Medicaid

Medicaid
source
Agency name	Medicaid
Logo width	150
Formed	July 30, 1965
Preceding1	Various state medical assistance programs
Jurisdiction	United States
Headquarters	Hubert H. Humphrey Building, Washington, D.C.
Employees	Approx. 6,000 (Centers for Medicare & Medicaid Services)
Budget	$728 billion (FY 2021)
Chief1 name	Chiquita Brooks-LaSure
Chief1 position	Administrator, Centers for Medicare & Medicaid Services
Parent department	United States Department of Health and Human Services
Parent agency	Centers for Medicare & Medicaid Services

Medicaid. It is a joint federal and state program that provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Established under the Social Security Amendments of 1965, it is administered by states according to federal requirements and is the single largest source of health coverage in the United States. The program is a key component of the nation's social safety net, working in tandem with Medicare and the Children's Health Insurance Program.

Overview

The program operates as a partnership between the federal government and individual states, territories, and the District of Columbia. The federal agency overseeing it is the Centers for Medicare & Medicaid Services within the United States Department of Health and Human Services. Each state administers its own program, leading to significant variation in eligibility, benefits, and provider payment rates across jurisdictions like California, Texas, and New York. This structure was a central feature of President Lyndon B. Johnson's Great Society initiatives, alongside the creation of Medicare. The program is distinct from but often coordinates with other federal initiatives such as the Supplemental Security Income program.

Eligibility and enrollment

Eligibility is primarily based on income, household size, disability, family status, and other factors, with specific categories including low-income families, qualified pregnant women, and individuals receiving Supplemental Security Income. The Patient Protection and Affordable Care Act, often called the Affordable Care Act, significantly expanded eligibility by allowing states to cover all adults with income up to 138% of the Federal Poverty Level. This expansion was upheld by the Supreme Court of the United States in the case National Federation of Independent Business v. Sebelius, though it was made optional for states. Enrollment processes are managed by state agencies, often in conjunction with the Health Insurance Marketplace established by the Affordable Care Act.

Benefits and services

Federal law requires state programs to provide certain mandatory benefits, including inpatient and outpatient hospital services, physician services, laboratory and X-ray services, and nursing facility services for individuals aged 21 or older. States may also elect to provide optional benefits such as prescription drug coverage, physical therapy, and dental services. Many states use managed care plans, contracting with entities like UnitedHealth Group and Anthem Inc., to deliver services. Special programs exist for specific populations, such as the Early and Periodic Screening, Diagnostic, and Treatment benefit for children.

Financing and administration

Financing is shared between the federal government and the states. The federal share is determined by a formula called the Federal Medical Assistance Percentage, which ranges from 50% to 83% depending on a state's per capita income relative to the national average. States fund their share through various means, including general revenue and, in some cases, provider taxes. Major expenditures include payments to hospitals like the Mayo Clinic and Cleveland Clinic, long-term care services, and managed care capitation payments. The Congressional Budget Office regularly analyzes the program's costs and enrollment trends.

History and legislative background

The program was signed into law on July 30, 1965, by President Lyndon B. Johnson as Title XIX of the Social Security Act, alongside the creation of Medicare. Key legislative changes followed, including the Tax Equity and Fiscal Responsibility Act of 1982, which allowed states to implement managed care, and the Omnibus Budget Reconciliation Act of 1990, which required coverage for certain children. The Balanced Budget Act of 1997 created the Children's Health Insurance Program. The most transformative recent change was the expansion provision within the Patient Protection and Affordable Care Act of 2010.

Impact and controversies

The program has dramatically reduced the number of uninsured Americans and is a critical payer for long-term care, including nursing homes. It has faced ongoing debates over its cost to federal and state budgets, often highlighted in debates over the United States federal budget. Policy controversies include the optional state expansion under the Affordable Care Act, leading to coverage gaps in non-expansion states, and proposals to convert funding to a block grant system, such as those included in the American Health Care Act of 2017. The program is also central to legal battles over funding for entities like Planned Parenthood and state flexibility waivers under Section 1115 of the Social Security Act.

Category:Medicaid Category:1965 establishments in the United States Category:Health economics in the United States