	Introduction

The President signed into law H.R. 3590 , the Patient Protection and Affordable Care Act (ACA; P.L. 111-148 ), on March 23, 2010. Seven days later, a second bill, H.R. 4872 , was signed into law by the President to modify ACA. This second law, the Health Care and Education Reconciliation Act of 2010 (the Reconciliation Act or HCERA; P.L. 111-152 ), was signed into law on March 30, 2010. Together these measures constitute what is referred to as the health care reform law, which makes many significant changes to the private and public markets for health insurance, as well as modifies aspects of the publicly financed health care delivery system. It also represents the most significant reform to the Medicaid program since its establishment in 1965. This report highlights some of the major changes to the Medicaid and CHIP programs and provides a timeline of effective dates for these provisions. In general, the Medicaid law (1) raises Medicaid income eligibility levels for certain people up to 133% of the federal poverty level, (2) adds both mandatory and optional benefits to Medicaid, (3) increases the federal matching payments for certain groups of beneficiaries and for particular services provided, (4) provides new requirements and incentives for states to improve quality of care and encourage more use of preventive services, and (5) makes a number of other Medicaid program changes. Regarding CHIP, the law includes a new requirement for states to maintain their current program structures through FY2019 and extends additional CHIP funding through FY2015. To help explain the most important Medicaid and CHIP changes, provision descriptions are grouped into the following six major issue areas: eligibility, benefits, financing, program integrity, demonstrations and grant funding, and miscellaneous. Appendix A provides a detailed implementation timeline of the Medicaid and CHIP provisions. Appendix B is a crosswalk between the provision titles and the amending sections of P.L. 111-148 and P.L. 111-152 for all of the Medicaid and CHIP provisions. Finally, Appendix C is a list of abbreviations used in this report and their definitions. Overview of the Medicaid and CHIP Provisions in the Health Reform Law

Key Medicaid and CHIP provisions included in the health reform law are summarized below.
The President signed into law H.R. 3590, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), on March 23, 2010. Seven days later, a second bill, H.R. 4872, was signed into law by the President to modify ACA. This second law, the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152), was signed into law on March 30, 2010. Together these measures constitute what is referred to as the health care reform law, which makes many significant changes to the private and public markets for health insurance, as well as modifies aspects of the publicly financed health care delivery system. It represents the most significant reform to the Medicaid program since its establishment in 1965. This report details some of the major changes to the Medicaid and CHIP programs and provides a timeline of effective dates for these provisions.
In general, the Medicaid law (1) raises Medicaid income eligibility levels for certain people up to 133% of the federal poverty level, (2) adds both mandatory and optional benefits to Medicaid, (3) increases the federal matching payments for certain groups of beneficiaries and for particular services provided, (4) provides new requirements and incentives for states to improve quality of care and encourage more use of preventive services, and (5) makes a number of other Medicaid program changes. Regarding CHIP, the law includes a new requirement for states to maintain their current program structures through FY2019 and extends additional CHIP funding through FY2015.
To help explain the most important Medicaid and CHIP changes, provision descriptions are grouped into the following six major issue areas: eligibility, benefits, financing, program integrity, demonstrations and grant funding, and miscellaneous. Appendix A provides a detailed implementation timeline of the Medicaid and CHIP provisions. Appendix B is a crosswalk between the provision titles and the amending sections of P.L. 111-148 and P.L. 111-152 for all of the Medicaid and CHIP provisions. Finally, Appendix B is a list of abbreviations used in this report and their definitions.
This report reflects the Medicaid and CHIP provisions at the time of ACA's enactment. It is meant to serve as a historical reference to the complete set of Medicaid and CHIP provisions included in the law, as of March 23, 2010. It will not be updated to capture subsequent legislative changes, program guidance, public notices, or rulemaking, or the June 28, 2012, U.S. Supreme Court decision in National Federation of Independent Business v. Sebelius, where the Court held that the federal government cannot terminate current Medicaid program federal matching funds if a state does not expand its Medicaid program. The U.S. Supreme Court decision effectively makes the ACA Medicaid expansion optional.