States are responding to the current fiscal crisis and uncertainty about federal health reform in very different ways. Several are holding back on planned coverage expansions, capping or even cutting eligibility for existing programs, or waiting for federal reform to unfold or the economy to turn around before implementing health reforms. Yet some states are forging ahead with health system reforms intended to strengthen the safety net, transform the delivery of health care, and contain long-term cost growth.
Despite budget crises and other economic challenges facing states, some are expanding eligibility and implementing strategies to increase enrollment of adults and children in public programs.
In February 2008, Wisconsin launched a health reform effort with three goals: provide universal coverage for children, simplify existing public programs, and remove barriers to stable coverage for families.
Under the 2008 Maryland Kids First Act, Maryland is using state income tax forms to identify families with children who may be uninsured and eligible for Medicaid or CHIP and sending them information about how to enroll.
Maryland recently began expanding Medicaid coverage to low-income parents and expanding health benefits to low-income childless adults as part of a larger set of health reforms aimed at reducing the number of uninsured, improving the quality of care, and containing costs.
Governors are increasingly concerned that federal health reform will hand them expensive new Medicaid obligations without money to pay for them.