|Year||Legislative milestones or key provisions|
|1965||Medicaid, an individual entitlement with federal-state financing, is enacted as Title XIX of the Social Security Act (the Act, (P.L. 89-97)) to provide health coverage for certain groups of low-income people. Title XIX:
Medicare is also created as Title XVIII of the Act.
|1967||Social Security Amendments of 1967 (P.L. 90-248) limit Medicaid eligibility to the medically needy, that is, individuals with income below 133⅓ percent of the AFDC maximum payment level for a given family size in a state. P.L. 90-248 also:
|1971||Social Security Amendments of 1971 (Public Law 92-223) allow states to provide Medicaid coverage for services in intermediate care facilities (ICFs), as well as those for “the mentally retarded” (ICF-MRs).|
|1972||Social Security Amendments of 1972 (P.L. 92-603): repeal the maintenance of effort, allowing states to reduce expenditures from one year to the next. It also:
|1977||Departments of Labor and Health, Education, and Welfare Appropriations Act for FY 1977 (P.L. 94-439) enacts the Hyde Amendment, prohibiting federal Medicaid payments for abortions except when the life of the mother is endangered and in cases of rape and incest.|
|1980||Omnibus Budget Reconciliation Act of 1980 (P.L. 96-499) enacts the Boren Amendment, which removes Medicaid’s state plan requirement to pay nursing facilities according to Medicare cost principles. Instead, the Boren Amendment requires Medicaid payments to be “reasonable and adequate” to meet the costs of “efficiently and economically operated” facilities.|
|1981||Omnibus Budget Reconciliation Act of 1981 (OBRA 81, P.L. 97–35) establishes two new types of Medicaid waivers to test new Medicaid payment methods:
OBRA 81 also:
|1982||Tax Equity and Fiscal Responsibility Act (P.L. 97-248) expands states’ options to impose cost-sharing requirements on Medicaid beneficiaries and services.|
|1984||Deficit Reduction Act of 1984 (P.L. 98–369) mandates Medicaid coverage of children born after September 30, 1983, up to age five, in AFDC-eligible families and mandates coverage for AFDC-eligible, first-time pregnant women and pregnant women in two-parent unemployed families.|
|1985||Consolidated Omnibus Budget Reconciliation Act of 1985 (P.L. 99–272) requires Medicaid coverage for all remaining AFDC-eligible pregnant women. It also requires hospice payments to be in the same amounts and using the same methodology as Medicare, and permits separate room and board payment for hospice patients residing in nursing facilities or ICFs.|
|1986||Omnibus Budget Reconciliation Act of 1986 (P.L. 99–509) requires states to cover treatment of emergency medical conditions for illegal immigrants otherwise eligible for Medicaid and allows states to cover pregnant women and infants under age one with income up to 100 percent of the federal poverty level (FPL) at their option.|
|1987||Omnibus Budget Reconciliation Act of 1987 (P.L. 100-203) requires that payment methods for nursing facilities take into account the cost of complying with new quality requirements. It also:
|1988||Medicare Catastrophic Coverage Act of 1988 (P.L. 100-360) requires states to phase in coverage for pregnant women and infants with incomes below 100 percent FPL. It also:
Family Support Act of 1988 (P.L. 100-485) requires states to extend 12 months of transitional Medicaid coverage to families leaving AFDC rolls due to earnings from work, and requires states to cover unemployed 2-parent families meeting AFDC income and resource (asset) standards.
|1989||Omnibus Budget Reconciliation Act of 1989 (OBRA 89, P.L. 101–239) requires states, by April 1, 1990, to provide Medicaid coverage to pregnant women and to children up to age six in families with income up to 133 percent FPL (or the state’s income threshold at enactment, if higher). It also:
|1990||Omnibus Budget Reconciliation Act of 1990 (P.L. 101–508) requires states to phase in Medicaid coverage for all poor children under age 19 born after September 30, 1983, by the year 2002. It also:
|1991||Medicaid Voluntary Contribution and Provider-Specific Tax Amendments (P.L. 102-234) restrict the use of provider donations and provider taxes as non-federal share. They also:
|1993||Omnibus Budget Reconciliation Act of 1993 (P.L. 103-66) places hospital-specific ceilings on DSH payments. It also:
|1996||Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L.104–193) repeals the AFDC program and replaces it with Temporary Assistance for Needy Families (TANF), a program that provides block grants to states. It also:
|1997||Balanced Budget Act of 1997 (BBA 97, P.L. 105-33) permits states to require most Medicaid beneficiaries to enroll in managed care plans without obtaining a Section 1915(b) waiver. The BBA also:
Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA, P.L. 106-113) slows the phase-out of cost-based payment for FQHCs and RHCs and increases DSH allotments for the District of Columbia, Minnesota, New Mexico, and Wyoming.
Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106-170) allows states to cover working disabled individuals with incomes above 250 percent FPL and requires them to pay income-related premiums.
Breast and Cervical Cancer Prevention and Treatment Act of 2000 (P.L. 106–354) allows states to provide Medicaid coverage at enhanced CHIP federal matching rates to uninsured women—regardless of their income or resources—who are screened by the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program and found to need treatment for breast or cervical cancer.
The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act, as incorporated into the Consolidated Appropriations Act, 2001 (P.L. 106-554) directs the Secretary to issue regulations tightening upper payment limits (UPLs), as well as:
Jobs and Growth Tax Relief Reconciliation Act of 2003 (P.L. 108-27) raises state-specific DSH allotments for FY 2004 for all states and through FY 2009 for low-DSH states.
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA, P.L. 108-173) creates Medicare Part D, a prescription drug benefit for Medicare enrollees effective January 1, 2006, shifting coverage of prescription drugs for dually eligible individuals from Medicaid to the new plans created under Medicare Part D. Additionally, the MMA:
|2005||Deficit Reduction Act of 2005 (P.L. 109-171) permits states to use benchmark coverage for certain populations, instead of the regular Medicaid benefits package. It also:
|2007||Medicare, Medicaid, and SCHIP Extension Act of 2007 (P.L. 110-173) extends CHIP funding through March 31, 2009 and extends Transitional Medical Assistance (TMA) for individuals transitioning from welfare to work. TMA provides Medicaid coverage to members of low-income families who would otherwise lose Medicaid coverage because of an increase in work hours or increased income from child or spousal support.|
|2009||Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA, P.L. 111-3) extends CHIP appropriations through 2013. CHIPRA also:
American Recovery and Reinvestment Act of 2009 (ARRA, P.L. 111-5) contains a temporary increase to the federal medical assistance percentage (FMAP) for 2009 and 2010. It also establishes the Health Information Technology for Economic and Clinical Health Act of 2009, which creates the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs to encourage providers to adopt, implement, operate, upgrade, or meaningfully use EHR technology.
|2010||Patient Protection and Affordable Care Act of 2010 (ACA, P.L. 111-148, as amended) expands Medicaid eligibility to include nearly all individuals under age 65 with incomes up to 133 percent FPL based on modified adjusted gross income. The U.S. Supreme Court later ruled in National Federation of Independent Business v. Sebelius that Congress could not compel states to participate in this Medicaid expansion. The ACA also:
Amendments to the ARRA incorporated into H.R. 1586 (P.L. 111-226) extend the ARRA FMAP increase through June 30, 2011.
|2012||Middle Class Tax Relief and Job Creation Act of 2012 (P.L. 112-96), extends Medicaid DSH allotment reductions to FY 2021.|
American Taxpayer Relief Act of 2012 (P.L. 112-240) extends Medicaid DSH allotment reductions to FY 2022.
Bipartisan Budget Act of 2013 (P.L. 113-67) allows state Medicaid agencies to recover any payments by a third party, rather than limiting recovery to payments made solely for health care items or services, and creates an exception to Medicaid’s anti-lien statute for third-party liability. It also delays the onset of Medicaid DSH allotment reductions until FY 2016 by eliminating the FY 2014 reduction and adding the FY 2015 reduction to that for FY 2016, and extends the reductions to FY 2023.
|2014||Protecting Access to Medicare Act of 2014 (P.L. 113-93) delays the implementation of the third-party liability changes enacted in the Bipartisan Budget Act of 2013. It also:
|2015||Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10) extends funding for CHIP through FY 2017, leaving the enhanced federal CHIP matching rate intact and extending the authorization of contingency fund payments through FY 2017. It also:
Bipartisan Budget Act of 2015 (P.L. 114-74) applies the Medicaid additional rebate requirement, imposed when a drug’s price rises faster than the rate of inflation, to generic drugs.
Consolidated Appropriations Act, 2016 (P.L. 114-113) provides additional funding for Medicaid and CHIP program integrity activities and limits state Medicaid durable medical equipment payment to Medicare payment rates.
|2016||21st Century Cures Act (P.L. 114-255) includes provisions addressing a range of different Medicaid issues, including several designed to enhance access to mental health services and improve program integrity:
Comprehensive Addiction and Recovery Act of 2016 (CARA, P.L. 114-198) excludes certain abuse-deterrent drug formulations from the definition of line-extension drugs in the Medicaid drug rebate program. Additionally, the statute:
Second Continuing Appropriations, Fiscal Year 2018 (P.L. 115-90) includes provisions to ensure the availability of CHIP redistribution funding for states experiencing CHIP funding shortfalls before December 31, 2017.
Continuing Appropriations Act, 2018 and Supplemental Appropriations for Disaster Relief Requirements Act, 2017 (P.L. 115-96) provided an appropriation to make semi-annual CHIP allotments for the first half of FY 2018.
|2018||The HEALTHY KIDS Act as incorporated into Making further continuing appropriations for the fiscal year ending September 30, 2018, and for other purposes (P.L. 115-120) extends funding for CHIP through FY 2023 and extends several other CHIP provisions until FY 2023, including:
The HEALTHY KIDS Act also
Bipartisan Budget Act of 2018 (P.L. 115-123) makes several changes to CHIP and Medicaid:
CHIP and children’s coverage
Extends for four additional years, FY 2024 – 2027:
Dually eligible beneficiaries
 HCFA was renamed the Centers for Medicare & Medicaid Services in 2001.
Source: MACPAC analysis as of February 2018.