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Health Law

An introduction to legal research in some of the major aspects of Health Law.

Abbreviated History of Children's Health Laws

MACPAC provides the Federal Legislative Milestones in Medicaid and CHIP. Some of the key components of this history for children's health law are:


Title XIX of the Social Security Act (the Act, (P.L. 89-97)) enacted Medicaid, an individual entitlement with federal-state financing, to provide health coverage for certain low-income groups. Title XIX linked Medicaid eligibility to receipt of Aid to Families with Dependent Children (AFDC) for families with dependent children under age 18 considered to be deprived of parental support due to the death, continued absence, incapacity, or unemployment of the principal family earner in a two-parent household.


Social Security Amendments of 1967 (P.L. 90-248) limited Medicaid eligibility to individuals with income below 133⅓ percent of the AFDC maximum payment level. P.L. 90-248 also established the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for all Medicaid-enrolled children under age 21.


Omnibus Budget Reconciliation Act of 1981 (OBRA 81, P.L. 97–35) instituted additional payments to hospitals serving a disproportionate share of Medicaid and low-income patients, which are now known as disproportionate share hospital (DSH) payments.


Deficit Reduction Act of 1984 (P.L. 98–369) mandated Medicaid coverage of children born after September 30, 1983, up to age five, in AFDC-eligible families and coverage for AFDC-eligible, first-time pregnant women and pregnant women in two-parent unemployed families.


Omnibus Budget Reconciliation Act of 1986 (P.L. 99–509) allowed states to cover pregnant women and infants under age one with income up to 100 percent of the federal poverty level (FPL) at their option.


Medicare Catastrophic Coverage Act of 1988 (P.L. 100-360) required states to phase in coverage for pregnant women and infants with incomes below 100 percent FPL.

Family Support Act of 1988 (P.L. 100-485) required states to extend 12 months of transitional Medicaid coverage to families leaving AFDC rolls due to earnings from work, and requires states to cover unemployed 2-parent families meeting AFDC income and resource (asset) standards.


Omnibus Budget Reconciliation Act of 1989 (OBRA 89, P.L. 101–239) required states to provide Medicaid coverage to pregnant women and to children up to age six in families with income up to 133 percent FPL (or the state’s income threshold at enactment, if higher). It also expanded the EPSDT benefit for children under age 21 to include optional diagnostic and treatment services that not covered under the state’s Medicaid program for adult beneficiaries.


Omnibus Budget Reconciliation Act of 1990 (P.L. 101–508) required states to phase in Medicaid coverage for all poor children under age 19 born after September 30, 1983, by the year 2002.


Omnibus Budget Reconciliation Act of 1993 (P.L. 103-66) established the Vaccines for Children program, which uses federal Medicaid funds to pay for vaccines provided to public health clinics and enrolled private providers.


Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L.104–193) repealed the AFDC program and replaced it with Temporary Assistance for Needy Families (TANF), a program that provides block grants to states. It also established Section 1931 family-coverage category, requiring states to extend Medicaid eligibility to families meeting July 16, 1996 AFDC eligibility criteria and allowing states to establish higher income eligibility thresholds.


Balanced Budget Act of 1997 (BBA 97, P.L. 105-33) permitted states to require that most Medicaid beneficiaries enroll in managed care plans without obtaining a waiver. The BBA also created the State Children’s Health Insurance Program (CHIP), providing federal matching funds to states to expand health insurance coverage for children above states’ Medicaid eligibility levels.


Breast and Cervical Cancer Treatment and Prevention Act of 2000 (P.L. 106–354) allowed states to provide Medicaid coverage at enhanced CHIP federal matching rates to uninsured women—regardless of their income or resources—who are screened by the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program and found to need treatment for breast or cervical cancer.

The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (P.L. 106-554) directed the Secretary to issue regulations tightening upper payment limits (UPLs), created a new prospective payment system for FQHCs and RHCs and established a floor for payments based on 100 percent of the average cost of services provided, and modified DSH funding amounts.


Medicare, Medicaid, and SCHIP Extension Act of 2007 (P.L. 110-173) extended CHIP funding through March 31, 2009 and provided Medicaid coverage to members of low-income families who would otherwise lose Medicaid coverage because of an increase in work hours or increased income from child or spousal support.


Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA, P.L. 111-3) extended CHIP appropriations through 2013. CHIPRA also:

  • established the express lane eligibility option, allowing states to rely on findings about eligibility factors from another program such as School Lunch or TANF in order to enroll eligible children in Medicaid and CHIP;
  • phased out coverage of parents by 2014;
  • established the Medicaid and CHIP Payment and Access Commission (MACPAC) to review state and federal Medicaid and CHIP access and payment policies and to make recommendations to the Congress, the Secretary, and the states on issues affecting Medicaid and CHIP populations; and
  • made children’s hospitals eligible for the 340B Drug Pricing Program requiring drug manufacturers to offer Medicaid the lowest price paid by any other purchaser of the drug.


Patient Protection and Affordable Care Act of 2010 (ACA, P.L. 111-148, as amended) expanded Medicaid eligibility to include nearly all individuals under age 65 with incomes up to 133 percent FPL based on modified adjusted gross income. The ACA also extended CHIP funding an additional two years through 2015 and enacts a 23 percentage point increase in CHIP’s enhanced FMAP.


The Protecting Access to Medicare Act of 2014 (P.L. 113-93) extended a number of other Medicaid-related provisions, such as the Medicaid and CHIP express lane eligibility program and required MACPAC to submit an annual report to Congress on DSH payments.


The Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10) extends funding for CHIP through FY 2017, leaving the enhanced federal CHIP matching rate intact and extending the authorization of contingency fund payments through FY 2017. It also:

  • permanently extended the Qualifying Individuals program, which pays Medicare Part B premiums for qualified individuals with incomes between 120–135 percent of FPL;
  • extended the state express lane eligibility (ELE) option for children in Medicaid or CHIP from September 30, 2015 through September 30, 2017. ELE permits states to rely on findings from another program designated as an Express Lane agency, such as the Supplemental Nutrition Assistance Program, the National School Lunch Program, or Head Start, when making Medicaid and CHIP eligibility determinations; and
  • delayed the time period for DSH allotment reductions to FYs 2018–2025, rather than FYs 2017–2024. Changes the aggregate amount of DSH allotment reductions to $2 billion in FY 2018, increasing by $1 billion each subsequent fiscal year up to $8 billion in FYs 2024 and 2025.

The Consolidated Appropriations Act, 2016 (P.L. 114-113) provided additional funding for Medicaid and CHIP program integrity activities and limited state Medicaid durable medical equipment payment to Medicare payment rates.


The 21st Century Cures Act (P.L. 114-255) includes provisions addressing a range of different Medicaid issues, including several designed to enhance access to mental health services and improve program integrity:

  • establishes a new requirement for states to screen and enroll all providers participating in Medicaid or CHIP managed care (who are not already enrolled) in the state’s fee-for-service program;
  • requires states to submit additional information to the Secretary about terminated providers, and requires the Secretary to create and maintain a centralized and uniform database of terminated Medicaid and CHIP providers with the reasons for termination;
  • specifies that children receiving Medicaid-covered inpatient psychiatric hospital services are eligible for the full range of EPSDT services.

Comprehensive Addiction and Recovery Act of 2016 (P.L. 114-198)  prohibits states from using or disclosing analytic technologies to identify improper Medicaid claims (including predictive modeling systems), except for the purposes of administering a state Medicaid or CHIP program (as long as a state has adequate data security and control policies).

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