Medicaid is the United States health program for individuals and families with low incomes and resources. It is jointly funded by the states and federal government, and is managed by the states. Among the groups of people served by Medicaid are eligible low-income parents, children, seniors, and people with disabilities. Medicaid is the largest source of funding for medical and health-related services for people with limited income.
History and participation
Medicaid was created on July 30, 1965 through Title XIX of the Social Security Act. Each state administers its own Medicaid program while the federal Centers for Medicare and Medicaid Services (CMS) monitors the state-run programs and establishes requirements for service delivery, quality, funding, and eligibility standards.
Each state may have its own name for the program. Examples include "Medi-Cal" in California, "MassHealth" in Massachusetts, and "TennCare" in Tennessee. States may bundle together the administration of Medicaid with other separate programs such as the State Children's Health Insurance Program (SCHIP), so the same organization that handles Medicaid in a state may also manage those additional programs. Separate programs may also exist in some localities that are funded by the states or their political subdivisions to provide health coverage for indigents and minors.
State participation in Medicaid is voluntary; however, all states have participated since 1982 when Arizona formed its Arizona Health Care Cost Containment System (AHCCCS) program. In some states Medicaid is subcontracted to private health insurance companies, while other states pay providers (i.e., doctors, clinics and hospitals) directly.
Comparisons with Medicare
Although their names are similar, Medicaid and Medicare are very different programs. Medicare is an entitlement program funded entirely at the federal level. It focuses primarily on the older population. As stated in the CMS website, Medicare is a health insurance program for people age 65 or older, people under age 65 with certain disabilities, and people of all ages with end stage renal disease.
Medicaid is not an entitlement program, and it is not solely funded at the federal level. Medicaid is a needs-based program: eligibility is determined by income. States provide up to half of the funding for the Medicaid program. In some states, counties also contribute funds. The main criterion for Medicaid eligibility is limited income and financial resources, a criterion which plays no role in determining Medicare coverage. Medicaid covers a wider range of health care services than Medicare. In 2001, about 6.5 million Americans were enrolled in both Medicare and Medicaid, also known as Medicare dual eligible.
Medicaid is a joint federal-state program that provides health insurance coverage to low-income children, parents, seniors and people with disabilities. While Congress and the Centers for Medicare and Medicaid Services set out the main rules under which Medicaid operates, each state runs its own program. As a result, the eligibility rules differ significantly from state to state, although all states must follow the same basic framework.
Both the federal government and state governments have made changes to the eligibility requirements and restrictions over the years. This has most recently occurred with the passage of the Deficit Reduction Act (DRA) of 2005 (Pub.L. No. 109-171) which significantly changed rules governing the treatment of asset transfers and homes of nursing home residents. The implementation of these changes will proceed state-by-state over the next few years. To be certain of your rights under the Act you should consult an expert, as the rules are complex. The DRA now requires that anyone seeking Medicaid must produce documents to prove that he or she is a United States citizen or resident alien.
Unlike Medicare, which is solely a federal program, Medicaid is a joint federal-state program. Each state operates its own Medicaid system, but this system must conform to federal guidelines in order for the state to receive matching funds and grants. The federal matching formula is different from state to state, depending on each state's poverty level. The wealthiest states only receive a federal match of 50% while poorer states receive a larger match.
Medicaid funding has become a major budgetary issue for many states over the last few years, with the program, on average, taking up 22% of each state's budget. According to CMS, the Medicaid program provided health care services to more than 46.0 million people in 2001. In 2002, Medicaid enrollees numbered 39.9 million Americans, the largest group being children (18.4 million or 46 percent). It is estimated that 42.9 million Americans will be enrolled in 2004 (19.7 million of them children) at a total cost of $295 billion. Medicaid payments assist nearly 60 percent of all nursing home residents and about 37 percent of all childbirths in the United States.
Medicaid is also the program that provides the largest portion of federal money spent for health care on people living with HIV. Typically, poor people who are HIV positive must progress to AIDS before they can qualify under the "disabled" category. More than half of people living with AIDS are estimated to receive Medicaid payments. Two other programs that provide financial assistance to people living with HIV/AIDS are the Social Security Disability Insurance (SSDI) and the Supplemental Security Income.
Medicaid planners typically advise retirees and other individuals facing high nursing home costs to adopt strategies that will protect their financial assets in the event of nursing home admission. State Medicaid programs do not consider the value of one's home in calculating eligibility, therefore it is often recommended that retirees pursue home ownership. By adopting the recommended strategies, many seniors hope they will quickly qualify for Medicaid benefits if the need for long-term care arises.
During the 1990s, many states received waivers from the Federal government to create Medicaid managed care programs. Under managed care, Medicaid recipients are enrolled in a private health plan, which receives a fixed monthly premium from the state. The health plan is then responsible for providing for all or most of the recipient's healthcare needs. Today, all but a few states use managed care to provide coverage to a significant proportion of Medicaid enrollees. Nationwide, roughly 60% of enrollees are enrolled in managed care plans. Core eligibility groups of poor children and parents are most likely to be enrolled in managed care, while the aged and disabled eligibility groups more often remain in traditional "fee for service" Medicaid.
Some states operate a program known as the Health Insurance Premium Payment Program (HIPP). This program allows a Medicaid Recipient to have private health insurance paid for by Medicaid. Often this allows the recipient to have better coverage, and have more doctors available to them.
- 1965 PL 89-97 Medicaid
- 1997 PL 105-33 Balanced Budget Act (Children's Health Insurance Program)
- 1990 OBRA Federal legislation: the beginnings of the Health Insurance Premium Payment Program (HIPP), under the George Bush Administration
- CMS official web site.
- Trends in Medicare, October 2006. Staff Paper of the Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services
- AT Wiki on Assistivetech.net
- Read Congressional Research Service (CRS) Reports regarding Medicaid
- Kaiser Family Foundation - Substantial resources on Medicaid including federal eligibility requirements, benefits, financing and administration.
- State Health Facts Data on health care spending, utilization, and insurance coverage, including details extensive Medicaid information.
- State of the States 2006 - Information on state health reforms, including Medicaid (PDF).
- Medicaid information from Families USA
- Medicaid Reform - The Basics from The Century Foundation
- National Association of State Medicaid Directors Organization representing the chief executives of state Medicaid programs.
- Ohio Medicaid Basics A primer on one state's Medicaid program.
- Florida's Agency for Health Care Administration - Information on the State of Florida's Medicaid program (Click on the "Medicaid" link on the left hand side).
- Drug Channels blog - Analysis of Average Manufacturer Price (AMP) system.