An Implementation Analysis of States’ Experiences in Transitioning “Stairstep” Children from Separate CHIP to Medicaid

The ACA required Medicaid to cover all children with incomes up to 138 percent of the federal poverty level (FPL) as of January 2014. Whereas all states were previously required to cover children under age 6 in families with incomes up to 138 percent of FPL and children ages 6 to 18 up to 100 percent of FPL through Medicaid, children ages 6 to 18 with family incomes between 100 and 138 percent of FPL were permitted to be covered through separate CHIP. At the time the ACA was enacted, 21 states covered these so-called “stairstep” children through separate CHIP and thus needed to transition them to Medicaid in order to comply with the ACA requirement. Such a transition raises concerns about continuity of coverage and access for children transitioning, along with concerns about potential confusion for parents and providers. This report describes 10 states’ approaches to the transition, identifying common challenges and lessons learned that could support future transitions between health coverage programs.