| Medicaid is the US health insurance program | | | | each state runs its own program. As a result, |
| for individuals and families with low incomes | | | | the eligibility rules are somewhat different |
| and resources. It is jointly funded by the | | | | in every state, although the framework is the |
| states and federal government, and is managed | | | | same throughout the country. |
| by the states. Among the groups of people | | | | |
| served by Medicaid are eligible low-income | | | | Both the federal government and most state |
| parents, children, seniors, and people with | | | | governments have made many changes to the |
| disabilities. Medicaid is the largest source | | | | eligibility requirements and restrictions |
| of funding for medical and health-related | | | | over the years. This has most recently |
| services for people with limited income. | | | | occurred with the passage of the Deficit |
| | | | Reduction Act (DRA) of 2005 (Pub.L. No. |
| History and participation | | | | 109-171) which significantly changed rules |
| | | | governing the treatment of asset transfers |
| Medicaid was created on July 30, 1965 through | | | | and homes of nursing home residents. The |
| Title XIX of the Social Security Act. Each | | | | implementation of these changes will proceed |
| state administers its own Medicaid program | | | | state-by-state over the next few years. To be |
| while the federal Centers for Medicare and | | | | certain of your rights under the Act you |
| Medicaid Services (CMS) monitors the | | | | should consult an expert, as the rules are |
| state-run programs and establishes | | | | complex. The DRA now requires that anyone |
| requirements for service delivery, quality, | | | | seeking Medicaid must produce documents to |
| funding, and eligibility standards. | | | | prove that they are a United States citizen |
| | | | or resident alien. |
| Each state may have their own names for the | | | | |
| program. Examples include "Medi-Cal" in | | | | Budget |
| California, "MassHealth" in Massachusetts, | | | | |
| and "TennCare" in Tennessee. States may | | | | Unlike Medicare, which is totally federal, |
| bundle together the administration of | | | | Medicaid is a joint federal-state program. |
| Medicaid with other separate programs such as | | | | Each state operates its own Medicaid system, |
| the State Children's Health Insurance Program | | | | but this system must conform to federal |
| (SCHIP), so the same organization that | | | | guidelines in order for the state to receive |
| handles Medicaid in a state may also manage | | | | matches and grants. The federal matching |
| those additional programs. Separate programs | | | | formula is different from state to state, |
| may also exist in some localities that are | | | | depending on each state's poverty level. The |
| funded by the states or their political | | | | wealthiest states only receive a federal |
| subdivisions to provide health coverage for | | | | match of 50% while poorer states receive a |
| indigents and minors. | | | | larger match. |
| | | | |
| State participation in Medicaid is voluntary; | | | | Medicaid funding has become a major budgetary |
| however, all states have participated since | | | | issue for many states over the last few |
| 1982 when Arizona formed its AHCCCS program. | | | | years, with the program, on average, taking |
| In some states Medicaid is subcontracted to | | | | up a quarter of each state's budget. |
| private health insurance companies, while | | | | According to CMS, the Medicaid program |
| other states pay providers (i.e., doctors, | | | | provided health care services to more than |
| clinics and hospitals) directly to ensure | | | | 46.0 million people in 2001. In 2002, |
| that individuals receive proper medical | | | | Medicaid enrollees numbered 39.9 million |
| attention. | | | | Americans, the largest group being children |
| | | | (18.4 million or 46 percent). It is estimated |
| Comparisons with Medicare | | | | that 42.9 million Americans will be enrolled |
| | | | in 2004 with (19.7 million of them children). |
| Although their names are similar, Medicaid | | | | Medicaid payments assist nearly 60 percent of |
| and Medicare are very different programs. | | | | all nursing home residents and about 37 |
| Medicare is an entitlement program funded | | | | percent of all childbirths in the United |
| entirely at the federal level. It focuses | | | | States. |
| primarily on the older population. As stated | | | | |
| in the CMS website,[2] Medicare is a health | | | | Medicaid is also the program that provides |
| insurance program for people age 65 or older, | | | | the largest portion of federal money spent |
| people under age 65 with certain | | | | for health care on people living with HIV. |
| disabilities, and people of all ages with end | | | | Typically, poor people who are HIV positive |
| stage renal disease. | | | | must progress to AIDS before they can qualify |
| | | | under the "disabled" category. More than half |
| Medicaid is also an entitlement program, but | | | | of people living with AIDS are estimated to |
| it is not solely funded at the federal level. | | | | receive Medicaid payments. Two other programs |
| States provide up to half of the funding for | | | | that provide financial assistance to people |
| the Medicaid program. In some states, | | | | living with HIV/AIDS are the Social Security |
| counties also contribute funds. The main | | | | Disability Insurance (SSDI) and the |
| criterion for Medicaid eligibility is limited | | | | Supplemental Security Income. |
| income and financial resources, a criterion | | | | |
| which plays no role in determining Medicare | | | | Financial advisors typically advise retirees |
| coverage. Medicaid covers a wider range of | | | | and other individuals facing high health |
| health care services than Medicare. In 2001, | | | | costs to adopt strategies that will protect |
| about 6.5 million Americans were enrolled in | | | | their financial assets in the event of large |
| both Medicare and Medicaid, also known as | | | | medical bills. Many programs do not consider |
| Medicare dual eligible. | | | | the value of one's home in calculating |
| | | | eligibility, therefore it is often |
| Eligibility | | | | recommended that retirees pursue home |
| | | | ownership. By adopting the recommended |
| Medicaid is a joint federal-state program | | | | strategies, seniors hope they will quickly |
| that provides health insurance coverage to | | | | qualify for Medicaid benefits if the need for |
| low-income children, seniors and people with | | | | long-term care arises. A person should seek |
| disabilities. While Congress and the Centers | | | | advice from a qualified expert who is |
| for Medicare and Medicaid Services set out | | | | familiar with Medicaid rules and financial |
| the main rules under which Medicaid operates, | | | | planning. |