Home >> Legislative History
| 1965 | July 30, 1965 Lyndon Johnson signed legislation that created the Medicaid program. |
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| 1967 | The Social Security Amendments of 1967 mandate Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services for eligible children under the age of 21. |
| 1971 | States are given the option to cover services in intermediate care facilities (ICFs) for the elderly, disabled and mentally retarded with lower level of care needs than those available in skilled nursing facilities. |
| 1972 | The Social Security Amendments of 1972 established the Supplemental Security Income (SSI) program of cash assistance for the elderly and individuals with disabilities. States must either cover SSI recipients or use their 1972 Medicaid eligibility standards for the elderly and individuals with disabilities. |
| 1977 | Secretary of the Department of Health, Education and Welfare created the Health Care Financing Administration to administer the Medicaid and Medicare programs. |
| 1981 | The Omnibus Reconciliation Act of 1981 (OBRA 81), as part of required federal budget savings, reduced federal matching payments to states by specific percentages for the period FY 1982-1984. OBRA 81 repealed a requirement that states pay Medicare hospital payment rates, but allowed states to make additional payments to hospitals that serve a disproportionate share of Medicaid and low-income patients. These hospitals then became known as the disproportionate share hospitals (DSH). OBRA 81 also established two new types of waivers: 1915(b) freedom-of-choice waivers, which allowed states to pursue mandatory managed care enrollment of certain Medicaid populations, and the 1915(c) HCBS waiver, which allowed states to cover home- and community-based long-term care services for the elderly and individuals with disabilities at risk of institutional care. |
| 1982 | The Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) revised previous Medicaid cost-sharing policies to expand state options for imposing nominal cost-sharing on certain Medicaid beneficiaries and services. TEFRA allowed states to extend Medicaid coverage to children under age 18 with disabilities that require institutional care, but are living at home. This was accomplished by waiving requirements for families that fall within SSI income restrictions. |
| 1984 | The Deficit Reduction Act of 1984 mandates coverage of children born after September 30, 1983, up to age 5, of AFDC-eligible families. Coverage for AFDC eligible first-time pregnant women and pregnant women in two-parent unemployed families are mandatory. |
| 1985 | The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA 1985) mandates coverage for all remaining AFDC eligible pregnant women. |
| 1986 | The Omnibus Reconciliation Act of 1986 (OBRA 86) required states to cover treatment of emergency medical conditions for illegal immigrants, otherwise eligible for Medicaid. OBRA 86 also gave states the option of covering pregnant women and infants (up to 1 year of age) with incomes up to 100% of FPL and allowed states to pay for Medicare premiums and cost-sharing for low-income qualified Medicare beneficiaries (QMBs) with income at or below 100% of FPL. |
| 1987 | The Omnibus Reconciliation Act of 1987 (OBRA 87) gave states the option of covering pregnant women and children under the age of 1 in families with income up to 185% of FPL. OBRA 87 enacted nursing home reforms that upgraded quality of care requirements and revised monitoring and enforcement of facilities participating in Medicaid. |
| 1988 | The Medicare Catastrophic Coverage of 1988 (MCCA) required states to pay the Medicare premiums and cost-sharing for low-income Medicaid beneficiaries with incomes below 100% of FPL. MCCA also required states to phase in coverage for pregnant women and infants in families with incomes up to 100% of FPL. MCCA established new eligibility rules for institutionalized individuals whose spouses remain in the community to prevent spousal impoverishment. |
| 1989 | The Omnibus Reconciliation Act of 1989 (OBRA 89) mandated coverage for pregnant women and children under the age of 6 in families with incomes at or below 133% of FPL (whether or not they were receiving AFDC cash assistance). OBRA 89 also expanded EPSDT benefits for children under 21 to included needed services even if the services were not covered under for adult beneficiaries. OBRA 89 also required states to cover services provided by federally-qualified health centers (FQHCs). |
| 1990 | The Omnibus Budget Reconciliation Act of 1990 (OBRA 90) mandated coverage of children ages 6 through 18 in families with incomes at or below 100% of FPL (whether or not they were receiving AFDC cash assistance) with coverage phased in one year at a time and completed by 2002. OBRA 90 required states to pay Medicare premiums for Medicare beneficiaries with income between 100 and 120 percent of the federal poverty level, also known as special low-income Medicare beneficiaries (SLMBs). OBRA 90 established the Medicaid prescription rebate program requiring pharmaceutical manufacturers to give "best price" rebates to states and federal governments. |
| 1991 | The Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of 1991 restricted the use of revenues from provider donations and taxes as the state share of Medicaid expenditures. It placed a national ceiling on the Medicaid special payments to DSH hospitals. |
| 1993 | The Clinton Administration begins approving section 1115 waivers to states allowing more statewide expansion demonstrations. The Omnibus Budget Reconciliation At of 1993 placed facility-specific ceilings on special payments to DSH hospitals, established national standards for state use of formularies to manage their prescription drug benefit and tightened prohibitions against the transfer of assets in order to qualify for Medicaid nursing home coverage. |
| 1996 | The Personal Responsibility and Work Opportunity Act of 1996 (PRWOA) repealed the AFDC individual entitlement to cash assistance and replaced it with the Temporary Assistance for Needy Families (TANF) block grant to states ending the formal linkage between welfare and Medicaid eligibility. PRWOA required states to cover families meeting July 16, 1996 AFDC eligibility standards and allowed them to cover families with higher incomes. PRWOA extended Medicaid coverage for non-emergency services for eligible legal immigrants entering the US on or after August 22, 1996 for five years. |
| 1997 | The Balanced Budget Act of 1997 (BBA 1997) established the State Children's Health Insurance Program (SCHIP) allowing states to cover uninsured children in families with incomes below 200% of FPL who were ineligible for Medicaid. The federal matching rate for costs of SCHIP services were enhanced. BBA 97 permitted states to require Medicaid beneficiaries to enroll in managed care plans without obtaining a section 1915(b) waiver. |
| 1999 | The Ticket to Work and Work Incentives Improvement Act of 1999 allowed states to cover working disabled individuals with incomes above 250% of FPL and impose income-related premiums for such coverage. |
| 2000 | Breast and Cervical Cancer Prevention and Treatment Act of 2000 allowed states to cover uninsured women with breast and cervical cancer, regardless of income or resources, at enhanced SCHIP federal matching rate. The Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act directs the Secretary of HHS to issue regulations tightening upper payment limits. |
| 2001 | The 1115 waiver initiative, Health Insurance Flexibility and Accountability, is introduced allowing states to demonstrate comprehensive state approaches that will increase the number of individuals with health insurance coverage using current-level Medicaid and SCHIP resources. Pennsylvania passed Act 2001-77 on June 26, 2001, also known as the Tobacco Settlement Act. This act established the Medical Assistance for Workers with Disabilities (MAWD) program that was implemented effective January 1, 2002. |
| 2003 | The Jobs and Growth Tax Relief Reconciliation Act of 2003 raises all state Medicaid matching rates by 2.95 percentage points for the period of April 2003 through June 2004. Medicare Prescription Drug Improvement and Modernization Act establishes a new Medicare Part D prescription drug program enacted with full premium subsidies for individuals with incomes below 135% of FPL. Medicaid drug coverage for dual-eligibles, those who qualify for both Medicaid and Medicare, is transferred to Medicare effective January 1, 2006. |
| 2005 | Congress passes a budget resolution requiring $10 billion in cost savings from the Medicaid Program. Michael Leavitt, Secretary of the Department of Health and Human Services, established an advisory Medicaid commission. |
This timeline was produced from the Kaiser Family Foundation's Medicaid: an interactive timeline at http://www.kff.org/medicaid/Medicaid_timeline.cfm and also from United States government legislation.