Medicaid is a joint federal-state program that helps cover medical costs for people who have limited income and resources. It covers a variety of health care services, including doctor visits, hospital stays, and long-term care.
It also helps provide special nutrition services through WIC. Many Americans would not have access to health coverage if it weren’t for Medicaid.
Eligibility
The eligibility requirements for Medicaid vary by state, but all states cover certain groups of people under their Medicaid program, including low-income children and parents, pregnant women, elderly people, and people with disabilities.
In addition, some of these groups are eligible for Supplemental Security Income (SSI), which is a cash benefit from the federal government for low-income adults who are aged, blind or disabled. SSI beneficiaries are automatically eligible for Medicaid and the comprehensive package of health care benefits as long as they meet SSI eligibility requirements.
The income and assets required for Medicaid eligibility vary by state. To qualify for Medicaid, a person must have income below 138 percent of the federal poverty level and a limited amount of assets. The income amount for most individuals is determined using the Medical Assistance Group Income (MAGI) methodology, which considers taxable income and tax filing relationships to determine financial eligibility.
Coverage
Medicaid is a government program that provides free health care to the nation’s most vulnerable populations, including children and their families, people with disabilities, and seniors. It provides a broad range of medical services, long-term care, and social services.
State eligibility rules for Medicaid are based on income and family size, as well as disability, age, and other factors. These rules vary among states, but most Medicaid recipients qualify if they meet certain income eligibility requirements tied to household size.
Those who qualify for coverage typically have 12 months to renew their coverage, but they have to keep up with any income changes or return needed paperwork. This makes it difficult for many low-income workers to stay covered.
The federal Families First Coronavirus Response Act of 2020, enacted in March 2020, gives states extra funds to cover enrollees during the COVID-19 pandemic and allows them to continue coverage even if their income increases slightly or they miss a renewal deadline. However, this continuous coverage requirement will end in 2023, and states can start full eligibility redeterminations for anyone who has not been re-enrolled by then.
Costs
Medicaid is a program that provides health coverage to low-income people. States receive federal matching funds to provide certain mandatory benefits, such as hospital, physician, and nursing home services. They also have broad discretion in how to purchase and provide these services.
Enrollment and spending in the state Medicaid program increase during economic downturns. This increases costs to states in addition to the cost of state tax revenues.
While enrollment and spending growth in 2014 and 2015 was largely driven by expansion, growth has moderated in more recent years. The COVID-19 pandemic and a strong economy have contributed to slower spending growth. Higher costs for prescription drugs, long-term services and supports, and behavioral health services as well as policy decisions to implement targeted provider rate increases are also contributing factors (MACPAC 2019).
Managed care
If you have Medicaid, you may be part of a health plan called “managed care.” Managed care is a type of healthcare plan that contracts with health care providers to provide care at a reduced cost.
Many managed care plans also offer additional services, such as health education classes and transportation, to help you stay healthy. There are three main types of managed care plans: HMOs, PPOs, and POS.
The primary goal of managed care is to reduce costs for members while improving quality of care. This can be done by coordinating care, providing preventive services and monitoring your health.
While there is no single long-term solution to slow the growth of program (including Medicaid) spending, it is important to note that the overall trend of health spending growth is generally driven by unit costs/prices rather than utilization of services. In addition, waste, fraud, and abuse increase costs and contribute to unsustainable trends.
