Medicaid Health Article

Definition

Medicaid is a federal-state entitlement program for low-income citizens of the United States. The Medicaid program is part of Title XIX of the Social Security Act Amendment that became law in 1965. Medicaid offers federal matching funds to states for costs incurred in paying health care providers for serving covered individuals. State participation is voluntary, but since 1982, all 50 states have chosen to participate in Medicaid.

Medicaid benefits

Medicaid benefits cover basic health care and long-term care services for eligible persons. About 58% of Medicaid spending covers hospital and other acute care services. The remaining 42% pays for nursing home and long-term care.

States that choose to participate in Medicaid must offer the following basic services:

• hospital care, both inpatient and outpatient
• nursing home care
• physician services
• laboratory and diagnostic x ray services
• immunizations and other screening, diagnostic, and treatment services for children
• family planning
• health center and rural health clinic services
• nurse midwife and nurse practitioner services
• physician assistant services

Participating states may offer the following optional services and receive federal matching funds for them:

• prescription medications
• institutional care for the mentally retarded
• home- or community-based care for the elderly, including case management
• personal care for the disabled
• dental and vision care for eligible adults

Because participating states are allowed to design their own benefits packages as long as they meet federal minimum requirements, Medicaid benefits vary considerably from state to state. About half of all Medicaid spending covers groups of people and services above the federal minimum.

Eligibility for Medicaid

Medicaid covers three major groups of low-income Americans:

• All recipients. In 2001, Medicaid covered 44 million low-income persons in the United States.
• Parents and children. In 2001, Medicaid covered 24 million low-income children, approximately one-fifth of all children in the United States. It provided coverage to an estimated 9.3 million low-income adults in families with children; most of these low-income adults were women.
• The elderly. In 2001, Medicaid covered five million adults over the age of 65. Medicaid is the largest single purchaser of long-term and nursing home care in the United States.
• The disabled. About 17% of Medicaid recipients are blind or disabled. Most of these persons are eligible for Medicaid because they receive assistance through the Supplemental Security Income (SSI) program.

All Medicaid recipients must have incomes and resources below specified eligibility levels. These levels vary from state to state depending on the local cost of living and other factors. For example, in 2001, the federal poverty level (FPL) was determined to be $14,630 for a family of three on the mainland of the United States, but $16,830 in Hawaii and $18,290 in Alaska.

In most cases, persons must be citizens of the United States to be eligible for Medicaid, although legal immigrants may qualify in some circumstances depending on their date of entry. Illegal aliens are not eligible for Medicaid, except for emergency care.

Persons must fit into an eligibility category to receive Medicaid, even if their income is low. Childless couples and single childless adults who are not disabled or elderly are not eligible for Medicaid.