Fact Sheet
March 2010

Maintenance of Effort Requirements under Health Reform

The Affordable Care Act requires states to keep the same eligibility levels for adults in Medicaid until the health insurance marketplaces (also known as "exchanges") are fully functional in 2014. States must keep the same eligibility levels for children in Medicaid and CHIP (the Children's Health Insurance Program) until 2019.

If a state violates this requirement, known as "maintenance of effort" (or MOE), it will lose all federal matching funds for Medicaid until it corrects the violation.

Advocates and state policy makers can use this fact sheet to learn more about how the health care law prevents cuts to Medicaid and CHIP eligibility levels and prohibits policies that make it harder for people to get or keep coverage through these programs.