The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) required states to provide Medicaid coverage to all children with incomes up to 138 percent of the federal poverty level (FPL) beginning in January 2014, affecting 21 states that had been covering some of these children in separate CHIP (the so-called stairstep children). MACPAC engaged Mathematica Policy Research to conduct a study on approaches taken by states to transition stairstep children from separate CHIP to Medicaid and the effect of the transition on use of health care services. The study produced two reports:
- An Implementation Analysis of States’ Experiences in Transitioning Stairstep Children from Separate CHIP to Medicaid, and
- The Impact of Transitioning Stairstep Children from Separate CHIP to Medicaid on Use of Health Services: Evidence from Colorado and New York
The first report describes strategies for planning and implementing the transition, as well as challenges experienced, based on interviews with state officials and stakeholders in 10 states. The 10 states selected had a large number of children estimated to be eligible for the transition. The practices identified could inform how any future large-scale transitions of children’s coverage are implemented.
The follow-up report provides findings from an analysis of administrative enrollment, claims, and encounter data from Colorado and New York, selected for this study because they implemented the transition before January 2014 and thus had post-transition data for a longer period of time than other states. The analysis compared health care utilization before and after the stairstep transition. The results show an increase in use of dental services by children who transitioned to Medicaid in both states, and a small decline in use of outpatient services by these children in New York.
The study was prepared under contract to the Medicaid and CHIP Payment and Access Commission (MACPAC). The findings, statements, and views expressed in this report are those of the authors and do not necessarily reflect those of MACPAC.