Health Care Reform Moves Forward, Includes Big Changes to Medicaid

On November 7, 2009, the House passed the Affordable Health Care for America Act (H.R. 3962). The Senate passed its version of health care reform, the Patient Protection and Affordable Care Act (H.R. 3590), on December 24, 2009. Both bills include major changes to Medicaid, most notably a mandatory expansion of eligibility. Under the House bill, Medicaid would be expanded to cover all individuals under age 65 with incomes at or below 150% of the federal poverty level (FPL). The federal government would pay 100% of the cost of the expansion for two years, after which states would pay 9% of the total expansion cost. The Senate bill contains a mandatory expansion to 133% FPL, with 100% federal financing for the first three years. States would then receive an enhanced federal matching rate that varies by state. 

This Issue Brief provides an overview of the House and Senate bills, focusing on changes to Medicaid and the Children’s Health Insurance Program (CHIP). Subsequent briefs will address other aspects of the bills, including new initiatives around the health care workforce, long-term care, and prevention and wellness; Medicaid demonstrations and pilot programs; program integrity; and the interactions of Medicaid and CHIP with the new health insurance exchanges.