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Medicaid

From Academic Kids

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 the indigent (that is, it pays for medical assistance for certain 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. Thus, 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.

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. Medicaid currently covers 53 million Americans, paying for nearly 60 percent of all nursing home residents and about 37 percent of all births in the United States.

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.

Important legislation

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

See also


External Links

  • Medicare (http://www.cms.hhs.gov/medicare/)
  • Medicaid (http://www.cms.hhs.gov/medicaid/)
  • Ohio Medicaid Basics (http://www.hpio.net/publications/medicaidbasics.html) A primer on one state's Medicaid program.
  • State Health Facts (http://www.statehealthfacts.org) Data on health care spending, utilization, and insurance coverage, including details extensive Medicaid information.
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