• Talking Points
  • January 10, 2017

Key Provisions of the Affordable Care Act for Children

The Affordable Care Act (ACA) includes a number of important provisions intended to make children's health care more age-appropriate, affordable, accessible and timely. As the future of the ACA is considered, it is important that children do not lose the protections and gains created by these provisions. 

  • Private coverage through the Exchanges – More than 1 million children are covered by Exchange plans.
  • Reforms of the overall private insurance market:
    • No exclusions or increased costs for pre-existing conditions – Children with an ongoing health condition cannot be denied coverage or charged more because of that condition.
    • No annual or lifetime benefit caps – Children who have high medical costs are assured their private coverage, including coverage through large employers, won't end because their benefit is capped at a certain dollar amount.
    • Preventive services are covered without cost-sharing – Children can receive vital well-baby and well-child preventive screenings and scheduled immunizations at no cost to their families.
    • Dependent coverage up to age 26 – Young adults can remain on their parent(s)' plan until age 26.
  • Coverage of pediatric, habilitative services – All private plans in the individual and small group markets must now cover pediatric and habilitative1 services. Prior to the ACA, these key benefits were not always covered. 
  • Medicaid/CHIP maintenance of effort – States cannot roll back the Medicaid and CHIP eligibility standards, methodologies and procedures they had in place for children's coverage as of March 23, 2010. 
  • Enhanced federal CHIP matching rate – The 23 percentage point enhanced federal match for CHIP has helped states continue coverage for children and address budgetary shortfalls. 
  • Children's hospitals' eligibility for federal drug discounts – The ACA expanded 340B Drug Pricing Program eligibility to children's hospitals so they can provide reduced-price drugs to patients, expand comprehensive health services and continue to serve patients who cannot pay.
  • Delivery system reforms – The ACA advances new models of care through the new Center for Medicare and Medicaid Innovation, a state option that provides coverage to individuals with chronic conditions through a "health home" and other initiatives. Children are benefiting from this new focus on improved care and smarter spending.

Reference: 

Services that help a child keep, learn or improve skills and functioning, such as therapy for a child who isn't walking or talking at the expected age.