Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey

Executive Summary
  1. Kaiser Family Foundation, Distribution of Eligibility for ACA Health Coverage Among those Remaining Uninsured as of 2017 (Washington, DC: Kaiser Family Foundation, December 2018), https://www.kff.org/health-reform/state-indicator/distribution-of-eligibility-for-aca-coverage-among-the-remaining-uninsured/

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  2. Kaiser Family Foundation, Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State (Washington, DC: Kaiser Family Foundation, March 2019), https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/#Table3

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  3. Samantha Artiga, Petry Ubri, and Julia Zur, The Effects of Premiums and Cost Sharing on Low-Income Populations: Updated Review of Research Findings ((Washington, DC: Kaiser Family Foundation, June 2017), https://www.kff.org/medicaid/issue-brief/the-effects-of-premiums-and-cost-sharing-on-low-income-populations-updated-review-of-research-findings/

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  4. Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga, The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review, (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018/        

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  5. Robin Rudowitz and MaryBeth Musumeci, “Partial Medicaid Expansion” with ACA Enhanced Matching Funds: Implications for Financing and Coverage, (Washington, DC: Kaiser Family Foundation, February 2019), https://www.kff.org/medicaid/issue-brief/partial-medicaid-expansion-with-aca-enhanced-matching-funds-implications-for-financing-and-coverage/

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  6. Governor Janet Mills, Letter to CMS Administrator Seema Verma, January 22, 2019, https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/me/mainecare/me-mainecare-approval-reponse-ltr-01222019.pdf

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  7. Office of Governor Michelle Lujan Grisham, “Gov. Lujan Grisham Announces Plan to Reverse Medicaid Policies that Create Barriers to Accessing Coverage,” (Office of Governor Michelle Lujan Grisham, Press Release, February 13, 2019), https://www.governor.state.nm.us/2019/02/13/gov-lujan-grisham-announces-plan-to-reverse-medicaid-policies-that-create-barriers-to-accessing-coverage/

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  8. South Carolina Department of Health and Human Services, “Community Engagement Section 1115 Waiver Application,” South Carolina Department of Health and Human Services (March 4, 2019), https://www.scdhhs.gov/public-notice/community-engagement-section-1115-demonstration-waiver-application-0

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  9. The Alaska State Legislature, SB 7, 31st Legislature (2019-2020), accessed March 11, 2019, http://www.akleg.gov/basis/Bill/Detail/31?Root=sb%207

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  10. The Iowa Legislature, Senate File 538, 88th General Assembly, accessed March 11, 2019, https://www.legis.iowa.gov/legislation/BillBook?ba=SF%20538&ga=88

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  11. The Montana Legislature, HB 658, 66th Legislature, accessed March 25, 2019, http://laws.leg.mt.gov/legprd/LAW0210W$BSIV.ActionQuery?P_BILL_NO1=658&P_BLTP_BILL_TYP_CD=HB&Z_ACTION=Find&P_SESS=20191

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  12. Rachel Garfield, Robin Rudowitz, and MaryBeth Musumeci, Implications of a Medicaid Work Requirement: National Estimates of Potential Coverage Losses Appendix, (Washington, DC: Kaiser Family Foundation, June 2018), https://www.kff.org/report-section/implications-of-a-medicaid-work-requirement-national-estimates-of-potential-coverage-losses-appendix/

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  13. Kaiser Family Foundation, Implications of Emerging Waivers on Streamlined Medicaid Enrollment and Renewal Processes, (Washington, DC: Kaiser Family Foundation, February 2018), https://www.kff.org/medicaid/fact-sheet/implications-of-emerging-waivers-on-streamlined-medicaid-enrollment-and-renewal-processes/

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  14. Rachel Garfield, Kendal Orgera, and Anthony Damico, The Uninsured and the ACA: A Primer - Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act, (Washington, DC: Kaiser Family Foundation, January 2019), https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/

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  15. Centers for Medicare and Medicaid Services, “Medicaid & CHIP Monthly Applications, Eligibility Determinations, and Enrollment Reports: January 2014 - December 2018 (preliminary)”, Centers for Medicare and Medicaid Services, (February 28, 2019), https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/monthly-reports/index.html

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  16. Tricia Brooks, Child Enrollment in Medicaid and CHIP Down 600k Children in 2018, (Washington, DC: Georgetown University Center for Children and Families, March 2019), https://ccf.georgetown.edu/2019/03/02/child-enrollment-in-medicaid-and-chip-took-another-hit-in-november-down-600k-children-in-2018/

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  17. Phil Galewitz, “Missouri's shrinking Medicaid rolls raise red flag on vetting process,” Kaiser Health News, (February 11, 2019), https://www.stltoday.com/news/local/govt-and-politics/missouri-is-pushing-eligible-people-off-medicaid-including-thousands-of/article_c4bbec5b-26e5-55a6-936a-8904224dbfa7.html?

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  18. Kathleen Gifford, Eileen Ellis, Barbara Coulter Edwards, Aimee Lashbrook, Elizabeth HintonLarisa Antonisse, and Robin Rudowitz, States Focus on Quality and Outcomes Amid Waiver Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019, (Washington, DC: Kaiser Family Foundation, October 2018),  https://www.kff.org/medicaid/report/states-focus-on-quality-and-outcomes-amid-waiver-changes-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2018-and-2019/

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  19. Michael Ollove,”Child Enrollment in Public Health Programs Fell by 600K Last Year,” Governing, (March 8, 2019),   http://www.governing.com/topics/health-human-services/sl-chip-medicaid-children-enrollment.html

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  20. Samantha Artiga, Rachel Garfield, and Anthony Damico, Estimated Impacts of the Proposed Public Charge Rule on Immigrants and Medicaid, (Washington, DC: Kaiser Family Foundation, October 2018), https://www.kff.org/disparities-policy/issue-brief/estimated-impacts-of-the-proposed-public-charge-rule-on-immigrants-and-medicaid/.

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Introduction
  1. Rachel Garfield, Robin Rudowitz, and MaryBeth Musumeci, Implications of a Medicaid Work Requirement: National Estimates of Potential Coverage Losses Appendix, (Washington, DC: Kaiser Family Foundation, June 2018), https://www.kff.org/report-section/implications-of-a-medicaid-work-requirement-national-estimates-of-potential-coverage-losses-appendix/

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  2. Kaiser Family Foundation, Implications of Emerging Waivers on Streamlined Medicaid Enrollment and Renewal Processes, (Washington, DC: Kaiser Family Foundation, February 2018), https://www.kff.org/medicaid/fact-sheet/implications-of-emerging-waivers-on-streamlined-medicaid-enrollment-and-renewal-processes/

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Medicaid and CHIP Eligibility
  1. 305% FPL with the five percentage point income disregard that is applied to MAGI-based groups.

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  2. U.S. Congress. House. Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act of 2018. HR 6, 115th Congress. Introduced in House June 13, 2018. https://www.congress.gov/bill/115th-congress/house-bill/6

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  3. Some states also have state-funded family planning programs.

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  4. Some immigrants with qualified status, such as refugees and asylees, do not have to wait five years before enrolling. Some immigrants, such as those with temporary protected status, are lawfully present but do not have a qualified status and are not eligible to enroll in Medicaid or CHIP regardless of their length of time in the country

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  5. This option also extends coverage to lawfully present immigrants without a qualified status.

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  6. The District of Columbia, Illinois, Massachusetts, New York, Oregon and Washington use state funds to cover income-eligible children regardless of immigration status. In addition, some states use state funds to cover adult immigrants, but the coverage is often limited to targeted groups.

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  7. Elizabeth Hinton, MaryBeth Musumeci, Robin Rudowitz, Larisa Antonisse, Cornelia Hall, Section 1115 Medicaid Demonstration Waivers: The Current Landscape of Approved and Pending Waivers (Washington, DC: Kaiser Family Foundation, February 2019), https://www.kff.org/medicaid/issue-brief/section-1115-medicaid-demonstration-waivers-the-current-landscape-of-approved-and-pending-waivers/

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  8. Kaiser Family Foundation, Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State (Washington, DC: Kaiser Family Foundation, March 2019), https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/#Table5

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  9. This count excludes Maine, which rejected previously approved waiver terms and conditions in January 2019. Six states (DE, MA, MD, RI, TN, and UT) have retroactive coverage waivers that are not included in this count because they pre-date the ACA and may have been associated with achieving the budgetary savings necessary to expand coverage before federal law authorized the use of Medicaid funds for childless adults.

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  10. Rachel Garfield, Robin Rudowitz, and MaryBeth Musumeci, Implications of a Medicaid Work Requirement: National Estimates of Potential Coverage Losses (Washington, DC: Kaiser Family Foundation, June 2018), https://www.kff.org/medicaid/issue-brief/implications-of-a-medicaid-work-requirement-national-estimates-of-potential-coverage-losses/

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  11. Rachel Garfield, Robin Rudowitz, MaryBeth Musumeci, and Anthony Damico, Implications of Work Requirements in Medicaid: What Does The Data Say? (Washington, DC: Kaiser Family Foundation, June 2018), https://www.kff.org/medicaid/issue-brief/implications-of-work-requirements-in-medicaid-what-does-the-data-say/

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  12. MaryBeth Musumeci, Robin Rudowitz, and Barbara Lyons, Medicaid Work Requirements in Arkansas: Experience and Perspectives of Enrollees (Washington, DC: Kaiser Family Foundation, December 2018), https://www.kff.org/medicaid/issue-brief/medicaid-work-requirements-in-arkansas-experience-and-perspectives-of-enrollees/

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  13. Samantha Artiga, Petry Ubri, and Julia Zur, The Effects of Premiums and Cost Sharing on Low-Income Populations: Updated Review of Research Findings ((Washington, DC: Kaiser Family Foundation, June 2017), https://www.kff.org/medicaid/issue-brief/the-effects-of-premiums-and-cost-sharing-on-low-income-populations-updated-review-of-research-findings/

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  14. Robin Rudowitz, MaryBeth Musumeci, and Cornelia Hall, January State Data for Medicaid Work Requirements in Arkansas (Washington, DC: Kaiser Family Foundation, February 2019), https://www.kff.org/medicaid/issue-brief/state-data-for-medicaid-work-requirements-in-arkansas/

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  15. MaryBeth Musumeci, Robin Rudowitz, and Barbara Lyons, Medicaid Work Requirements in Arkansas: Experience and Perspectives of Enrollees (Washington, DC: Kaiser Family Foundation, December 2018), https://www.kff.org/medicaid/issue-brief/medicaid-work-requirements-in-arkansas-experience-and-perspectives-of-enrollees/

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  16. Kaiser Family Foundation, Implications of Emerging Waivers on Streamlined Medicaid Enrollment and Renewal Processes, (Washington, DC: Kaiser Family Foundation, February 2018), https://www.kff.org/medicaid/fact-sheet/implications-of-emerging-waivers-on-streamlined-medicaid-enrollment-and-renewal-processes/

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Medicaid and CHIP Enrollment and Renewal Processes
  1. Tennessee is phasing the online application in by county with statewide access planned for early 2019.

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  2. The Oklahoma Legislature, HB 1270, 56th Legislature (2017), accessed March 11, 2019, http://www.oklegislature.gov/BillInfo.aspx?Bill=hb1270&Session=1800

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  3. The Mississippi Legislature, HB 1010, Regular Session 2017, accessed March 11, 2019, http://billstatus.ls.state.ms.us/2017/PDF/history/HB/HB1090.xml

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  4. Martha Heberlein, Tricia Brooks, Joan Alker, Samantha Artiga and Jessica Stephens, Getting into Gear for 2014: Findings from a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost Sharing Policies in Medicaid and CHIP, 2012-2013, (Washington, DC: Kaiser Family Foundation, January 2013), https://www.kff.org/medicaid/report/getting-into-gear-for-2014-findings-from-a-50-state-survey-of-eligibility-enrollment-renewal-and-cost-sharing-policies-in-medicaid-and-chip-2012-2013/.

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Premiums and Cost Sharing
  1. Samantha Artiga, Petry Ubri, and Julia Zur, The Effects of Premiums and Cost Sharing on Low-Income Populations: Updated Review of Research Findings ((Washington, DC: Kaiser Family Foundation, June 2017), https://www.kff.org/medicaid/issue-brief/the-effects-of-premiums-and-cost-sharing-on-low-income-populations-updated-review-of-research-findings/

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Looking Ahead
  1. Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga, The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review, (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018/       

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  2. Larisa Antonisse and Robin Rudowitz, An Overview of State Approaches to Adopting the Medicaid Expansion, (Washington, DC: Kaiser Family Foundation, February 2019), https://www.kff.org/report-section/an-overview-of-state-approaches-to-adopting-the-medicaid-expansion-issue-brief/

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  3. Robin Rudowitz and MaryBeth Musumeci, “Partial Medicaid Expansion” with ACA Enhanced Matching Funds: Implications for Financing and Coverage, (Washington, DC: Kaiser Family Foundation, February 2019), https://www.kff.org/medicaid/issue-brief/partial-medicaid-expansion-with-aca-enhanced-matching-funds-implications-for-financing-and-coverage/

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  4. Governor Janet Mills, Letter to CMS Administrator Seema Verma, January 22, 2019, https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/me/mainecare/me-mainecare-approval-reponse-ltr-01222019.pdf

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  5. Office of Governor Michelle Lujan Grisham, “Gov. Lujan Grisham Announces Plan to Reverse Medicaid Policies that Create Barriers to Accessing Coverage,” (Office of Governor Michelle Lujan Grisham, Press Release, February 13, 2019), https://www.governor.state.nm.us/2019/02/13/gov-lujan-grisham-announces-plan-to-reverse-medicaid-policies-that-create-barriers-to-accessing-coverage/

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  6. South Carolina Department of Health and Human Services, “Community Engagement Section 1115 Waiver Application,” South Carolina Department of Health and Human Services (March 4, 2019), https://www.scdhhs.gov/public-notice/community-engagement-section-1115-demonstration-waiver-application-0

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  7. The Alaska State Legislature, SB 7, 31st Legislature (2019-2020), accessed March 11, 2019, http://www.akleg.gov/basis/Bill/Detail/31?Root=sb%207

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  8. The Iowa Legislature, Senate File 538, 88th General Assembly, accessed March 11, 2019, https://www.legis.iowa.gov/legislation/BillBook?ba=SF%20538&ga=88

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  9. The Montana Legislature, HB 658, 66th Legislature, accessed March 25, 2019, http://laws.leg.mt.gov/legprd/LAW0210W$BSIV.ActionQuery?P_BILL_NO1=658&P_BLTP_BILL_TYP_CD=HB&Z_ACTION=Find&P_SESS=20191

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  10. Rachel Garfield, Robin Rudowitz, and MaryBeth Musumeci, Implications of a Medicaid Work Requirement: National Estimates of Potential Coverage Losses Appendix, (Washington, DC: Kaiser Family Foundation, June 2018), https://www.kff.org/report-section/implications-of-a-medicaid-work-requirement-national-estimates-of-potential-coverage-losses-appendix/

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  11. Kaiser Family Foundation, Implications of Emerging Waivers on Streamlined Medicaid Enrollment and Renewal Processes, (Washington, DC: Kaiser Family Foundation, February 2018), https://www.kff.org/medicaid/fact-sheet/implications-of-emerging-waivers-on-streamlined-medicaid-enrollment-and-renewal-processes/

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  12. Rachel Garfield, Kendal Orgera, and Anthony Damico, The Uninsured and the ACA: A Primer - Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act, (Washington, DC: Kaiser Family Foundation, January 2019), https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/

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  13. Centers for Medicare and Medicaid Services, “Medicaid & CHIP Monthly Applications, Eligibility Determinations, and Enrollment Reports: January 2014 - December 2018 (preliminary)”, Centers for Medicare and Medicaid Services, (February 28, 2019), https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/monthly-reports/index.html

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  14. Tricia Brooks, Child Enrollment in Medicaid and CHIP Down 600k Children in 2018, (Washington, DC: Georgetown University Center for Children and Families, March 2019), https://ccf.georgetown.edu/2019/03/02/child-enrollment-in-medicaid-and-chip-took-another-hit-in-november-down-600k-children-in-2018/

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  15. Phil Galewitz, “Missouri's shrinking Medicaid rolls raise red flag on vetting process,” Kaiser Health News, (February 11, 2019), https://www.stltoday.com/news/local/govt-and-politics/missouri-is-pushing-eligible-people-off-medicaid-including-thousands-of/article_c4bbec5b-26e5-55a6-936a-8904224dbfa7.html?

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  16. Kathleen Gifford, Eileen Ellis, Barbara Coulter Edwards, Aimee Lashbrook, Elizabeth HintonLarisa Antonisse, and Robin Rudowitz, States Focus on Quality and Outcomes Amid Waiver Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019, (Washington, DC: Kaiser Family Foundation, October 2018), https://www.kff.org/medicaid/report/states-focus-on-quality-and-outcomes-amid-waiver-changes-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2018-and-2019/

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  17. Michael Ollove,”Child Enrollment in Public Health Programs Fell by 600K Last Year,” Governing, (March 8, 2019),   http://www.governing.com/topics/health-human-services/sl-chip-medicaid-children-enrollment.html

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  18. Samantha Artiga, Rachel Garfield, and Anthony Damico, Estimated Impacts of the Proposed Public Charge Rule on Immigrants and Medicaid, (Washington, DC: Kaiser Family Foundation, October 2018), https://www.kff.org/disparities-policy/issue-brief/estimated-impacts-of-the-proposed-public-charge-rule-on-immigrants-and-medicaid/.

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