina, North Dakota, Oregon, Pennsylvania, Tennessee, Texas, Utah, West Virginia, and Wyoming. The Henry J. Kaiser Family Foundation estimates that 562,103 children will be impacted by the transition, with the largest numbers coming from Texas (131,070 children), Florida (71,329 children), and Georgia (59,435 children). On August 9, the Centers for Medicare and Medicaid Services issued a FAQ document to assist states tackling stairstep eligibility (view the FAQs beginning on question #10).
States will continue to discuss whether to continue CHIP in the future, as the ACA extends funding for CHIP only through FY15 and continues the authority for the program through 2019.