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The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) required states to provide Medicaid coverage to all children with incomes up to 138 percent of the federal poverty level (FPL) beginning in January 2014, affecting 21 states that had been covering some of these children in separate CHIP (the so-called stairstep children). In this report, we use administrative enrollment, claims, and encounter data from two early adopting states to estimate the transition’s effect on access to and use of services. We compared health care utilization before and after the implementation of the stairstep transition among children eligible for it in Colorado and New York. We benchmarked these before-and-after trends against those of a comparison population of children who remained consistently eligible for Medicaid throughout the entire study period.

The study was prepared under contract to the Medicaid and CHIP Payment and Access Commission (MACPAC). The findings, statements, and views expressed in this report are those of the authors and do not necessarily reflect those of MACPAC.