This report from the Center on Budget and Policy Priorities explores the effects of overturning the maintenance-of-effort provision of the Affordable Care Act. This comes as some governors are considering reducing their Medicaid and Children's Health Insurance Plan coverage to combat budget challenges.

From the report: 

The Affordable Care Act requires states to maintain their current Medicaid and Children’s Health Insurance Program eligibility standards until 2014, when new, nationwide Medicaid eligibility standards take effect and state-based health insurance exchanges will begin operating. However, citing state budget problems, a number of Republican governors have asked Congress to repeal these “maintenance of effort” provisions so that they can reduce Medicaid and CHIP expenditures by covering fewer people.

Repealing the maintenance-of-effort provision would almost certainly result in a sharp increase in the number of Americans who are uninsured, as states scale back eligibility for low-income children, parents, seniors, and/or people with serious disabilities — the principal groups of people whom Medicaid covers. During the recession of the early 2000s, some 34 states cut back Medicaid and CHIP eligibility — causing 1.2 million to 1.6 million low-income adults and children to lose coverage — before Congress acted to prevent states from making further eligibility cuts as a condition of receipt of federal fiscal assistance enacted in 2003.

Full Report: Repealing Health Reform’s Maintenance of Effort Provision Could Cause Millions of Children, Parents, Seniors, and People With Disabilities to Lose Coverage (PDF |212 KB) 

Center on Budget and Policy Priorities. (2011). Repealing health reform's maintenance of effort provision could cause millions of children, parents, seniors, and people with disabilities to lose coverage. Soloman, J.