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 Benefits and Eligibility for MCH Populations Explained in Three Easy Charts!

By Carolyn McCoy, MPH
Senior Policy Manager, AMCHP

Open enrollment for ACA health insurance plans began on Oct. 1, 2013, with new plans beginning on Jan. 1, 2014. State Title V MCH programs can play a role in educating women, children and their families about projected eligibility levels for various health insurance coverage options as well as eligibility for minimum health plan benefit levels. State MCH programs also can begin to anticipate where there may be potential gaps in health insurance coverage and benefits for MCH populations.

AMCHP created a fact sheet designed to assist state MCH programs in these efforts. The easy-to-follow charts depict the federal minimum eligibility levels for each income scenario, including identified and potential gaps in eligibility for MCH populations both with and without Medicaid expansion. The fact sheet also is designed to be interactive with hyperlinks to direct readers to detailed resources as well as source documents. The fact sheet lays out the projected minimum or essential health insurance benefits for MCH populations, including children and youth with special health care needs (CYSHCN), for each of the following coverage options or scenarios: Medicaid, Children’s Health Insurance Plan (CHIP), insurance purchased through the health insurance marketplace (aka health insurance exchange), and safety-net services for those remaining uninsured. It is important to note that eligibility for public insurance coverage is limited to those who live in the United States, have satisfactory immigration status, and are not incarcerated.

This fact sheet provides an overview of federal benefit and coverage requirements under the ACA. However, the actual benefits package, cost sharing and affordability for families will vary widely depending on the state. The fact sheet can be found here in the AMCHP Center for Health Reform Implementation.