Medicaid: A Lifeline for Low-Income Families and Individuals
Medicaid is a vital public health insurance program providing essential health care coverage to low-income families and individuals in the United States. Jointly funded by the federal government and individual states, Medicaid operates at the state level, resulting in varying coverage and administration across different states. This program is available only to those who meet specific income-based criteria. As of September 2020, approximately 70.6 million people were covered by Medicaid.
Key Highlights
- Medicaid is a collaboration between federal and state governments offering healthcare coverage to low-income individuals.
- The federal government pays a portion of Medicaid costs, while states design and administer their own programs.
- Eligibility is income-based relative to the federal poverty level (FPL).
- Medicaid increases coverage and improves overall health for beneficiaries.
Delving Deeper into Medicaid
Established in 1965 by President Lyndon B. Johnson and authorized by Title XIX of the Social Security Act, Medicaid is a government-sponsored insurance program for individuals and families with insufficient income to cover healthcare costs. Rather than providing direct medical services, Medicaid covers expenses like doctor visits, hospital stays, long-term care, and other health-related services.
Each state is responsible for determining eligibility, the type of coverage provided, and payment processes for healthcare providers, as it administers its own Medicaid program. The federal government matches state spending, varying from a minimum of 50% to a maximum of 83%, depending on the state. All states have adopted Medicaid, making it the primary source of healthcare funding for low-income individuals in the U.S. In 2019, total Medicaid spending was $613.5 billion, with the federal government accounting for 64.5% of the expenditure and individual states covering 35.6%.
Medicaid covers these primary groups:
- Low-income children and their parents
- Pregnant women
- People with disabilities
- Adults over the age of 65
Under the Patient Protection and Affordable Care Act (ACA), eligibility was expanded to include adults under 65 with incomes below 133% of the FPL. Subsequently, children make up 38% of enrollees but account for only 18% of costs, while people with disabilities represent 14% of enrollees but account for 36% of costs.
Special Conditions for Medicaid Eligibility
Eligibility for Medicaid is determined by submitting an application through the Health Insurance Marketplace or directly through your state’s Medicaid agency. Income is calculated based on an individual’s modified adjusted gross income (MAGI), considering taxable income plus certain deductions.
Key income criteria include:
- Individuals and families must have incomes between 100% - 200% of the FPL or below 138% for specific beneficiaries like children, pregnant women, elderly individuals, and those with disabilities.
Changes to eligibility and program details are regularly updated, so visiting the Medicaid website is essential for the latest information.
Recent Policy Changes
The Trump administration allowed states to implement work requirements for Medicaid eligibility, resulting in 18,000 people in Arkansas losing coverage before this policy was suspended.
Medicaid vs. the Affordable Care Act (ACA)
Signed into law in 2010, the ACA, widely known as Obamacare, expanded Medicaid eligibility to U.S. citizens and legal residents earning up to 138% of the poverty line in participating states. Despite the expansion initiative, the U.S. Supreme Court ruled that states are not obliged to participate to continue receiving pre-established Medicaid funding. As of March 2021, 12 states had not expanded Medicaid: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming.
The Advantages of Medicaid
Medicaid has significantly reduced the number of uninsured Americans. In 2013, prior to major ACA provisions, 44 million people lacked health insurance. By 2017, this figure decreased to 27.4 million.
For many low-income individuals, Medicaid remains a crucial source of health coverage, providing access to necessary medical care and improving overall well-being. This accessibility decreases the need for costly emergency services and enhances health outcomes for those who might otherwise remain uninsured.
Related Terms: Affordable Care Act, federal poverty level, Medicare, Social Security Act, healthcare benefits.
References
- Medicaid.gov. “September 2020 Medicaid & CHIP Enrollment Data Highlights”.
- Medicaid.gov. “Program History”.
- Congressional Research Service. “Medicaid’s Federal Medical Assistance Percentage (FMAP)”, Pages 2, 16, and 17.
- U.S. Centers for Medicare & Medicaid Services. “NHE Fact Sheet”.
- Kaiser Family Foundation. “Federal and State Share of Medicaid Spending”.
- MACPAC. “Eligibility”.
- MACPAC. “Medicaid Expansion to the New Adult Group”.
- U.S. Centers for Medicare & Medicaid Services. “2018 Actuarial Report on the Financial Outlook for Medicaid”, Page 60 and 61.
- U.S. Centers for Medicare & Medicaid Services. “Federal Poverty Level (FPL)”.
- U.S. Centers for Medicare & Medicaid Services. “RE: Opportunities to Promote Work and Community Engagement Among Medicaid Beneficiaries”, Pages 1-10.
- The Commonwealth Fund. “Status of Medicaid Expansion and Work Requirement Waivers”.
- U.S. District Court of Appeals in the District of Columbia. “Charles Gresham*v.*Alex Azar, II, 19-5094 (D.C. Cir. 2020)”, Pages 16-19.
- U.S. Centers for Medicare & Medicaid Services. “Read the Affordable Care Act”.
- U.S. Supreme Court. “National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012)”, Pages 522-524 and 575-588.
- Kaiser Family Foundation. “Status of State Medicaid Expansion Decisions: Interactive Map”.
- Kaiser Family Foundation. “The Uninsured and the ACA: A Primer”, Page 7.
