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BOX 5.1A Brief History of Medicaid Legislation Concerning Children
The Social Security Act of 1965, Title XIX, authorizes Medicaid, a federal-state matching entitlement program, to provide medical assistance for low-income families with dependent children and low-income aged, blind, or disabled individuals.
Congress creates the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program to ensure that all Medicaid-eligible children under age 21 receive appropriate comprehensive, periodic health assessments and follow-up treatments for detected illnesses.
The Omnibus Budget Reconciliation Act (OBRA) of 1981 removes limits on the number of state waivers granted under Medicaid.
OBRA of 1986 gives states the option of covering pregnant women and children with incomes up to the federal poverty level, regardless of the state's Aid to Families with Dependent Children (AFDC) eligibility guidelines. Thus, Medicaid is delinked from AFDC, and more pregnant women and children become eligible for Medicaid, particularly in southern and western states.
OBRA of 1987 gives states the option of covering children through age 7 who live in families with incomes below 100 percent of the federal poverty level.
The Medicare Catastrophic Coverage Act of 1988 mandates a phased-in Medicaid eligibility for pregnant women and infants in families with incomes below 100 percent of the federal poverty level.
OBRA of 1989 mandates Medicaid eligibility for all pregnant women and children ages 0 to 5, in families with incomes up to 133 percent of the federal poverty level.
The law requires that states provide any medically necessary treatment called for through an EPSDT program screening, whether or not that treatment service is included in the state's Medicaid plan. Most governors are opposed to this new provision because of its budgetary implications.
The EPSDT program is strengthened: states must establish separate schedules for health, vision, and dental screenings, and states are required to increase participation in screening and diagnosis to 80 percent for children enrolled in the Medicaid program.
Children under the age of 6 years whose families have incomes up to 133 percent of the federal poverty level.
Older children up to 19 years of age who were born after September 30, 1983, and who live in families with incomes at or below the federal poverty level.
Children who receive adoption assistance or foster care.
Pregnant women whose incomes are up to 133 percent of the federal poverty level.
Infants born to Medicaid-eligible pregnant women.
Children who receive federal Supplemental Security Income (SSI).
Children in families that meet the AFDC criteria in place prior to welfare reform.