By NextBestFitEnroll children and adults 55–64
Year 1, Day 1 · UHA; employers; statesDiscuss this step
Every existing law, program, institution, or practice this step changes: what it is today, what happens to it, when, and what that costs or trades off.
| What | Today | Change | Trade-off |
|---|---|---|---|
| Children's Health Insurance Program (CHIP) absorbedYear 1 Federal programs | 7.3M children; separate state programs or Medicaid expansions; some premiums. | Children move to UHP in Year 1; CHIP funding is redirected. | Ends coverage gaps when children age out or family income changes. |
| School-based health services billed to Medicaid replacedYear 1 States & localities | Schools bill Medicaid for services to eligible students (therapy, nursing). | Schools bill UHP for every student, which removes eligibility checks. | More funding for school health services; schools must meet UHP billing standards. |
| Medicaid EPSDT standard for children expandedYear 1 Patients | Medicaid must cover any medically necessary service for children under 21, a broader standard than most private plans. | Kept as the UHP standard for everyone under 21. | Children keep the strongest coverage standard in U.S. law; broad medical-necessity rules raise costs. |
| 24-month Medicare waiting period for people on disability (SSDI) endsYear 1 Federal programs | People approved for SSDI wait two years for Medicare. | Ends in Year 1: SSDI recipients of any age enroll in UHP immediately, ahead of their age wave. | Covers some of the sickest people right away; adds cost in Year 1 before the matching revenue arrives. |