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