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The Affordable Care Act Becomes Law

On March 23, 2010, President Obama signed the Affordable Care Act. The law expands health coverage and puts in place comprehensive health insurance reforms that will roll out over four years and beyond, with most changes taking place in 2014. Other improvements are already in place. Use this timeline to learn about what's changing for Medicaid and the Children's Health Insurance Program (CHIP) and when. This timeline includes major Medicaid provisions in the Affordable Care Act but does not include every change; the Healthcare.gov ACA timeline has information on other Affordable Care Act provisions. For information on federal guidance that has been released related to Medicaid and CHIP, see ACA provisions.

2010  2011  2012  2013  2014  2015


  • Improving Care and Lowering Costs: Providing Federal Funding and Expanding the Role of the Medicaid and CHIP Payment and Access Commission (MACPAC) (Effective FY 2010)

Provides federal funding for and expands the role of the congressionally-created, independent Medicaid and CHIP Payment and Access Commission (MACPAC). MACPAC is tasked with reviewing state and federal Medicaid and CHIP access and payment policies and making recommendations to Congress, the Secretary of Health and Human Services (HHS), and the states.

See www.macpac.gov.

  • Improving Care and Lowering Costs: Creating the National Prevention, Health Promotion and Public Health Council (Effective June 2010)

The Council is established to develop a national prevention, health promotion and public health strategy to improve the health of Americans. The Council released the National Prevention Strategy.

See information on the National Prevention, Health Promotion and Public Health Council.

  • Improving Care and Lowering Costs: Increasing the Medicaid prescription drug rebate percentage for brand name drugs (Effective January 1, 2010); Extension of rebate to managed care plans (Effective March 23, 2010)

The Medicaid drug rebate percentage is increased to 23.1 percent for brand name prescription drugs (with certain exceptions) and to 13 percent for generic prescription drugs. It also extends the drug rebate to Medicaid managed care plans.

See information on Benefits.

  • Coordinating Care and Lowering Costs: Establishes the Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office) (Effective March 1, 2010)

The Medicare-Medicaid Coordination office coordinates CMS policy for people who receive benefits from both Medicaid and Medicare ("dual eligibles"). The office seeks to ensure that dual eligible enrollees have full access to seamless, high quality health care and to make the system as cost-effective as possible.

See Medicare-Medicaid Coordination Office.

  • Increasing Access to Affordable Care: Federal funding for coverage of low-income adults (Effective April 1, 2010)

States have the option to receive federal matching funds to provide Medicaid to low-income individuals and adults in families with incomes up to 133 percent of the federal poverty level (FPL) ($14,500 for an individual in 2011) (Children are already eligible for Medicaid and CHIP at and above 133 percent FPL). States choose the income eligibility threshold. In January 2014, all individuals up to this income level will be eligible for Medicaid in every state.

See Early Option Federal Policy Guidance.

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  • Improving Care and Lowering Costs: Creating Health Homes to Coordinate Care (Effective January 1, 2011)

Creates a new option for states to address and receive additional federal support for the enhanced integration and coordination of primary, acute, behavioral health (mental health and substance abuse), and long-term services and supports for people across the lifespan with chronic illness. The federal government provides 90 percent federal matching payments for health home related services for the first eight quarters the program is effective.

See more information on health homes and health homes federal policy guidance.

  • Improving Care and Lowering Costs: Establishing the Center for Medicare and Medicaid Innovation (the "Innovation Center") (Effective January 1, 2011)

Establishes the Innovation Center to test, evaluate, and spread the best solutions from the diversity of health care innovators around the country. The Innovation Center tests innovative payment and service delivery models that enhance the quality of health care services while lowering costs.

See innovations.cms.gov

  • Improving Care and Lowering Costs: Providing grants to states for participation in the Medicaid Incentives for Prevention of Chronic Diseases Program (Effective January 1, 2011)

The law creates the Medicaid Incentives for Prevention of Chronic Disease Program to test and evaluate the effectiveness of a program to provide financial and non-financial incentives to Medicaid enrollees of all ages who participate in prevention programs to address at least one chronic disease prevention goal.

See Medicaid Incentives for Prevention of Chronic Diseases Program grants

  • Improving Care and Lowering Costs: Prohibiting federal payments to states for Medicaid services related to certain health care-acquired conditions (Effective July 1, 2011)

Identifies state practices that prohibit payment for health care-acquired conditions and incorporate such practices, as appropriate, to Medicaid. States must implement non-payment policies for a minimum set of provider preventable conditions and have the flexibility to incorporate state-identified conditions for non-payment.

See Quality of Care and Delivery Systems.

  • Improving Care and Lowering Costs: Community First Choice: Promoting Community-Based Services Options (Effective October 1, 2011)

Establishes a new option for States to provide person-centered home and community-based attendant services and supports to help increase individuals with disabilities' ability to live in the community. States choosing to participate in this new option will receive a 6 percentage point increase in Federal matching funds for related expenditures.

See more information on Community-Based Long-Term Services and Supports.

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  • Improving Care and Lowering Costs: Finalizing a core set of quality measures for adult Medicaid enrollees (Effective January 1, 2012)

By January 1, 2012, the Secretary will establish the Medicaid Quality Measurement Program to expand existing quality measures, identify gaps in current quality measurement, establish priorities for the development and advancement of quality measures, and consult with relevant stakeholders.

  • Increasing Access to Affordable Care: Additional Funding for the Children's Health Insurance Program (Effective October 1, 2012)

States will receive two more years of funding for the Children's Health Insurance Program to continue coverage for children not eligible for Medicaid.

See Children's Health Insurance Program.

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  • Increasing Access to Affordable Care and Improving Care and Lowering Costs: Improving access to preventive services in Medicaid (Effective January 1, 2013)

Allows States to cover specified preventive services at no cost to Medicaid adult enrollees.  (Children are already entitled to preventive services under the EPSDT benefit). Provides states with a 1 percentage point increase in federal matching payments to provide these services.

  • Increasing Access to Affordable Care: Increasing Medicaid Payments for Primary Care Physicians-Effective January 1, 2013-December 31, 2014

As Medicaid programs and providers prepare to cover more patients in 2013, the Affordable Care Act requires states to pay primary care physicians no less than 100 percent of Medicare payment rates in 2013 and 2014 for primary care services. The increase above current payment levels is fully funded by the federal government.

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  • Increasing Access to Affordable Care: Expanding Medicaid Eligibility (Effective January 1, 2014)

As of January 1, 2014, Americans under age 65 who have incomes less than 133 percent of the federal poverty level ($14,500 for an individual and $29,700 for a family of four in 2011) who are not pregnant and not otherwise eligible for Medicaid, will be eligible to enroll in Medicaid. This new coverage ends the long-time exclusion of low-income adults from Medicaid coverage.

States will receive 100 percent federal funding for the first three years to support this expanded coverage, phasing down to no less than 90 percent federal funding in subsequent years. States that have already expanded coverage to this group will also receive additional federal support.

See more information about Eligibility.

  • Increasing Access to Affordable Health Care: Creating a System of Affordable Health Coverage (Effective January 1, 2014)

Starting in 2014, there will be a new system of coverage in which eligibility and enrollment is coordinated across Medicaid, the Children's Health Insurance Program, and the newly created Affordable Insurance Exchanges. People who cannot get insurance through their employer will be able to buy it directly in an Affordable Insurance Exchange.

An Exchange is a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans and may be able to receive a premium tax credit. Exchanges will offer a choice of health plans that meet certain benefits and cost standards.

See more information about Coordination with Affordable Insurance Exchanges.

  • Improving Access to Affordable Care: Permitting hospitals to make presumptive eligibility determinations (Effective January 1, 2014)

Hospitals and clinics that are participating Medicaid providers can determine, based on preliminary applicant information, whether a person is eligible for Medicaid for purposes of providing medical assistance during a presumptive eligibility period. This broadens the populations for which presumptive eligibility decisions may be made.

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  • Improving Access to Affordable Care: Increasing the federal matching rate for the Children's Health Insurance Program (October 1, 2015)

Federal matching funds for the Children's Health Insurance Program will increase by 23 percentage points, up to a cap of 100 percent, in order to help states pay for coverage of uninsured children.

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