	Introduction

The Bipartisan Budget Act of 2018 (BBA 2018, P.L. 115-123 ), which was enacted on February 9, 2018, addresses a number of issues that were before Congress. Specifically, appropriations for most federal agencies and programs were set to expire on February 8, 2018, and BBA 2018 extends continuing appropriations for these agencies and programs through March 23, 2018. In addition, BBA 2018 includes FY2018 supplemental appropriations, an increase to the debt limit, increases to the statutory spending limits for FY2018 and FY2019, tax provisions, and numerous provisions extending or making changes to mandatory spending programs, among other topics. Division E of BBA 2018 is titled the Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act, which includes provisions affecting the following programs: Medicare; Medicaid; the State Children's Health Insurance Program (CHIP); public health programs; the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program; foster care and child welfare; social impact partnerships; child support enforcement; and prison data reporting. This report provides information about the provisions from Division E of BBA 2018 related to CHIP, certain public health programs, the MIECHV program, and the Medicaid program. These other CHIP-related provisions include the Child Enrollment Contingency Fund, the qualifying states option, the Express Lane Eligibility option, the maintenance of effort (MOE) for children, the Pediatric Quality Measures Program, and the outreach and enrollment program. BBA 2018 further extends CHIP funding and these other CHIP-related provisions through FY2027. Public Health3

BBA 2018 extends funding for a number of public health programs funded through mandatory appropriations. Among the programs that receive additional funding through BBA 2018 for FY2018 and FY2019 are two Special Diabetes Programs, the Health Professions Opportunity Grant Program, and the National Health Service Corps. BBA 2018 also extends or increases FY2018 and FY2019 mandatory funding for—and makes programmatic changes to—the Family-to-Family Health Information Program, an abstinence education program now known as the Sexual Risk Avoidance Education program; the Personal Responsibility Education Program (which relates to teen pregnancy prevention); the health center program; and the teaching health center graduate medical education program. In addition to the funding extensions included in the BBA 2018, the law reduces the amounts appropriated to the Public Health and Prevention Fund as a funding offset. BBA 2018 extends mandatory funding of $400 million for the program for each of FY2017 through FY2022. Under the BBA 2018, jurisdictions may use some MIECHV funding for a pay-for-outcomes initiative. Medicaid6

BBA 2018 includes some Medicaid provisions as offsets. These Medicaid offsets are (1) modifying the reductions to Medicaid disproportionate share hospital (DSH) allotments; (2) making various changes to the third-party liability (TPL) rules; (3) requiring states to consider "qualified lottery winnings" and/or "qualified lump sum income" when determining Medicaid eligibility for certain individuals; (4) changing the rebate obligation with respect to line-extension drugs; and (5) rescinding funds from the Medicaid Improvement Fund. Abbreviated Summary of Provisions

 Table 1 provides a high-level summary of the provisions under Division E of BBA 2018 for CHIP, public health, the MIECHV program, and Medicaid.
The Bipartisan Budget Act of 2018 (BBA 2018, P.L. 115-123), which was enacted on February 9, 2018, addresses a number of issues that were before Congress. For example, appropriations for most federal agencies and programs were to expire on February 8, 2018, and BBA 2018 extends continuing appropriations for these agencies and programs through March 23, 2018. In addition, BBA 2018 includes FY2018 supplemental appropriations, an increase to the debt limit, increases to the statutory spending limits for FY2018 and FY2019, tax provisions, and numerous provisions extending or making changes to mandatory spending programs, among other topics.
Division E of BBA 2018 is titled the Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act, which includes provisions affecting the following programs:
Medicare; Medicaid; the State Children's Health Insurance Program (CHIP); public health programs; the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program; foster care and child welfare; social impact partnerships; child support enforcement; and prison data reporting.
This report provides information about the provisions from Division E of BBA 2018 related to CHIP, certain public health programs, the MIECHV program, and the Medicaid program.
BBA 2018 extends CHIP funding and other CHIP-related provisions (i.e., the Child Enrollment Contingency Fund, the qualifying states option, the Express Lane Eligibility option, the maintenance of effort [MOE] for children, the Pediatric Quality Measures Program, and the outreach and enrollment program) for FY2024 through FY2027.
BBA 2018 extends funding for a number of public health programs that were funded through direct appropriations. Among the programs that receive additional funding through BBA 2018 for FY2018 and FY2019 are two Special Diabetes Programs, funding for the Health Professions Opportunity Grant Program, and the National Health Service Corps. BBA 2018 also extends funding, and in some cases increased funding, with programmatic changes for the Family-to-Family Health Information Program, an abstinence education program now known as the Sexual Risk Avoidance Education program; the Personal Responsibility Education Program (which relates to teen pregnancy prevention); the health center program; and the teaching health center graduate medical education program. In addition, the law reduces the amounts appropriated to the Public Health and Prevention Fund as a funding offset.
BBA 2018 also extends funding of $400 million annually for the MIECHV program from FY2017 through FY2022. It requires states and other jurisdictions to continue to track and report on performance outcomes. It also allows jurisdictions to use some MIECHV funding for a pay-for-outcomes initiative, among other changes.
BBA 2018 includes some Medicaid provisions as offsets. These Medicaid offsets are related to (1) Medicaid disproportionate share hospital (DSH) allotments; (2) the third-party liability (TPL) rules; (3) consideration of "qualified lottery winnings" and/or "qualified lump sum income" when determining Medicaid eligibility; (4) the rebate obligation with respect to line-extension drugs; and (5) the Medicaid Improvement Fund.
This report provides a table with abbreviated summaries for the provisions in Division E of BBA 2018 related to CHIP, certain public health programs, the MIECHV program, and the Medicaid program. The table is followed by detailed summaries for each of these provisions, including background information and descriptions of the BBA 2018 provision.