Issue Brief The Quiet Revolution in Health Care Coverage

During the 1990s, medical assistance for low-income children in Illinois (and other states) underwent a quiet revolution. This revolution was shaped by a series of major policy developments at the national level: federal mandates for expansion of Medicaid coverage to all children in families below the federal poverty line; federal welfare reform legisla-tion, which “delinked ” Medicaid from the welfare system; and the State Children’s Health Insurance Program (SCHIP), which gave states new options for extending eligibility beyond federal Medicaid mandates. The convergence of these policy changes has resulted in a fundamental transformation in health care coverage for children — a shift from welfare-based to income-based eligibility. Many more children are now eligible for either Medicaid or SCHIP, and the composition of medical assistance caseloads has changed dramatically. The quiet revolution also presents ongoing policy challenges, which include reducing disparities in coverage of low-income children and parents and closing the gap between eligibility and actual enrollment.1 Welfare-Based and Poverty-Related Eligibility For several decades, the principal Medicaid eligibility pathway for children was the wel