Reductions in Adult Eligibility Post-ACA

The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) included a maintenance-of-effort (MOE) requirement that prevented states from reducing Medicaid and CHIP eligibility from the date of the health law’s enactment until 2014 for adults, and through fiscal year 2019 for children. The goal of the MOE was to maintain existing coverage until new options became available through expanded Medicaid and subsidized exchange coverage, but it was unclear if states would reduce or eliminate eligibility in response to new coverage options once the MOE expired. This presentation looks at changes since 2014 and finds that overall, states have made few changes to eligibility. Where states have made changes, they have not created gaps in coverage.