Medicaid

Medicaid in the United States is a program managed by the states and funded jointly by the states and federal government to provide health insurance for individuals and families with low incomes and resources. Medicaid is the largest source of funding for medical and health-related services for people with limited income. Among the groups of people served by Medicaid are eligible low-income parents, children, seniors, and people with disabilities.

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) (formerly the Health Care Financing Administration) in the United States Department of Health and Human Services monitors the state-run programs and establishes requirements for service delivery, quality, funding, and eligibility standards.

Medicaid policies for eligibility, services, and payment are complex and vary considerably, even among states of similar size or geographic proximity. A person who is eligible for Medicaid in one state may not be eligible in another state, and the services provided by one state may differ considerably in amount, duration, or scope from services provided in a similar or neighboring State. In addition, state legislatures may change Medicaid eligibility, services, and/or reimbursement during the year.

State participation in Medicaid is voluntary; however, all states have participated since 1982. In some states Medicaid pays private health insurance companies that contract with the state Medicaid program, while other states pay providers (i.e., doctors, clinics and hospitals) directly to ensure that individuals receive proper medical attention. The State Children's Health Insurance Program (SCHIP) was established in 1997.

In addition, other programs may exist in some localities that are funded by the states or their political subdivisions to provide health coverage for indigents and minors. There is also general confusion about the differences between Medicaid and Medicare (United States), which is an entirely federal health insurance program available for people age 65 or older, younger people with disabilities, and a few other groups. While Medicaid and Medicare cover similar groups, they are entirely different programs. For example, Medicaid covers a wider range of health care services than Medicare and does not have premiums or deductibles like Medicare. In 2001, about 6.5 million Americans were enrolled in both Medicare and Medicaid.

Medicaid has become a major budgetary issue for many states over the last few years, with the program, on average, taking up a quarter of each state's budget. According to CMS, the Medicaid program provided health care services to more than 46.0 million people in 2001 [1]. 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 with 19.7 million being children. Medicaid pays for nearly 60 percent of all nursing home residents and about 37 percent of all births in the United States.

Medicaid is also the the program that provides the largest portion of federal money spent for health care on people living with HIV (Whetten-Goldstein and Nguyen 22). More than half of people living with AIDS are estimated to receive Medicaid payments. Most often, poor people who are HIV positive must progress to full blown AIDS before they can qualify under the "disabled" category. 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.

In 2005, Medicaid became a major focus of lawmakers, as Congress debated funding cuts for the program. The budget reforms called for $10 billion in cuts over five years.

Eligibility

According to CMS there are 25 different eligibility categories that are classified into five broad coverage groups [2]:

• Pregnant women
• Children and teenagers
• People who are aged
• People who are blind
• People who are disabled

Important legislation

• 1965 PL 89-97 Medicaid
• 1997 PL 105-33 Balanced Budget Act (Children’s Health Insurance Program)

References

Whetten-Goldstein, Kathryn and Trang Quyen Nguyen. You're the first one I've told: new faces of HIV in the South. Rutgers University Press, New Brunswick: 2003.

See also

• Medicare (United States)

External links

• CMS official web site.

• Medicare
• Medicaid

• Medicare official web site for beneficiaries.

• Medi-Cal - California's version of Medicaid

• Ohio Medicaid Basics A primer on one state's Medicaid program.

• Kaiser Family Foundation - Substantial resources on Medicaid including federal eligibility requirements, benefits, financing and administration.

• National Association of State Medicaid Directors Organization representing the chief executives of state Medicaid programs.

• State Health Facts Data on health care spending, utilization, and insurance coverage, including details extensive Medicaid information.

• State Coverage Initiatives Information on state health reforms, including Medicaid expansion.