“Maintenance of Effort” in 200 Words

More than 95 percent of U.S. children have health insurance. This record high rate includes more than 35 million kids with public insurance through Medicaid and the Children’s Health Insurance Program (CHIP), an increasing number of which come from working families.

One important piece of the federal health law that helped to maintain kids’ coverage is the maintenance of effort (MoE) provision, which sounds wonky but is really quite simple. The MoE requires that public insurance programs not roll back income eligibility and coverage levels for children, thus “maintain the effort” that was in place prior to the federal law’s passage. This obligates states to prioritize children’s health and prevents kids from being cut off from needed care.

History tells us that without these MoE obligations, states facing budgetary pressures will use strategies to cut costs by scaling back kids’ public coverage. If the MoE expires in 2019 as scheduled, even if CHIP and Medicaid remain in place with no major changes, millions of children could lose access to coverage.

As the new administration takes steps toward repealing the Affordable Care Act and its replacement remains unclear, it’s critical that we continue what has worked in reaching this milestone of kids’ coverage so that they are not inadvertently harmed by our failure to maintain it.



Jennifer Clendening, MPA, MBE, is a former health policy manager at PolicyLab.

This post is part of our “____ in 200 Words” series. In this series, we tackle issues related to children’s health policy and explain and connect you to resources to help understand them further, all in 200 words. If you have any suggestions for a topic in this series, please send a note to PolicyLab’s Communications Manager Lauren Walens.