Array ( [0] => {{Short description|United States social health care program for families and individuals with limited resources}} [1] => {{Distinguish|Medicare (United States)}} [2] => {{Use mdy dates|date=September 2014}} [3] => [[File:Centers for Medicare and Medicaid Services logo.svg|250px|thumb|[[Centers for Medicare and Medicaid Services]] (Medicaid administrator) logo]] [4] => [5] => In the [[United States]], '''Medicaid''' is a government program that provides [[health insurance]] for adults and children with limited income and resources. The program is partially funded and primarily managed by [[U.S. state|state]] governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding. [6] => [7] => Medicaid was established in 1965 and was significantly expanded by the [[Affordable Care Act]] (ACA), which was passed in 2010. In most states, anyone with income up to 138% of the federal [[Poverty line in the United States#Measures of poverty|poverty line]] qualifies for Medicaid coverage under the provisions of the ACA.{{Cite web|title=Medicaid, Children's Health Insurance Program, & Basic Health Program Eligibility Levels |url=https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-childrens-health-insurance-program-basic-health-program-eligibility-levels/index.html |access-date=2021-02-14 |publisher=Medicaid}} A 2012 [[Supreme Court of the United States|Supreme Court]] decision established that states may continue to use pre-ACA Medicaid eligibility standards and receive previously established levels of federal Medicaid funding; in states that make that choice, income limits may be significantly lower, and able-bodied adults may not be eligible for Medicaid at all.{{Cite web|url=https://www.medicaid.gov/affordable-care-act/eligibility/index.html|title=Eligibility |publisher=Medicaid |language=en-us|access-date=2018-04-12}} [8] => [9] => Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 85 million low-income and disabled people as of 2022;{{ r | Medicaid_gov_2022-12_data }} in 2019, the program paid for half of all U.S. births. As of 2017, the total annual cost of Medicaid was just over $600 billion, of which the federal government contributed $375 billion and states an additional $230 billion. States are not required to participate in the program, although all have since 1982. In general, Medicaid recipients must be [[Citizenship in the United States|U.S. citizens]] or qualified non-citizens, and may include low-income adults, their children, and people with certain [[Disability|disabilities]].{{cite web |title=Coverage for lawfully present immigrants |url=https://www.healthcare.gov/immigrants/lawfully-present-immigrants/ |publisher=Healthcare.gov |access-date=9 January 2019}} {{As of|2022}} 45% of those receiving Medicaid or [[Children's Health Insurance Program|CHIP]] were children. {{ cite web | url=https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html | title=December 2022 Medicaid & CHIP Enrollment Data Highlights | last= | first= | date= | access-date=2023-04-10 | archive-url= | archive-date= | pages= | quote=92,340,585 individuals were enrolled in Medicaid and CHIP in the 50 states and the District of Columbia that reported enrollment data for December 2022. 85,280,085 individuals were enrolled in Medicaid. 7,060,500 individuals were enrolled in CHIP. 41,670,091 individuals were enrolled in CHIP or were children enrolled in the Medicaid program in the 49 states and the District of Columbia that reported child enrollment data for December 2022 representing 46.3% of total Medicaid and CHIP program enrollment. }} [10] => [11] => Medicaid also covers long-term services and supports, including both nursing home care and home- and community-based services, for those with low incomes and minimal assets; the exact qualifications vary by state. Medicaid spent $215 billion on such care in 2020, over half of the total $402 billion spent on such services.{{cite web |title=10 Things About Long-Term Services and Supports (LTSS) |author=Priya Chidambaram and Alice Burns |url=https://www.kff.org/medicaid/issue-brief/10-things-about-long-term-services-and-supports-ltss/ |date=15 September 2022 |access-date=24 September 2023 |publisher=KFF}} Of the 7.7 million Americans who used long-term services and supports in 2020, about 5.6 million were covered by Medicaid, including 1.6 million of the 1.9 million in institutional settings.{{cite web |title=How Many People Use Medicaid Long-Term Services and Supports and How Much Does Medicaid Spend on Those People? |author=Priya Chidambaram and Alice Burns |url=https://www.kff.org/medicaid/issue-brief/how-many-people-use-medicaid-long-term-services-and-supports-and-how-much-does-medicaid-spend-on-those-people/ |date=14 August 2023 |access-date=24 September 2023 |publisher=KFF}} [12] => [13] => Medicaid covers healthcare costs for people with low incomes, while [[Medicare (United States)|Medicare]] is a universal program providing health coverage for the elderly. Medicaid offers elder care benefits not normally covered by Medicare, including nursing home care and personal care services. There are also dual health plans for people who have both Medicaid and Medicare.{{cite web |title=Medicare & Medicaid |url=https://www.hhs.gov/answers/medicare-and-medicaid/index.html |publisher=HHS.gov U.S. Department of Health & Human Services |access-date=17 February 2021}} Along with Medicare, [[Tricare]], and [[Veterans Health Administration#Non-Medical Programs|ChampVA]], Medicaid is one of the four government-sponsored [[medical insurance]] programs in the United States. The U.S. Centers for Medicare & Medicaid Services in [[Baltimore]], [[Maryland]] provides federal oversight.{{cite web|title=Medicaid|url=https://www.medicaid.gov/medicaid/index.html|access-date=24 February 2023 |department=www.medicaid.gov|publisher=U.S. Centers for Medicare & Medicaid Services in Baltimore}} [14] => [15] => Research shows that existence of the Medicaid program improves health outcomes, health insurance coverage, access to health care, and recipients' financial security and provides economic benefits to states and health providers.{{Cite news|url=http://econofact.org/evidence-on-the-value-of-medicaid|title=Evidence on the Value of Medicaid |last1=Gottlieb|first1=Joshua D. |last2=Shepard|first2=Mark | name-list-style = vanc |date=2017-07-02|work=Econofact|access-date=2017-07-05 }}{{Cite web|url=https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-august-2019/|title=The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review|last1=Antonisse|first1=Larisa|first2=Madeline|last2=Guth|date=2019-08-15|website=The Henry J. Kaiser Family Foundation|language=en-US|access-date=2019-09-26}}{{cite web|title=The evidence on Medicaid expansion|publisher=American Medical Association|url=https://www.ama-assn.org/system/files/2020-10/research-summary-benefits-of-medicaid-expansion.pdf}} [16] => {{TOC limit}} [17] => [18] => == Features == [19] => Beginning in the 1980s, many states received waivers from the federal government to create [[Medicaid managed care]] programs. Under managed care, Medicaid recipients are enrolled in a private health plan, which receives a fixed monthly premium from the state. The health plan is then responsible for providing for all or most of the recipient's healthcare needs. Today, all but a few states use managed care to provide coverage to a significant proportion of Medicaid enrollees. As of 2014, 26 states have contracts with [[Managed Care Organization|managed care organizations]] (MCOs) to deliver long-term care for the elderly and individuals with disabilities. The states pay a monthly capitated rate per member to the MCOs, which in turn provide comprehensive care and accept the risk of managing total costs.{{cite web |publisher=Agency for Healthcare Research and Quality |url=https://innovations.ahrq.gov/perspectives/states-turn-managed-care-constrain-medicaid-long-term-care-costs |title=States Turn to Managed Care To Constrain Medicaid Long-Term Care Costs |date=April 9, 2014 |access-date=April 14, 2014}} Nationwide, roughly 80% of Medicaid enrollees are enrolled in managed care plans.{{cite web|url=http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Managed-Care/Managed-Care-site.html|title=Managed Care|publisher=medicaid.gov|language=en-us|archive-url=https://web.archive.org/web/20160220125540/https://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/managed-care/managed-care-site.html|archive-date=2016-02-20|url-status=dead|access-date=2015-12-10}} Core eligibility groups of low-income families are most likely to be enrolled in managed care, while the "aged" and "disabled" eligibility groups more often remain in traditional "[[fee for service]]" Medicaid. [20] => [21] => Because service level costs vary depending on the care and needs of the enrolled, a cost per person average is only a rough measure of actual cost of care. The annual cost of care will vary state to state depending on state approved Medicaid benefits, as well as the state specific care costs. A 2014 [[Kaiser Family Foundation]] report estimates the national average per capita annual cost of Medicaid services for children to be $2,577, adults to be $3,278, persons with disabilities to be $16,859, aged persons (65+) to be $13,063, and all Medicaid enrollees to be $5,736.{{Cite web|date=2017-06-09|title=Medicaid Spending per Enrollee (Full or Partial Benefit)|url=https://www.kff.org/medicaid/state-indicator/medicaid-spending-per-enrollee/|access-date=2021-02-14|website=KFF|language=en-US}} [22] => [23] => == History == [24] => {{Healthcare in the United States}} [25] => The [[Social Security Amendments of 1965]] created Medicaid by adding [[Social Security Act#Title XIX—Grants to States for Medical Assistance Programs|Title XIX]] to the [[Social Security Act]], 42 U.S.C. §§ 1396 et seq. Under the program, the federal government provided matching funds to states to enable them to provide Medical Assistance to residents who met certain eligibility requirements. The objective was to help states assist residents whose income and resources were insufficient to pay the costs of traditional commercial health insurance plans. [26] => [27] => By 1982, all states were participating. The last state to do so was Arizona. [28] => [29] => The [[Medicaid Drug Rebate Program]] and the [[Health Insurance Premium Payment Program]] (HIPP) were created by the [[Omnibus Budget Reconciliation Act of 1990]] (OBRA-90). This act helped to add Section 1927 to the Social Security Act of 1935 and became effective on January 1, 1991. This program was formed due to the costs that Medicaid programs were paying for discount price outpatient drugs.{{cite web|url=http://www.cms.hhs.gov/MedicaidDrugRebateProgram/|publisher=HHS|title=Medicaid Drug Rebate Program Overview|url-status=dead|archive-url=https://web.archive.org/web/20071214143730/http://www.cms.hhs.gov/MedicaidDrugRebateProgram/|archive-date=December 14, 2007|df=mdy-all}} [30] => [31] => The [[Omnibus Budget Reconciliation Act of 1993]] (OBRA-93) amended Section 1927 of the Act, bringing changes to the Medicaid Drug Rebate Program. It requires states to implement a [[Medicaid estate recovery]] program to recover from the estate of deceased beneficiaries the long-term-care-related costs paid by Medicaid, and gives states the option of recovering all non-long-term-care costs, including full medical costs.{{cite web|url=http://aspe.hhs.gov/daltcp/reports/estaterec.htm |title=Medicaid Estate Recovery|publisher=U.S. Department of Health and Human Services|date=April 2005}} [32] => [33] => Medicaid also offers a Fee for Service (Direct Service) Program to schools throughout the United States for the reimbursement of costs associated with the services delivered to students with [[special education]] needs.{{cite web|url=http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Fee-for-Service.html|title=Fee for Service (Direct Service) Program|publisher=Medicaid.gov|access-date=August 7, 2012|archive-url=https://web.archive.org/web/20120813142149/http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Fee-for-Service.html|archive-date=August 13, 2012|url-status=dead}} Federal law mandates that children with disabilities receive a "free appropriate public education" under Section 504 of The Rehabilitation Act of 1973.{{Cite web|title=Free Appropriate Public Education under Section 504|url=https://www2.ed.gov/about/offices/list/ocr/docs/edlite-FAPE504.html|access-date=2021-02-14|website=www2.ed.gov|language=en}} Decisions by the United States Supreme Court and subsequent changes in federal law require states to reimburse part or all of the cost of some services provided by schools for Medicaid-eligible disabled children. [34] => [35] => === Expansion under the Affordable Care Act === [36] => [37] => [[File:Medicaid expansion map of US. Affordable Care Act.svg|thumb|upright=1.35|[[Medicaid coverage gap#Medicaid expansion|ACA Medicaid expansion]] by state:{{cite web |title=Status of State Medicaid Expansion Decisions: Interactive Map |date=December 2023 |url=https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map |publisher=[[Kaiser Family Foundation|KFF]]. Map is updated as changes occur. Click on states for details.}} [38] => {{legend|#2b83ba|Not adopted}} [39] => {{legend|#89CC7F|Adopted}} [40] => {{legend|#FECDAC|Implemented}}]] [41] => [[File:Uninsured Rate Comparing Medicaid Expansion States vs. Non Expansion.png|thumb|upright=1.35|States that expanded Medicaid under ACA had a lower uninsured rate in 2018 at various income levels.{{Cite web |url=https://www.census.gov/library/publications/2019/demo/p60-267.html|title=Health Insurance Coverage in the United States: 2018|date=September 10, 2019}}]] [42] => [43] => The [[Affordable Care Act]] (ACA), passed in 2010, substantially expanded the Medicaid program. Before the law was passed, some states did not allow able-bodied adults to participate in Medicaid, and many set income eligibility far below the Federal poverty level. Under the provisions of the law, any state that participated in Medicaid would need to expand coverage to include anyone earning up to 138% of the Federal poverty level beginning in 2014. The costs of the newly covered population would initially be covered in full by the Federal government, although states would need to pay for 10% of those costs by 2020.{{cite news |author=HHS Press Office |date=March 29, 2013 |title=HHS finalizes rule guaranteeing 100 percent funding for new Medicaid beneficiaries |location=Washington, DC |publisher=U.S. Department of Health & Human Services |url=https://www.hhs.gov/news/press/2013pres/03/20130329a.html |access-date=April 23, 2013 |quote=effective January 1, 2014, the federal government will pay 100 percent of defined cost of certain newly eligible adult Medicaid beneficiaries. These payments will be in effect through 2016, phasing down to a permanent 90 percent matching rate by 2020. |archive-date=April 8, 2013 |archive-url=https://web.archive.org/web/20130408193512/http://www.hhs.gov/news/press/2013pres/03/20130329a.html |url-status=dead }}
{{cite journal |author=Centers for Medicare & Medicaid Services |date=April 2, 2013 |title=Medicaid program: Increased federal medical assistance percentage changes under the Affordable Care Act of 2010: Final rule |journal=Federal Register |volume=78 |issue=63 |pages=19917–19947 |quote=(A) 100 percent, for calendar quarters in calendar years (CYs) 2014 through 2016; (B) 95 percent, for calendar quarters in CY 2017; (C) 94 percent, for calendar quarters in CY 2018; (D) 93 percent, for calendar quarters in CY 2019; (E) 90 percent, for calendar quarters in CY 2020 and all subsequent calendar years.}}{{cite web |title=HHS finalizes rule guaranteeing 100 percent funding for new medicaid beneficiaries |url=https://www.thelundreport.org/keywords/department-health-and-human-services |website=The Lund Report |access-date=23 June 2022 |archive-url=https://web.archive.org/web/20201030161511/https://www.thelundreport.org/content/hhs-finalizes-rule-guaranteeing-100-percent-funding-new-medicaid-beneficiaries |archive-date=30 October 2020 |location=Portland OR |date=29 March 2013 |agency=Department of Health and Human Services}}{{Cite web|url=https://archive-it.org/collections/3926?fc=meta_Date:2013|title=Archive-It - News Releases|website=archive-it.org}}{{Cite web |url=https://www.cbpp.org/research/how-health-reforms-medicaid-expansion-will-impact-state-budgets |title=How Health Reform's Medicaid Expansion Will Impact State Budgets |date=July 11, 2012 |website=Center on Budget and Policy Priorities}} [44] => [45] => However, in 2012, the Supreme Court held in ''[[National Federation of Independent Business v. Sebelius]]'' that withdrawing all Medicaid funding from states that refused to expand eligibility was unconstitutionally coercive. States could choose to maintain pre-existing levels of Medicaid funding and eligibility, and some did; over half the national uninsured population lives in those states.{{cite news |title=States' Policies on Health Care Exclude Some of the Poorest |url=https://www.nytimes.com/2013/05/25/us/states-policies-on-health-care-exclude-poorest.html |newspaper=The New York Times |date=May 24, 2013 |author=Robert Pear |access-date=May 25, 2013 |quote=In most cases, [Sandy Praeger, Insurance Commissioner of Kansas], said adults with incomes from 32 percent to 100 percent of the poverty level ($6,250 to $19,530 for a family of three) "will have no assistance".}} As of March 2023, 40 states have accepted the [[Affordable Care Act]] Medicaid extension, as has the [[Washington, D.C.|District of Columbia]], which has its own Medicaid program; 10 states have not.{{Cite web |url=http://kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/ |title=Current Status of State Medicaid Expansion Decisions |access-date=February 26, 2023 |archive-date=November 27, 2016 |archive-url=https://web.archive.org/web/20161127103011/http://kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/ |url-status=dead }} Among adults aged 18 to 64, states that expanded Medicaid had an uninsured rate of 7.3% in the first quarter of 2016, while non-expansion states had a 14.1% uninsured rate.{{Cite web |url=http://hrms.urban.org/briefs/health-insurance-coverage-ACA-March-2016.html |title=Health Reform Monitoring Survey |access-date=December 5, 2016 |archive-date=November 21, 2016 |archive-url=https://web.archive.org/web/20161121020226/http://hrms.urban.org/briefs/health-insurance-coverage-ACA-March-2016.html |url-status=dead }} [46] => [47] => The [[Centers for Medicare and Medicaid Services]] (CMS) estimated that the cost of expansion was $6,366 per person for 2015, about 49 percent above previous estimates. An estimated 9 to 10 million people had gained Medicaid coverage, mostly low-income adults.{{Cite web|url=https://www.elderlawanswers.com/medicaids-power-to-recoup-benefits-paid-estate-recovery-and-liens-12018|title=Medicaid's Power to Recoup Benefits Paid: Estate Recovery and Liens|website=ElderLawAnswers|date=December 13, 2012|language=en|access-date=2019-08-07}} The Kaiser Family Foundation estimated in October 2015 that 3.1 million additional people were not covered in states that rejected the Medicaid expansion.{{Cite web |url=http://kff.org/disparities-policy/issue-brief/the-impact-of-the-coverage-gap-in-states-not-expanding-medicaid-by-race-and-ethnicity/ |title=The Impact of the Coverage Gap for Adultsin States not Expanding Medicaid |date=October 26, 2015}} [48] => [49] => In some states that chose not to expand Medicaid, income eligibility thresholds are significantly below 133% of the poverty line.{{cite news |url=https://www.washingtonpost.com/blogs/ezra-klein/wp/2012/07/05/what-happens-if-a-state-opts-out-of-medicaid-in-one-chart |title=What Happens if a State Opts Out of Medicaid, in One Chart |author=Kliff, Sarah |date=July 5, 2012 |newspaper=The Washington Post |access-date=July 15, 2012 |archive-date=July 13, 2012 |archive-url=https://web.archive.org/web/20120713153024/http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/07/05/what-happens-if-a-state-opts-out-of-medicaid-in-one-chart/ |url-status=dead }} Some of these states do not make Medicaid available to non-pregnant adults without disabilities or dependent children, no matter their income. Because subsidies on commercial insurance plans are not available to such individuals, most have few options for obtaining any medical insurance.{{cite web |title=Analyzing the Impact of State Medicaid Expansion Decisions |url=http://kff.org/medicaid/issue-brief/analyzing-the-impact-of-state-medicaid-expansion-decisions/ |publisher=Kaiser Family Foundation |date=July 17, 2013}}{{cite web |url=http://www.familiesusa.org/assets/pdfs/health-reform/Enrollment-Policy-Provisions.pdf |title=Enrollment Policy Provisions in the Patient Protection and Affordable Care Act |publisher=Families USA |access-date=April 1, 2012 |archive-date=March 31, 2012 |archive-url=https://web.archive.org/web/20120331052051/http://www.familiesusa.org/assets/pdfs/health-reform/Enrollment-Policy-Provisions.pdf |url-status=dead }} For example, in [[Kansas]], where only non-disabled adults with children and with an income below 32% of the poverty line were eligible for Medicaid, those with incomes from 32% to 100% of the poverty level ($6,250 to $19,530 for a family of three) were ineligible for both Medicaid and federal subsidies to buy insurance. [50] => [51] => Studies of the impact of Medicaid expansion rejections calculated that up to 6.4 million people would have too much income for Medicaid but not qualify for exchange subsidies.{{cite magazine |title=We Don't Know Everything About Obamacare. But We Know Who's Trying to Sabotage It |first=Jonathan |last=Cohn |magazine=The New Republic |date=July 19, 2013 |url=https://newrepublic.com/article/113947/obamacare-implementation-and-role-state-officials}} Several states argued that they could not afford the 10% contribution in 2020.{{cite news |url=https://money.cnn.com/2013/07/01/news/economy/medicaid-expansion-states/index.html |title=States forgo billions by opting out of Medicaid expansion |author=Tami Luhby |publisher=CNN |date=July 1, 2013}}{{cite web |url=https://www.usnews.com/debate-club/is-medicaid-expansion-good-for-the-states |title=Is Medicaid Expansion Good for the States? |work=U.S. News & World Report |date=n.d.}} Some studies suggested that rejecting the expansion would cost more due to increased spending on uncompensated [[emergency care]] that otherwise would have been partially paid for by Medicaid coverage.{{cite news |title=Wonkbook: The terrible deal for states rejecting Medicaid |url=https://www.washingtonpost.com/news/wonk/wp/2013/06/04/wonkbook-the-terrible-deal-for-states-rejecting-medicaid/?variant=116ae929826d1fd3&variant=116ae929826d1fd3 |date=June 4, 2013 |newspaper=The Washington Post |author1=Evan Soltas}} [52] => [53] => A 2016 study found that residents of [[Kentucky]] and [[Arkansas]], which both expanded Medicaid, were more likely to receive health care services and less likely to incur emergency room costs or have trouble paying their medical bills. Residents of [[Texas]], which did not accept the Medicaid expansion, did not see a similar improvement during the same period.{{Cite web |url=https://www.newscientist.com/article/2100311-obamacare-has-already-improved-health-of-low-income-americans |title=Obamacare has already improved health of low-income Americans |last=Rutkin |first=Aviva |language=en-US |access-date=August 15, 2016}} Kentucky opted for increased managed care, while Arkansas subsidized private insurance. Later, Arkansas and Kentucky governors proposed reducing or modifying their programs. From 2013 to 2015, the uninsured rate dropped from 42% to 14% in Arkansas and from 40% to 9% in Kentucky, compared with 39% to 32% in Texas.{{Cite web |url=https://www.hsph.harvard.edu/news/press-releases/medicaid-expansion-aca-lbetter-health-care-improved-health-low-income-adults/ |title=Medicaid expansion under ACA linked with better health care, improved health for low-income adults {{!}} News {{!}} Harvard T.H. Chan School of Public Health|website=www.hsph.harvard.edu|access-date=August 30, 2016|date=August 8, 2016}} [54] => [55] => A 2016 [[United States Department of Health and Human Services|DHHS]] study found that states that expanded Medicaid had lower premiums on exchange policies because they had fewer low-income enrollees, whose health, on average, is worse than that of people with higher income.{{Cite news |url=https://www.nytimes.com/2016/08/26/upshot/how-expanding-medicaid-may-lower-insurance-premiums.html |title=How Expanding Medicaid Can Lower Insurance Premiums for All |last=Sanger-katz |first=Margot |date=August 25, 2016 |newspaper=The New York Times |issn=0362-4331 |access-date=September 4, 2016}} [56] => [57] => The [[United States Census Bureau|Census Bureau]] reported in September 2019 that states that expanded Medicaid under ACA had considerably lower uninsured rates than states that did not. For example, for adults between 100% and 399% of poverty level, the uninsured rate in 2018 was 12.7% in expansion states and 21.2% in non-expansion states. Of the 14 states with uninsured rates of 10% or greater, 11 had not expanded Medicaid. A July 2019 study by the National Bureau of Economic Research (NBER) indicated that states enacting Medicaid expansion exhibited statistically significant reductions in mortality rates.{{Cite book|last1=Miller|first1=Sarah|last2=Altekruse|first2=Sean|last3=Johnson|first3=Norman|last4=Wherry|first4=Laura|date=July 2019|title=Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data|location=Cambridge, MA|publisher=National Bureau of Economic Research|series=NBER Working Paper No. 26081|doi=10.3386/w26081|s2cid=164463149|url=http://www.nber.org/papers/w26081.pdf }} [58] => [59] => The ACA was structured with the assumption that Medicaid would cover anyone making less than 133% of the Federal poverty level throughout the United States; as a result, premium tax credits are only available to individuals buying private health insurance through [[Health insurance marketplace|exchanges]] if they make more than that amount. This has given rise to the so-called [[Medicaid coverage gap]] in states that have not expanded Medicaid: there are people whose income is too high to qualify for Medicaid in those states, but too low to receive assistance in paying for private health insurance, which is therefore unaffordable to them.{{cite news | url=https://psmag.com/social-justice/the-medicaid-coverage-gap-persists | title=The Medicaid Coverage Gap Persists | work=Pacific Standard | date=26 January 2016 | accessdate=7 March 2016 | author=Gunn, Dwyer}} [60] => [61] => == State implementations == [62] => States may bundle together the administration of Medicaid with other programs such as the [[Children's Health Insurance Program]] (CHIP), so the same organization that handles Medicaid in a state may also manage the additional programs. Separate programs may also exist in some localities that are funded by the states or their political subdivisions to provide health coverage for indigents and minors. [63] => [64] => State participation in Medicaid is voluntary; however, all states have participated since 1982. In some states Medicaid is subcontracted to private health insurance companies, while other states pay providers (i.e., doctors, clinics and hospitals) directly. There are many services that can fall under Medicaid and some states support more services than other states. The most provided services are intermediate care for mentally disabled, prescription drugs and nursing facility care for under 21-year-olds. The least provided services include institutional religious (non-medical) health care, respiratory care for ventilator dependent and PACE (inclusive [[elderly care]]).{{cite book|last=Dáil|first=Paula vW.|title=Women and Poverty in 21st Century America|year=2012|publisher=McFarland|location=NC, USA|isbn=978-0-7864-4903-3|page=137|url=http://www.mcfarlandpub.com/book-2.php?id=978-0-7864-4903-3|archive-url=https://archive.today/20130128155831/http://www.mcfarlandpub.com/book-2.php?id=978-0-7864-4903-3|url-status=dead|archive-date=2013-01-28}} [65] => [66] => Most states administer Medicaid through their own programs. A few of those programs are listed below: [67] => * [[Arizona]]: [[Arizona Health Care Cost Containment System|AHCCCS]] [68] => * [[California]]: [[Medi-Cal]] [69] => * [[Connecticut]]: [[HUSKY D]] [70] => * [[Maine]]: MaineCare [71] => * [[Massachusetts]]: [[MassHealth]] [72] => * [[New Jersey]]: [https://njfamilycare.dhs.state.nj.us/ NJ FamilyCare] [73] => * [[Oregon]]: [[Oregon Health Plan]] [74] => * [[Oklahoma]]: [[Soonercare]] [75] => * [[Tennessee]]: [[TennCare]] [76] => * [[Washington (state)|Washington]]: [[Washington Apple Health]] [77] => * [[Wisconsin]]: [[BadgerCare]] [78] => [79] => As of January 2012, Medicaid and/or CHIP funds could be obtained to help pay employer health care premiums in [[Alabama]], [[Alaska]], Arizona, [[Colorado]], [[Florida]], and [[Georgia (U.S. state)|Georgia]].{{cite web|url=http://www.dol.gov/ebsa/pdf/chipmodelnotice.pdf|title=Medicaid and the Children's Health Insurance Program (CHIP) Offer Free Or Low-Cost Health Coverage To Children And Families|publisher=United States Department of Labor/Employee Benefits Security Administration|access-date=June 28, 2012|archive-url=https://web.archive.org/web/20111216042008/http://www.dol.gov/ebsa/pdf/chipmodelnotice.pdf|archive-date=December 16, 2011|url-status=dead}} [80] => [81] => === Differences by state === [82] => States must comply with federal law, under which each participating state administers its own Medicaid program, establishes eligibility standards, determines the scope and types of services it will cover, and sets the rate of reimbursement physicians and care providers. Differences between states are often influenced by the political ideologies of the state and cultural beliefs of the general population. The federal [[Centers for Medicare and Medicaid Services]] (CMS) closely monitors each state's program and establishes requirements for service delivery, quality, funding, and eligibility standards.{{cite web|date=2011|title=Annual Statistical Supplement|url=http://www.ssa.gov/policy/docs/statcomps/supplement/2011/medicaid.html|access-date=October 19, 2012|publisher=U.S. Social Security Administration, Office of Retirement and Disability Policy}} [83] => [84] => [[Medicaid estate recovery]] regulations also vary by state. (Federal law gives options as to whether non-long-term-care-related expenses, such as normal health-insurance-type medical expenses are to be recovered, as well as on whether the recovery is limited to probate estates or extends beyond.) [85] => [86] => ==== Political influences ==== [87] => Several political factors influence the cost and eligibility of tax-funded health care. According to a study conducted by Gideon Lukens, factors significantly affecting eligibility included "party control, the ideology of state citizens, the prevalence of women in legislatures, the line-item veto, and physician interest group size". Lukens' study supported the generalized hypothesis that [[Democratic Party (United States)|Democrats]] favor generous eligibility policies while [[Republican Party (United States)|Republicans]] do not.{{cite journal|last1=Lukens|first1=G.|date=23 September 2014|title=State Variation in Health Care Spending and the Politics of State Medicaid Policy|journal=Journal of Health Politics, Policy and Law|volume=39|issue=6|pages=1213–1251|doi=10.1215/03616878-2822634|pmid=25248962}} When the Supreme Court allowed states to decide whether to expand Medicaid or not in 2012, northern states, in which Democratic legislators predominated, disproportionately did so, often also extending existing eligibility. [88] => [89] => Certain states in which there is a Republican-controlled legislature may be forced to expand Medicaid in ways extending beyond increasing existing eligibility in the form of waivers for certain Medicaid requirements so long as they follow certain objectives. In its implementation, this has meant using Medicaid funds to pay for low-income citizens' health insurance; this private-option was originally carried out in Arkansas but was adopted by other Republican-led states.{{cite journal |last1=Rose |first1=Shanna |title=Opting In, Opting Out: The Politics of State Medicaid Expansion |journal=The Forum |date=1 January 2015 |volume=13 |issue=1 |doi=10.1515/for-2015-0011 |s2cid=147364036 }} However, private coverage is more expensive than Medicaid and the states would not have to contribute as much to the cost of private coverage.{{cite journal |last1=Zaloshnja |first1=Eduard |last2=Miller |first2=Ted R. |last3=Coben |first3=Jeffrey |last4=Steiner |first4=Claudia |title=How Often Do Catastrophic Injury Victims Become Medicaid Recipients? |journal=Medical Care |date=June 2012 |volume=50 |issue=6 |pages=513–519 |doi=10.1097/MLR.0b013e318245a686 |pmid=22270099 |jstor=23216705 |s2cid=33723607 }} [90] => [91] => Certain groups of people, such as migrants, face more barriers to health care than others due to factors besides policy, such as status, transportation and knowledge of the healthcare system (including eligibility).{{cite journal |last1=Mojtabai |first1=Ramin |last2=Feder |first2=Kenneth A. |last3=Kealhofer |first3=Marc |last4=Krawczyk |first4=Noa |last5=Storr |first5=Carla |last6=Tormohlen |first6=Kayla N. |last7=Young |first7=Andrea S. |last8=Olfson |first8=Mark |last9=Crum |first9=Rosa M. |title=State variations in Medicaid enrollment and utilization of substance use services: Results from a National Longitudinal Study |journal=Journal of Substance Abuse Treatment |date=June 2018 |volume=89 |pages=75–86 |doi=10.1016/j.jsat.2018.04.002 |pmid=29706176 |pmc=5964257 }} [92] => [93] => ==== Eligibility and coverage ==== [94] => {{more citations needed section|date=July 2020}} [95] => Medicaid eligibility policies are very complicated. In general, a person's Medicaid eligibility is linked to their eligibility for [[Aid to Families with Dependent Children]] (AFDC), which provides aid to children whose families have low or no income, and to the [[Supplemental Security Income]] (SSI) program for the aged, blind and disabled. States are required under federal law to provide all AFDC and SSI recipients with Medicaid coverage. Because eligibility for AFDC and SSI essentially guarantees Medicaid coverage, examining eligibility/coverage differences per state in AFDC and SSI is an accurate way to assess Medicaid differences as well. SSI coverage is largely consistent by state, and requirements on how to qualify or what benefits are provided are standard. However AFDC has differing eligibility standards that depend on: [96] => [97] => #The Low-Income Wage Rate: State welfare programs base the level of assistance they provide on some concept of what is minimally necessary. [98] => #Perceived Incentive for Welfare Migration. Not only do social norms within the state affect its determination of AFDC payment levels, but regional norms will affect a state's perception of need as well. [99] => [100] => ==== Reimbursement for care providers ==== [101] => Beyond the variance in eligibility and coverage between states, there is a large variance in the reimbursements Medicaid offers to care providers; the clearest examples of this are common [[Orthopedic surgery|orthopedic procedures]]. For instance, in 2013, the average difference in reimbursement for 10 common orthopedic procedures in the states of New Jersey and [[Delaware]] was $3,047.{{cite journal |last1=Lalezari |first1=Ramin M. |last2=Pozen |first2=Alexis |last3=Dy |first3=Christopher J. |title=State Variation in Medicaid Reimbursements for Orthopaedic Surgery |journal=The Journal of Bone and Joint Surgery |date=February 2018 |volume=100 |issue=3 |pages=236–242 |doi=10.2106/JBJS.17.00279 |pmid=29406345 |s2cid=25818917 |url=https://digitalcommons.wustl.edu/cgi/viewcontent.cgi?article=7654&context=open_access_pubs }} The discrepancy in the reimbursements Medicaid offers may affect the type of care provided to patients. [102] => [103] => In general, Medicaid plans pay providers significantly less than commercial insurers or Medicare would pay for the same care, paying around 67% as much as Medicare would for primary care and 78% as much for other services. This disparity has been linked to lower provider rates of participation in Medicaid programs vs Medicare or commercial insurance, and thus decreased access to care for Medicaid patients.{{cite journal | url=https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2020.00611 | doi=10.1377/hlthaff.2020.00611 | title=Medicaid Physician Fees Remained Substantially Below Fees Paid by Medicare in 2019 | year=2021 | last1=Zuckerman | first1=Stephen | last2=Skopec | first2=Laura | last3=Aarons | first3=Joshua | journal=Health Affairs | volume=40 | issue=2 | pages=343–348 | pmid=33523743 | s2cid=231755138 }} One component of the Affordable Care Act was a federally-funded increase in 2013 and 2014 in Medicaid payments to bring them up to 100% of equivalent Medicare payments, in an effort to increase provider participation. Most states did not subsequently continue this provision.{{citation | doi=10.1377/hpb20150511.588737 | title=Medicaid Primary Care Parity | year=2015 | doi-access=free }} [104] => [105] => == Enrollment == [106] => In 2002, Medicaid enrollees numbered 39.9 million Americans, with the largest group being children (18.4 million or 46%).{{cite web|title=A Profile of Medicaid: Chartbook 2000|url=https://www.cms.gov/TheChartSeries/downloads/2Tchartbk.pdf|access-date=March 31, 2012}} From 2000 to 2012, the proportion of hospital stays for children paid by Medicaid increased by 33% and the proportion paid by private insurance decreased by 21%.{{cite journal |vauthors=Witt WP, Wiess AJ, Elixhauser A |title=Overview of Hospital Stays for Children in the United States, 2012 |journal=HCUP Statistical Brief #186 |publisher=Agency for Healthcare Research and Quality |location=Rockville, MD |date=December 2014 |pmid=25695124 |url=https://www.hcup-us.ahrq.gov/reports/statbriefs/sb187-Hospital-Stays-Children-2012.jsp}} Some 43 million Americans were enrolled in 2004 (19.7 million of them children) at a total cost of $295 billion. In 2008, Medicaid provided health coverage and services to approximately 49 million low-income children, pregnant women, elderly people, and disabled people. In 2009, 62.9 million Americans were enrolled in Medicaid for at least one month, with an average enrollment of 50.1 million.{{Cite web|url=http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/downloads/MedicaidReport2010.pdf|title=2010 Actuarial Report on the Financial Outlook for Medicaid|publisher=Office of the Actuary|date=2010-12-21|website=www.cms.gov}} In [[California]], about 23% of the population was enrolled in [[Medi-Cal]] for at least 1 month in 2009–10.[http://www.dhcs.ca.gov/dataandstats/statistics/Documents/2_1_Reporting_Year_FY2009-10.pdf Medi-Cal Program Enrollment Totals for Fiscal Year 2009–10] {{Webarchive|url=https://web.archive.org/web/20120619021821/http://www.dhcs.ca.gov/dataandstats/statistics/Documents/2_1_Reporting_Year_FY2009-10.pdf |date=June 19, 2012 }}, [[California Department of Health Care Services]] Research and Analytic Studies Section, June 2011 As of 2017, the total annual cost of Medicaid was just over $600 billion, of which the federal government contributed $375 billion and states an additional $230 billion.{{Cite journal|last1=Franco Montoya|first1=Daniela|last2=Chehal|first2=Puneet Kaur|last3=Adams|first3=E. Kathleen|date=2020-04-02|title=Medicaid Managed Care's Effects on Costs, Access, and Quality: An Update|journal=Annual Review of Public Health|language=en|volume=41|issue=1|pages=537–549|doi=10.1146/annurev-publhealth-040119-094345|pmid=32237985|issn=0163-7525|doi-access=free}} According to CMS, the Medicaid program provided health care services to more than 92 million people in 2022.{{Cite web|url=https://www.medicaid.gov|title=New and Notable|access-date=2023-04-02|website=www.medicaid.gov|language=en-us}} [107] => [108] => Loss of income and medical insurance coverage during the [[2008 recession|2008–2009 recession]] resulted in a substantial increase in Medicaid enrollment in 2009. Nine U.S. states showed an increase in enrollment of 15% or more, putting a heavy strain on state budgets.{{Cite news|url=https://www.nytimes.com/2010/10/01/health/policy/01medicaid.html|title=Recession Drove Millions to Medicaid in '09, Survey Finds|last=Sack|first=Kevin | name-list-style = vanc |date=2010-09-30|work=The New York Times|language=en-US|issn=0362-4331}} [109] => [110] => The Kaiser Family Foundation reported that for 2013, Medicaid recipients were 40% white, 21% black, 25% Hispanic, and 14% other races.{{Cite news|url=https://www.kff.org/medicaid/state-indicator/medicaid-enrollment-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D|title=Medicaid Enrollment by Race/Ethnicity|work=The Henry J. Kaiser Family Foundation|language=en-US|access-date=January 13, 2018|archive-date=July 26, 2020|archive-url=https://web.archive.org/web/20200726224040/https://www.kff.org/medicaid/state-indicator/medicaid-enrollment-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D|url-status=dead}} [111] => [112] => == Comparisons with Medicare == [113] => Unlike Medicaid, [[Medicare (United States)|Medicare]] is a [[social insurance]] program funded at the federal level and focuses primarily on the older population.[http://www.medicare.gov/LongTermCare/Static/Home.asp Medicare.gov – Long-Term Care] {{webarchive|url=https://web.archive.org/web/20060418222026/http://www.medicare.gov/LongTermCare/Static/Home.asp|date=April 18, 2006}} Medicare is a [[Health insurance in the United States|health insurance]] program for people age 65 or older, people under age 65 with certain disabilities, and (through the [[End Stage Renal Disease Program]]) people of all ages with [[end-stage renal disease]].{{Cite web|url=http://www.cms.hhs.gov/MedicaidGenInfo/|title=Medicaid General Info|website=www.cms.hhs.gov|language=en-us}} The Medicare Program provides a Medicare part A covering hospital bills, Medicare Part B covering medical insurance coverage, and Medicare Part D covering purchase of [[prescription drug]]s. [114] => [115] => Medicaid is a program that is not solely funded at the federal level. States provide up to half of the funding for Medicaid. In some states, counties also contribute funds. Unlike Medicare, Medicaid is a [[means-tested]], [[needs-based]] [[Social welfare provision|social welfare]] or [[Social security#Social protection|social protection]] program rather than a [[social insurance]] program. Eligibility is determined largely by income. The main criterion for Medicaid eligibility is limited income and financial resources, a criterion which plays no role in determining Medicare coverage. Medicaid covers a wider range of health care services than Medicare. [116] => [117] => Some people are eligible for both Medicaid and Medicare and are known as [[Medicare dual eligible]] or medi-medi's.{{Cite web|url=http://www.cms.hhs.gov/DualEligible/|title=Dual Eligible|website=www.cms.gov|archive-url=https://web.archive.org/web/20080103023029/http://www.cms.hhs.gov/DualEligible/|archive-date=January 3, 2008|url-status=dead}}{{cite web|url=https://seniorquote.com/medi-medi-dual-eligibility/|title=Medi-Medi Dual Eligibility - Medicare, Medicaid and You - SeniorQuote |website=seniorquote.com}} In 2001, about 6.5 million people were enrolled in both Medicare and Medicaid. In 2013, approximately 9 million people qualified for Medicare and Medicaid.{{cite web |publisher=Agency for Healthcare Research and Quality |url=https://innovations.ahrq.gov/profiles/state%E2%80%93federal-program-provides-capitated-payments-plans-serving-those-eligible-medicare-and |title=State–Federal Program Provides Capitated Payments to Plans Serving Those Eligible for Medicare and Medicaid, Leading to Better Access to Care and Less Hospital and Nursing Home Use |date=July 3, 2013 |access-date=July 5, 2013}} [118] => [119] => == Benefits == [120] => There are two general types of Medicaid coverage. "Community Medicaid" helps people who have little or no medical insurance. Medicaid [[nursing home]] coverage helps pay for the cost of living in a nursing home for those who are eligible; the recipient also pays most of his/her income toward the nursing home costs, usually keeping only $66.00 a month for expenses other than the nursing home. [121] => [122] => Some states operate a program known as the [[Health Insurance Premium Payment Program]] (HIPP). This program allows a Medicaid recipient to have private health insurance paid for by Medicaid. As of 2008 relatively few states had premium assistance programs and enrollment was relatively low. Interest in this approach remained high, however.{{cite news|url=http://www.kff.org/medicaid/upload/7782.pdf|title=Choosing Premium AssistanceH: What does State experience tell us?|last=Alker|first=Joan|newspaper=KFF |date=2008|publisher=The [[Kaiser Family Foundation]]|name-list-style=vanc}} [123] => [124] => Included in the Social Security program under Medicaid are [[Dentistry|dental services]]. Registration for dental services is optional for people older than 21 years but required for people eligible for Medicaid and younger than 21.{{cite web|url=http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Dental-Care.html|title=Dental Coverage Overview|publisher=Medicaid|access-date=December 8, 2011|archive-url=https://web.archive.org/web/20111205140516/http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Dental-Care.html|archive-date=December 5, 2011|url-status=dead}} Minimum services include pain relief, [[Dental restoration|restoration of teeth]] and maintenance for dental health. [[EPSDT|Early and Periodic Screening, Diagnostic and Treatment]] (EPSDT) is a mandatory Medicaid program for children that focuses on prevention, early diagnosis and treatment of medical conditions. Oral screenings are not required for EPSDT recipients, and they do not suffice as a direct dental referral. If a condition requiring treatment is discovered during an oral screening, the state is responsible for paying for this service, regardless of whether or not it is covered on that particular Medicaid plan.{{cite web|url=http://www.cms.hhs.gov/MedicaidDentalCoverage/Downloads/dentalguide.pdf|title=Dental Guide|publisher=HHS|archive-url=https://web.archive.org/web/20111230040607/https://www.cms.gov/MedicaidDentalCoverage/Downloads/dentalguide.pdf|archive-date=2011-12-30|url-status=dead}} [125] => [126] => === Dental === [127] => Children enrolled in Medicaid are individually entitled under the law to comprehensive preventive and restorative dental services, but dental care utilization for this population is low. The reasons for low use are many, but a lack of dental providers who participate in Medicaid is a key factor.{{cite web|url=http://www.cdhp.org/system/files/TrendNotesOctober2009.pdf|title=CDHP.org|website=cdhp.org|access-date=February 10, 2011|archive-url=https://web.archive.org/web/20110725151252/http://www.cdhp.org/system/files/TrendNotesOctober2009.pdf|archive-date=July 25, 2011|url-status=dead}}{{full citation needed|date=April 2019}}{{dead link|date=April 2019}}U.S. General Accounting Office. Factors Contributing to Low Use of Dental Services by Low-Income Populations. Washington, DC: U.S. General Accounting Office. 2000. Few dentists participate in Medicaid – less than half of all active private dentists in some areas.Gehshan S, Hauck P, and Scales J. Increasing dentists' participation in Medicaid and SCHIP. Washington, DC: National Conference of State Legislatures. 2001. [http://ecom.ncsl.org/bookstore/productdetail.htm?prodid=0168000002&catsel=xhlt%3BHealth Ecom.ncsl.org]{{dead link|date=April 2019}} Cited reasons for not participating are low reimbursement rates, complex forms and burdensome administrative requirements.Edelstein B. Barriers to Medicaid Dental Care. Washington, DC: Children's Dental Health Project. 2000. [http://www.cdhp.org/resource/barriers_medicaid_dental_care CDHP.org]Krol D and Wolf JC. Physicians and dentists attitudes toward Medicaid and Medicaid patients: review of the literature. Columbia University. 2009. In Washington state, a program called Access to Baby and Child Dentistry (ABCD) has helped increase access to dental services by providing dentists higher reimbursements for oral health education and preventive and restorative services for children.{{cite web|url=https://innovations.ahrq.gov/profiles/medicaid-reimbursement-and-training-enable-primary-care-providers-deliver-preventive-dental|title=Comprehensive Statewide Program Combines Training and Higher Reimbursement for Providers With Outreach and Education for Families, Enhancing Access to Dental Care for Low-Income Children|date=February 27, 2013|publisher=Agency for Healthcare Research and Quality|access-date=May 13, 2013}}{{cite web|url=https://innovations.ahrq.gov/profiles/comprehensive-statewide-program-combines-training-and-higher-reimbursement-providers|title=Medicaid Reimbursement and Training Enable Primary Care Providers to Deliver Preventive Dental Care at Well-Child Visits, Enhancing Access for Low-Income Children|date=July 17, 2013|publisher=Agency for Healthcare Research and Quality|access-date=August 1, 2013}} After the passing of the [[Affordable Care Act]], many [[dentistry|dental]] practices began using [[Dental Service Organizations|dental service organizations]] to provide business management and support, allowing practices to minimize costs and pass the saving on to patients currently without adequate dental care.{{cite web|url=http://theadso.org/about-adso/dso-industry/|title=About DSOs|publisher=Association of Dental Support Organizations|access-date=March 24, 2016|archive-url=https://web.archive.org/web/20160315190004/http://theadso.org/about-adso/dso-industry/|archive-date=March 15, 2016|url-status=dead}}{{cite web|url=https://www.pacificresearch.org/fileadmin/documents/Studies/PDFs/DSOFinal.pdf|title=Benefits Created by Dental Service Organizations|last1=Winegarden|first1=Wayne|publisher=Pacific Research Institute|archive-url=https://web.archive.org/web/20160307070831/https://www.pacificresearch.org/fileadmin/documents/Studies/PDFs/DSOFinal.pdf|archive-date=March 7, 2016|url-status=dead|df=mdy-all}} [128] => [129] => == Eligibility == [130] => While Congress and the [[Centers for Medicare & Medicaid Services|Centers for Medicare and Medicaid Services]] (CMS) set out the general rules under which Medicaid operates, each state runs its own program. Under certain circumstances, an applicant may be denied coverage. As a result, the eligibility rules differ significantly from state to state, although all states must follow the same basic framework.[http://www.cms.hhs.gov/MedicaidEligibility/ "Medicaid Eligibility: Overview,"] {{Webarchive|url=https://web.archive.org/web/20080105024055/http://www.cms.hhs.gov/MedicaidEligibility/|date=January 5, 2008}} from the [[Centers for Medicare and Medicaid Services]] (CMS) website [131] => [132] => As of 2013, Medicaid is a program intended for those with low income, but a low income is not the only requirement to enroll in the program. Eligibility is ''categorical''—that is, to enroll one must be a member of a category defined by statute; some of these categories are: low-income children below a certain wage, pregnant women, parents of Medicaid-eligible children who meet certain income requirements, low-income disabled people who receive Supplemental Security Income (SSI) and/or [[Social Security Disability]] (SSD), and low-income seniors 65 and older. The details of how each category is defined vary from state to state. [133] => [134] => === PPACA income test standardization === [135] => As of 2019, when Medicaid has been expanded under the PPACA, eligibility is determined by an income test using [[Adjusted gross income|Modified Adjusted Gross Income]], with no state-specific variations and a prohibition on asset or resource tests.{{Cite web|url=https://www.medicaid.gov/medicaid/eligibility/index.html|title=Eligibility|website=www.medicaid.gov|language=en-us|access-date=2019-06-13}} [136] => [137] => === Non-PPACA eligibility === [138] => While Medicaid expansion available to adults under the PPACA mandates a standard income-based test without asset or resource tests, other eligibility criteria such as assets may apply when eligible outside of the PPACA expansion, including coverage for eligible seniors or disabled.{{Cite web|url=https://familiesusa.org/1115-waiver-element-asset-tests|title=1115 Waiver Element: Asset Tests|date=2017-11-09|website=Families USA|language=en|access-date=2019-06-13|archive-url=https://web.archive.org/web/20180119102248/http://familiesusa.org/1115-waiver-element-asset-tests|archive-date=January 19, 2018|url-status=dead}} These other requirements include, but are not limited to, assets, age, pregnancy, disability,{{cite web|url=http://www.id-dd.com/medicaremedicaid/|archive-url=https://archive.today/20141115034713/http://www.id-dd.com/medicaremedicaid/|url-status=dead|archive-date=15 November 2014|title=Medicare/Medicaid|website=ID-DD Resources|access-date=15 November 2014}} blindness, income, and resources, and one's status as a [[Citizenship of the United States|U.S. citizen]] or a [[Us resident|lawfully admitted immigrant]]. [139] => [140] => As of 2015, asset tests varied; for example, eight states did not have an asset test for a buy-in available to working people with disabilities, and one state had no asset test for the aged/blind/disabled pathway up to 100% of the [[Federal poverty level|Federal Poverty Level]].{{Cite web|url=https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-in-2015-report/|title=Medicaid Financial Eligibility for Seniors and People with Disabilities in 2015 - Report|last1=Watts|first1=Molly O'Malley|last2=Cornachione|first2=Elizabeth|date=2016-03-01|website=The Henry J. Kaiser Family Foundation|language=en-us|access-date=2019-06-13|archive-url=https://web.archive.org/web/20180921100242/https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-in-2015-report/|archive-date=September 21, 2018|url-status=dead}} [141] => [142] => More recently, many states have authorized financial requirements that will make it more difficult for working-poor adults to access coverage. In [[Wisconsin]], nearly a quarter of Medicaid patients were dropped after the state government imposed premiums of 3% of household income.{{Cite web|url=http://www.policymattersohio.org/wp-content/uploads/2015/02/Making-Medicaid-work-1.pdf|title=Making Medicaid Work|website=www.policymattersohio.org}} A survey in [[Minnesota]] found that more than half of those covered by Medicaid were unable to obtain prescription medications because of [[Copayment|co-payments]]. [143] => [144] => The [[Deficit Reduction Act of 2005]] (DRA) requires anyone seeking Medicaid to produce documents to prove that he is a United States citizen or resident alien. An exception is made for Emergency Medicaid where payments are allowed for the pregnant and disabled regardless of immigration status.{{cite web|title=Healthcare for Wisconsin Residents|url=http://www.dhs.wisconsin.gov/medicaid/Publications/p-10164.pdf|publisher=Wisconsin Department of Health and Family Services|access-date=October 5, 2011|archive-url=https://web.archive.org/web/20111130165600/http://www.dhs.wisconsin.gov/medicaid/Publications/p-10164.pdf|archive-date=November 30, 2011|url-status=dead}} Special rules exist for those living in a nursing home and disabled children living at home. [145] => [146] => ==== Supplemental Security Income beneficiaries ==== [147] => Once someone is approved as a beneficiary in the [[Supplemental Security Income]] program, they may automatically be eligible for Medicaid coverage (depending on the laws of the state they reside in).{{Cite web|url=https://www.ssa.gov/disabilityresearch/wi/medicaid.htm|title=Medicaid Information|website=www.ssa.gov|language=en|access-date=2018-07-13}} [148] => [149] => ==== Five year "look-back" ==== [150] => The DRA has created a five-year "look-back period". This means that any transfers without fair market value (gifts of any kind) made by the Medicaid applicant during the preceding five years are penalizable. [151] => [152] => The penalty is determined by dividing the average monthly cost of nursing home care in the area or State into the amount of assets gifted. Therefore, if a person gifted $60,000 and the average monthly cost of a nursing home was $6,000, one would divide $6000 into $60,000 and come up with 10. 10 represents the number of months the applicant would not be eligible for Medicaid. [153] => [154] => All transfers made during the five-year look-back period are totaled, and the applicant is penalized based on that amount after having already dropped below the Medicaid asset limit. This means that after dropping below the asset level ($2,000 limit in most states), the Medicaid applicant will be ineligible for a period of time. The penalty period does not begin until the person is eligible for Medicaid.42 U.S.C. 1396p [155] => [156] => Elders who gift or transfer assets can be caught in the situation of having no money but still not being eligible for Medicaid. [157] => [158] => ====Immigration status==== [159] => {{See also|Immigration to the United States}} [160] => [161] => Legal permanent residents (LPRs) with a substantial work history (defined as 40 quarters of Social Security covered earnings) or military connection are eligible for the full range of major federal means-tested benefit programs, including Medicaid (Medi-Cal).{{cite report|title=RL33809 Noncitizen Eligibility for Federal Public Assistance: Policy Overview |date=December 12, 2016|publisher=[[Congressional Research Service]]|url=https://www.everycrsreport.com/reports/RL33809.html}} {{PD-notice}} LPRs entering after August 22, 1996, are barred from Medicaid for five years, after which their coverage becomes a state option, and states have the option to cover LPRs who are children or who are pregnant during the first five years. Noncitizen SSI recipients are eligible for (and required to be covered under) Medicaid. Refugees and asylees are eligible for Medicaid for seven years after arrival; after this term, they may be eligible at state option. [162] => [163] => Nonimmigrants and unauthorized aliens are not eligible for most federal benefits, regardless of whether they are means tested, with notable exceptions for emergency services (e.g., Medicaid for emergency medical care), but states have the option to cover nonimmigrant and unauthorized aliens who are pregnant or who are children, and can meet the definition of "lawfully residing" in the United States. Special rules apply to several limited noncitizen categories: certain "cross-border" [[Native Americans in the United States|American Indians]], [[Hmong people|Hmong]]/Highland Laotians, [[parole]]es and conditional entrants, and cases of abuse. [164] => [165] => Aliens outside the United States who seek to obtain [[Visa policy of the United States|visas]] at U.S. consulates overseas or admission at U.S. ports of entry are generally denied entry if they are deemed "likely at any time to become a public charge".{{cite report|title=R43220 Public Charge Grounds of Inadmissibility and Deportability: Legal Overview |date=February 6, 2017|publisher=[[Congressional Research Service]]|url=https://www.everycrsreport.com/reports/R43220.html}} {{PD-notice}} Aliens within the United States who seek to adjust their status to that of lawful permanent resident (LPR), or who entered the United States without inspection, are also generally subject to exclusion and [[deportation]] on public charge grounds. Similarly, LPRs and other aliens who have been admitted to the United States are removable if they become a public charge within five years after the date of their entry due to causes that preexisted their entry. [166] => [167] => A 1999 policy letter from immigration officials defined "public charge" and identified which benefits are considered in public charge determinations, and the policy letter underlies current regulations and other guidance on the public charge grounds of inadmissibility and deportability. Collectively, the various sources addressing the meaning of public charge have historically suggested that an alien's receipt of public benefits, per se, is unlikely to result in the alien being deemed to be removable on public charge grounds. [168] => [169] => === Children and SCHIP === [170] => A child may be eligible for Medicaid regardless of the eligibility status of his parents. Thus, a child may be covered by Medicaid based on his individual status even if his parents are not eligible. Similarly, if a child lives with someone other than a parent, he may still be eligible based on its individual status.{{cite web|url=http://www.cms.hhs.gov/MedicaidEligibility/Downloads/MedicaidataGlance05.pdf|title=CMS.hhs.gov|website=hhs.gov|access-date=December 4, 2007|archive-url=https://web.archive.org/web/20080228045355/http://www.cms.hhs.gov/MedicaidEligibility/Downloads/MedicaidataGlance05.pdf|archive-date=February 28, 2008|url-status=dead}} [171] => [172] => One-third of children and over half (59%) of low-income children are insured through Medicaid or [[SCHIP]]. The insurance provides them with access to preventive and primary services which are used at a much higher rate than for the uninsured, but still below the utilization of privately insured patients. As of 2014, rate of uninsured children was reduced to 6% (5 million children remain uninsured).{{cite web |url=https://www.kff.org/health-reform/issue-brief/childrens-health-coverage-the-role-of-medicaid-and-chip-and-issues-for-the-future/ |title=Children's Health Coverage: The Role of Medicaid and CHIP and Issues for the Future |first1=Elizabeth |last1=Cornachione |first2=Robin |last2=Rudowitz |first3=Samantha |last3=Artiga |date=June 27, 2016 |publisher=[[Kaiser Family Foundation]] }} [173] => [174] => === HIV === [175] => Medicaid provided the largest portion of federal money spent on health care for people living with [[HIV]]/AIDS until the implementation of Medicare Part D, when the cost of prescription drugs for those eligible for both Medicare and Medicaid was shifted to Medicare. Unless low income people who are HIV positive meet some other eligibility category, they are not eligible for Medicaid assistance unless they can qualify under the "disabled" category to receive Medicaid assistance — for example, if they progress to [[AIDS]] ([[T-cell]] count drops below 200)."Medicaid and HIV/AIDS," Kaiser Family Foundation, fact sheet, [http://kff.org/hivaids/fact-sheet/medicaid-and-hivaids/ kff.org] {{Webarchive|url=https://web.archive.org/web/20160721032838/http://kff.org/hivaids/fact-sheet/medicaid-and-hivaids/ |date=July 21, 2016 }} The Medicaid eligibility policy differs from [[Journal of the American Medical Association]] (JAMA) guidelines, which recommend therapy for all patients with T-cell counts of 350 or less and even certain patients with a higher T-cell count. Due to the high costs associated with HIV medications, many patients are not able to begin [[antiretroviral]] treatment without Medicaid help. It is estimated that more than half of people living with AIDS in the United States receive Medicaid payments. Two other programs that provide financial assistance to people living with HIV/AIDS are the Social Security Disability Insurance (SSDI) and the Supplemental Security Income programs.{{Citation needed|date=February 2017}} [176] => [177] => == Utilization == [178] => During 2003–2012, the share of hospital stays billed to Medicaid increased by 2.5%, or 0.8 million stays.{{cite web | vauthors = Wiess AJ, Elixhauser A |title=Overview of Hospital Utilization, 2012 |work=HCUP Statistical Brief #180 |publisher=Agency for Healthcare Research and Quality |location=Rockville, MD |date=October 2014 |url=https://www.hcup-us.ahrq.gov/reports/statbriefs/sb179-Emergency-Department-Trends.jsp}} As of 2019, Medicaid paid for half of all births in the United States. [179] => [180] => Medicaid super utilizers (defined as Medicaid patients with four or more admissions in one year) account for more hospital stays (5.9 vs.1.3 stays), longer lengths of stay (6.1 vs. 4.5 days), and higher hospital costs per stay ($11,766 vs. $9,032).{{cite journal |vauthors=Jiang HJ, Barrett ML, Sheng M |title=Characteristics of Hospital Stays for Nonelderly Medicaid Super-Utilizers, 2012 |journal=HCUP Statistical Brief #184 |publisher=Agency for Healthcare Research and Quality |location=Rockville, MD |date=November 2014 |pmid=25590126 |url=https://www.hcup-us.ahrq.gov/reports/statbriefs/sb184-Hospital-Stays-Medicaid-Super-Utilizers-2012.jsp}} Medicaid super-utilizers were more likely than other Medicaid patients to be male and to be aged 45–64 years. Common conditions among super-utilizers include [[mood disorder]]s and [[Mental disorder|psychiatric disorders]], as well as [[Diabetes mellitus|diabetes]], [[cancer]] treatment, [[sickle cell anemia]], [[sepsis]], [[congestive heart failure]], [[chronic obstructive pulmonary disease]], and complications of devices, implants, and [[Graft (surgery)|grafts]]. [181] => [182] => == Budget and financing == [183] => [[File:U.S. healthcare GDP.gif|none|Medicaid spending as part of total [[Health care in the United States|U.S. healthcare]] spending (public and private). Percent of [[gross domestic product]] (GDP). [[Congressional Budget Office]] chart.[http://www.cbo.gov/ftpdocs/87xx/doc8758/MainText.3.1.shtml#1077141 The Long-Term Outlook for Health Care Spending] {{Webarchive|url=https://web.archive.org/web/20120126173451/http://www.cbo.gov/ftpdocs/87xx/doc8758/MainText.3.1.shtml#1077141 |date=January 26, 2012 }}. Figure 2. [[Congressional Budget Office]].|thumb|603x603px]] [184] => Unlike Medicare, which is solely a federal program, Medicaid is a joint federal-state program. Each state administers its own Medicaid system that must conform to federal guidelines for the state to receive Federal [[matching funds]]. Financing of Medicaid in the [[American Samoa]], [[Puerto Rico]], [[Guam]], and the [[United States Virgin Islands|U.S. Virgin Islands]] is instead implemented through a [[Block grant (United States)|block grant]].{{Cite web | url=https://www.dcreport.org/2019/06/11/puerto-ricos-post-maria-medicaid-crisis/ |title = Puerto Rico's Post-Maria Medicaid Crisis|date = June 11, 2019}} The Federal government matches state funding according to the [[Federal Medical Assistance Percentages]].[http://www.ssa.gov/OP_Home/ssact/title11/1101.htm SSA.gov], Social Security Act. Title IX, Sec. 1101(a)(8)(B) The wealthiest states only receive a federal match of 50% while poorer states receive a larger match.{{cite book|last1=Mitchell|first1=Alison|title=Medicaid's Federal Medical Assistance Percentage (FMAP)|date=April 25, 2018|publisher=Congressional Research Service|location=Washington, DC|url=https://fas.org/sgp/crs/misc/R43847.pdf|access-date=5 May 2018}} [185] => [186] => Medicaid funding has become a major budgetary issue for many states over the last few years, with states, on average, spending 16.8% of state general funds on the program. If the federal match expenditure is also counted, the program, on average, takes up 22% of each state's budget.{{cite web|url=http://www.nasbo.org/Publications/PDFs/Fiscal%20Survey%20of%20the%20States%20June%202007.pdf|title=Microsoft Word – Final Text.doc|website=nasbo.org|access-date=November 27, 2007|archive-url=https://web.archive.org/web/20071127095746/http://www.nasbo.org/Publications/PDFs/Fiscal%20Survey%20of%20the%20States%20June%202007.pdf|archive-date=November 27, 2007|url-status=dead}}[http://ccf.georgetown.edu/index/medicaid-and-state-budgets-looking-at-the-facts "Medicaid and State Budgets: Looking at the Facts"], Georgetown University Center for Children and Families, May 2008. Some 43 million Americans were enrolled in 2004 (19.7 million of them children) at a total cost of $295 billion.{{cite web|url= http://www.cbpp.org/cms/index.cfm?fa=view&id=2223 |title=Policy Basics: Introduction to Medicaid|date=January 6, 2009}} In 2008, Medicaid provided health coverage and services to approximately 49 million low-income children, pregnant women, elderly people, and disabled people.{{Citation needed|date=January 2012}} Federal Medicaid outlays were estimated to be $204 billion in 2008.[https://web.archive.org/web/20070820164040/http://www.whitehouse.gov/omb/budget/fy2008/hhs.html "Budget of the United States Government, FY 2008"], Department of Health and Human Services, 2008. In 2011, there were 7.6 million hospital stays billed to Medicaid, representing 15.6% (approximately $60.2 billion) of total aggregate inpatient hospital costs in the United States.Torio CM, Andrews RM. National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011. HCUP Statistical Brief #160. Agency for Healthcare Research and Quality, Rockville, MD. August 2013. [http://hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp] {{Webarchive|url=https://web.archive.org/web/20170314171958/https://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp|date=March 14, 2017}} At $8,000, the mean cost per stay billed to Medicaid was $2,000 less than the average cost for all stays.{{cite journal |vauthors=Pfuntner A, Wier LM, Steiner C |title=Costs for Hospital Stays in the United States, 2011. |journal=HCUP Statistical Brief #168 |publisher=Agency for Healthcare Research and Quality |location=Rockville, MD |date=December 2013 |pmid=24455786 |url=http://hcup-us.ahrq.gov/reports/statbriefs/sb168-Hospital-Costs-United-States-2011.jsp |access-date=January 24, 2014 |archive-date=July 29, 2020 |archive-url=https://web.archive.org/web/20200729154431/https://www.hcup-us.ahrq.gov/reports/statbriefs/sb168-Hospital-Costs-United-States-2011.jsp |url-status=dead }} [187] => [188] => Medicaid does not pay benefits to individuals directly; Medicaid sends benefit payments to health care providers. In some states Medicaid beneficiaries are required to pay a small fee (co-payment) for medical services. Medicaid is limited by federal law to the coverage of "medically necessary services".{{cite journal | vauthors = Adler PW | title = Is it lawful to use Medicaid to pay for circumcision? | journal = Journal of Law and Medicine | volume = 19 | issue = 2 | pages = 335–53 | date = December 2011 | pmid = 22320007 | url = http://www.doctorsopposingcircumcision.org/pdf/2011-12_Adler.pdf | access-date = April 30, 2012 | archive-url = https://web.archive.org/web/20141129090312/http://www.doctorsopposingcircumcision.org/pdf/2011-12_Adler.pdf | archive-date = November 29, 2014 | url-status = dead }} [189] => [190] => Since the Medicaid program was established in 1965, "states have been permitted to recover from the estates of deceased Medicaid recipients who were over age 65 when they received benefits and who had no surviving spouse, minor child, or adult disabled child".Eugene Kiely, [http://www.factcheck.org/2014/01/medicaid-estate-recovery-program/ Medicaid Estate Recovery Program], [[FactCheck.org]], [[Annenberg Public Policy Center]], University of Pennsylvania (January 10, 2014). In 1993, Congress enacted the [[Omnibus Budget Reconciliation Act of 1993]], which required states to attempt to recoup "the expense of long-term care and related costs for deceased Medicaid recipients 55 or older." The Act allowed states to recover other Medicaid expenses for deceased Medicaid recipients 55 or older, at each state's choice. However, states were prohibited from estate recovery when "there is a surviving spouse, a child under the age of 21 or a child of any age who is blind or disabled". The Act also carved out other exceptions for adult children who have served as caretakers in the homes of the deceased, property owned jointly by siblings, and income-producing property, such as farms". Each state now maintains a [[Medicaid Estate Recovery Program]], although the sum of money collected significantly varies from state to state, "depending on how the state structures its program and how vigorously it pursues collections." [191] => [192] => On November 25, 2008, a new federal rule was passed that allows states to charge premiums and higher co-payments to Medicaid participants.[http://www.gpoaccess.gov/fr/ search: 42 CFR Parts 447 and 457] {{webarchive|url=https://web.archive.org/web/20120310235019/http://www.gpoaccess.gov/fr/ |date=March 10, 2012 }} This rule enabled states to take in greater revenues, limiting financial losses associated with the program. Estimates figure that states will save $1.1 billion while the federal government will save nearly $1.4 billion. However, this meant that the burden of financial responsibility would be placed on 13 million Medicaid recipients who faced a $1.3 billion increase in co-payments over 5 years.{{cite news|url=https://www.nytimes.com/2008/11/27/us/27medicaid.html |work=The New York Times |first=Robert |last=Pear |title=New Medicaid Rules Allow States to Set Premiums and Higher Co-Payments |date=November 27, 2008}} The major concern is that this rule will create a disincentive for low-income people to seek healthcare. It is possible that this will force only the sickest participants to pay the increased premiums and it is unclear what long-term effect this will have on the program. [193] => [194] => A 2019 study found that Medicaid expansion in [[Michigan]] had net positive fiscal effects for the state.{{Cite journal|last1=Levy|first1=Helen|last2=Ayanian|first2=John Z.|last3=Buchmueller|first3=Thomas C.|last4=Grimes|first4=Donald R.|last5=Ehrlich|first5=Gabriel|title=Macroeconomic Feedback Effects of Medicaid Expansion: Evidence from Michigan|journal=Journal of Health Politics, Policy and Law|volume=45|pages=5–48|language=en|doi=10.1215/03616878-7893555|pmid=31675091|year=2020|issue=1|doi-access=free}} [195] => [196] => == Effects == [197] => [198] => === Coverage gains === [199] => A 2019 review by Kaiser Family Foundation of 324 studies on Medicaid expansion concluded that "expansion is linked to gains in coverage; improvements in access, financial security, and some measures of health status/outcomes; and economic benefits for states and providers." [200] => [201] => === Mortality and disability reduction === [202] => A 2021 study found that Medicaid expansion as part of the Affordable Care Act led to a substantial reduction in mortality, primarily driven by reductions in disease-related deaths.{{Cite journal|last1=Miller|first1=Sarah|last2=Johnson|first2=Norman|last3=Wherry|first3=Laura R|date=2021|title=Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data*|journal=The Quarterly Journal of Economics|volume=136|issue=3|pages=1783–1829|doi=10.1093/qje/qjab004|issn=0033-5533|doi-access=free}} A 2018 study in the ''[[Journal of Political Economy]]'' found that upon its introduction, Medicaid reduced infant and child mortality in the 1960s and 1970s.{{cite journal |last1=Goodman-Bacon |first1=Andrew |title=Public Insurance and Mortality: Evidence from Medicaid Implementation |journal=Journal of Political Economy |date=February 2018 |volume=126 |issue=1 |pages=216–262 |doi=10.1086/695528 |s2cid=158783532 |url=http://www-personal.umich.edu/~ajgb/medicaid_ajgb.pdf }} The decline in the mortality rate for nonwhite children was particularly steep. A 2018 study in the ''American Journal of Public Health'' found that the infant mortality rate declined in states that had Medicaid expansions (as part of the Affordable Care Act) whereas the rate rose in states that declined Medicaid expansion.{{cite journal |last1=Bhatt |first1=Chintan B. |last2=Beck-Sagué |first2=Consuelo M. |title=Medicaid Expansion and Infant Mortality in the United States |journal=American Journal of Public Health |date=April 2018 |volume=108 |issue=4 |pages=565–7 |pmid=29346003 |pmc=5844390 |doi=10.2105/ajph.2017.304218 }} A 2020 ''JAMA'' study found that Medicaid expansion under the ACA was associated with reduced incidence of advanced-stage breast cancer, indicating that Medicaid accessibility led to early detection of breast cancer and higher survival rates.{{Cite journal|last1=Blanc|first1=Justin M. Le|last2=Heller|first2=Danielle R.|last3=Friedrich|first3=Ann|last4=Lannin|first4=Donald R.|last5=Park|first5=Tristen S.|date=2020-07-01|title=Association of Medicaid Expansion Under the Affordable Care Act With Breast Cancer Stage at Diagnosis|url= |journal=JAMA Surgery|language=en|volume=155|issue=8|pages=752–758|doi=10.1001/jamasurg.2020.1495|pmc=7330827|pmid=32609338}} A 2020 study found no evidence that Medicaid expansion adversely affected the quality of health care given to Medicare recipients.{{Cite journal|last1=Carey|first1=Colleen M.|last2=Miller|first2=Sarah|last3=Wherry|first3=Laura R.|date=2020|title=The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare|url=https://www.aeaweb.org/articles?id=10.1257/app.20190176|journal=American Economic Journal: Applied Economics|language=en|volume=12|issue=4|pages=288–318|doi=10.1257/app.20190176|s2cid=225044690|issn=1945-7782}} A 2018 study found that Medicaid expansions in [[New York (state)|New York]], Arizona, and Maine in the early 2000s caused a 6% decline in the mortality rate: "HIV-related mortality (affected by the recent introduction of antiretrovirals) accounted for 20% of the effect. Mortality changes were closely linked to county-level coverage gains, with one life saved annually for every 239 to 316 adults gaining insurance. The results imply a cost per life saved ranging from $327,000 to $867,000 which compares favorably with most estimates of the value of a statistical life."{{cite journal|last1=Sommers|first1=Benjamin D.|date=July 2017|title=State Medicaid Expansions and Mortality, Revisited: A Cost-Benefit Analysis|url=https://dash.harvard.edu/bitstream/1/27305958/1/Mcaid%20Mortality%20Revisited%20DASH%20Version.pdf|journal=American Journal of Health Economics|volume=3|issue=3|pages=392–421|doi=10.1162/ajhe_a_00080|s2cid=53488456}} [203] => [204] => A 2016 paper found that Medicaid has substantial positive long-term effects on the health of recipients: "Early childhood Medicaid eligibility reduces mortality and disability and, for whites, increases extensive margin labor supply, and reduces receipt of disability transfer programs and public health insurance up to 50 years later. Total income does not change because earnings replace disability benefits."{{cite journal|last1=Goodman-Bacon|first1=Andrew|date=December 2016|title=The Long-Run Effects of Childhood Insurance Coverage: Medicaid Implementation, Adult Health, and Labor Market Outcomes|url=https://www.nber.org/papers/w22899|journal=NBER Working Paper|series=Working Paper Series |publisher=National Bureau of Economic Research|pages=22899|doi=10.3386/w22899|doi-access=free}} The government recoups its investment in Medicaid through savings on benefit payments later in life and greater payment of taxes because recipients of Medicaid are healthier: "The government earns a discounted annual return of between 2% and 7% on the original cost of childhood coverage for these cohorts, most of which comes from lower cash transfer payments". A 2019 [[National Bureau of Economic Research]] paper found that when [[Hawaii]] stopped allowing [[Compact of Free Association|Compact of Free Association (COFA)]] migrants to be covered by the state's Medicaid program that Medicaid-funded hospitalizations declined by 69% and emergency room visits declined by 42% for this population, but that uninsured ER visits increased and that Medicaid-funded ER visits by infants substantially increased.{{Cite journal|last1=Halliday|first1=Timothy J|last2=Akee|first2=Randall Q|last3=Sentell|first3=Tetine|last4=Inada|first4=Megan|last5=Miyamura|first5=Jill|date=2019|title=The Impact of Medicaid on Medical Utilization in a Vulnerable Population: Evidence from COFA Migrants|series=Working Paper Series |url=http://www.nber.org/papers/w26030|doi=10.3386/w26030|hdl-access=free|hdl=10419/215175|s2cid=198255625}} Another NBER paper found that Medicaid expansion reduced mortality.{{Cite journal|last1=Miller|first1=Sarah|last2=Altekruse|first2=Sean|last3=Johnson|first3=Norman|last4=Wherry|first4=Laura R|date=2019|title=Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data|series=Working Paper Series |url=http://www.nber.org/papers/w26081|doi=10.3386/w26081|s2cid=164463149}} [205] => [206] => A 2021 ''American Economic Review'' study found that early childhood access to Medicaid "reduces mortality and disability, increases employment, and reduces receipt of disability transfer programs up to 50 years later. Medicaid has saved the government more than its original cost and saved more than 10 million quality adjusted life years."{{Cite journal |last=Goodman-Bacon |first=Andrew |date=2021 |title=The Long-Run Effects of Childhood Insurance Coverage: Medicaid Implementation, Adult Health, and Labor Market Outcomes |url=https://www.aeaweb.org/articles?id=10.1257/aer.20171671 |journal=American Economic Review |language=en |volume=111 |issue=8 |pages=2550–2593 |doi=10.1257/aer.20171671 |issn=0002-8282 |s2cid=237710097}} [207] => [208] => === Rural hospitals boosted revenue === [209] => A 2020 study found that Medicaid expansion boosted the revenue and operating margins of rural hospitals, had no impact on small urban hospitals, and led to declines in revenue for large urban hospitals.{{Cite journal|last1=Moghtaderi|first1=Ali|last2=Pines|first2=Jesse|last3=Zocchi|first3=Mark|last4=Black|first4=Bernard|date=2020|title=The effect of Affordable Care Act Medicaid expansion on hospital revenue|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.4157|journal=Health Economics|language=en|volume=29|issue=12|pages=1682–1704|doi=10.1002/hec.4157|issn=1099-1050|pmid=32935892|s2cid=221748484}} A 2021 study found that expansions of adult Medicaid dental coverage increasingly led dentists to locate to poor, previously underserved areas.{{Cite journal|date=2021|title=Medicaid and provider supply|url=https://www.sciencedirect.com/science/article/abs/pii/S0047272721000669|journal=Journal of Public Economics|language=en|volume=200|doi=10.1016/j.jpubeco.2021.104430|issn=0047-2727|last1=Huh|first1=Jason|page=104430|s2cid=236254325}} A 2019 paper by [[Stanford University]] and [[Wharton School of Business]] economists found that Medicaid expansion "produced a substantial increase in hospital revenue and profitability, with larger gains for government hospitals. On the benefits side, we do not detect significant improvements in patient health, although the expansion led to substantially greater hospital and emergency room use, and a reallocation of care from public to private and better-quality hospitals."{{cite journal |last1=Duggan |first1=Mark |last2=Gupta |first2=Atul |last3=Jackson |first3=Emilie |title=The Impact of the Affordable Care Act: Evidence from California's Hospital Sector |journal=NBER Working Paper |series=Working Paper Series |date=2019 |pages=25488 |url=http://www.nber.org/papers/w25488 |publisher=National Bureau of Economic Research |doi=10.3386/w25488 |s2cid=169278577 |doi-access=free }} [210] => [211] => === Financial and health security increase === [212] => A 2017 survey of the academic research on Medicaid found it improved recipients' health and financial security. Studies have linked Medicaid expansion with increases in employment levels and student status among enrollees.{{Cite journal|last1=Tipirneni|first1=Renuka|last2=Ayanian|first2=John Z.|last3=Patel|first3=Minal R.|last4=Kieffer|first4=Edith C.|last5=Kirch|first5=Matthias A.|last6=Bryant|first6=Corey|last7=Kullgren|first7=Jeffrey T.|last8=Clark|first8=Sarah J.|last9=Lee|first9=Sunghee|last10=Solway|first10=Erica|last11=Chang|first11=Tammy|date=2020-01-03|title=Association of Medicaid Expansion With Enrollee Employment and Student Status in Michigan|journal=JAMA Network Open|language=en|volume=3|issue=1|pages=e1920316|doi=10.1001/jamanetworkopen.2019.20316|pmc=7042869|pmid=32003820|doi-access=free}}{{Cite journal|last1=Hall|first1=Jean P.|last2=Shartzer|first2=Adele|last3=Kurth|first3=Noelle K.|last4=Thomas|first4=Kathleen C.|date=2018-07-19|title=Medicaid Expansion as an Employment Incentive Program for People With Disabilities|journal=American Journal of Public Health|volume=108|issue=9|pages=1235–1237|doi=10.2105/AJPH.2018.304536|issn=0090-0036|pmc=6085052|pmid=30024794}}{{Cite journal|last1=Hall|first1=Jean P.|last2=Shartzer|first2=Adele|last3=Kurth|first3=Noelle K.|last4=Thomas|first4=Kathleen C.|date=2016-12-20|title=Effect of Medicaid Expansion on Workforce Participation for People With Disabilities|journal=American Journal of Public Health|volume=107|issue=2|pages=262–264|doi=10.2105/AJPH.2016.303543|issn=0090-0036|pmc=5227925|pmid=27997244}} A 2017 paper found that Medicaid expansion under the Affordable Care Act "reduced unpaid medical bills sent to collection by $3.4 billion in its first two years, prevented new delinquencies, and improved [[credit score]]s. Using data on credit offers and pricing, we document that improvements in households' financial health led to better terms for available credit valued at $520 million per year. We calculate that the financial benefits of Medicaid double when considering these indirect benefits in addition to the direct reduction in out-of-pocket expenditures."{{cite journal|last1=Brevoort|first1=Kenneth|last2=Grodzicki|first2=Daniel|last3=Hackmann|first3=Martin B|date=November 2017|title=Medicaid and Financial Health|url=https://www.nber.org/papers/w24002|journal=NBER Working Paper|series=Working Paper Series |publisher=National Bureau of Economic Research|pages=24002|doi=10.3386/w24002|doi-access=free}} Studies have found that Medicaid expansion reduced rates of poverty and severe [[Food security|food insecurity]] in certain states.{{cite journal|last1=Zewde|first1=Naomi|last2=Wimer|first2=Christopher|date=January 2019|title=Antipoverty Impact Of Medicaid Growing With State Expansions Over Time|journal=Health Affairs|volume=38|issue=1|pages=132–138|doi=10.1377/hlthaff.2018.05155|pmid=30615519|s2cid=58641724 }}{{Cite journal|last=Himmelstein|first=Gracie|date=2019-07-18|title=Effect of the Affordable Care Act's Medicaid Expansions on Food Security, 2010–2016|journal=American Journal of Public Health|volume=109|issue=9|pages=e1–e6|doi=10.2105/AJPH.2019.305168|issn=0090-0036|pmc=6687269|pmid=31318597}} Studies on the implementation of work requirements for Medicaid in Arkansas found that it led to an increase in uninsured individuals, medical debt, and delays in seeking care and taking medications, without any significant impact on employment.{{Cite web|url=https://www.latimes.com/science/la-sci-arkansas-medicaid-work-requirements-backfire-20190619-story.html|title=Arkansas' Medicaid work requirement left people uninsured without boosting employment|last=Galewitz|first=Phil|website=[[Los Angeles Times]]|access-date=2019-06-22|date=June 19, 2019}}{{Cite journal|last1=Sommers|first1=Benjamin D.|last2=Goldman|first2=Anna L.|last3=Blendon|first3=Robert J.|last4=Orav|first4=E. John|last5=Epstein|first5=Arnold M.|date=2019-06-19|title=Medicaid Work Requirements — Results from the First Year in Arkansas|journal=New England Journal of Medicine|volume=381|issue=11|pages=1073–1082|doi=10.1056/NEJMsr1901772|pmid=31216419|issn=0028-4793|doi-access=free}}{{Cite journal|date=2020|title=Medicaid Work Requirements In Arkansas: Two-Year Impacts On Coverage, Employment, And Affordability Of Care|url= |journal=Health Affairs|doi=10.1377/hlthaff.2020.00538|last1=Sommers|first1=Benjamin D.|last2=Chen|first2=Lucy|last3=Blendon|first3=Robert J.|last4=Orav|first4=E. John|last5=Epstein|first5=Arnold M.|volume=39|issue=9|pages=1522–1530|pmid=32897784|pmc=7497731}} A 2021 study in the ''American Journal of Public Health'' found that Medicaid expansion in Louisiana led to reductions in [[medical debt]].{{Cite journal|last1=Callison|first1=Kevin|last2=Walker|first2=Brigham|date=2021|title=Medicaid Expansion and Medical Debt: Evidence From Louisiana, 2014–2019|journal=American Journal of Public Health|volume=111|issue=8|pages=e1–e7|doi=10.2105/AJPH.2021.306316 |pmc=8489609 |pmid=34213978|s2cid=235724057|issn=0090-0036}} [213] => [214] => === Political participation increase === [215] => A 2017 study found that Medicaid enrollment increases political participation (measured in terms of voter registration and turnout).{{cite journal|last1=Clinton|first1=Joshua D.|last2=Sances|first2=Michael W.|date=2 November 2017|title=The Politics of Policy: The Initial Mass Political Effects of Medicaid Expansion in the States|journal=American Political Science Review|volume=112|issue=1|pages=167–185|doi=10.1017/S0003055417000430|s2cid=96427012}} [216] => [217] => === Crime reduction === [218] => Studies have found that Medicaid expansion reduced crime. The proposed mechanisms for the reduction were that Medicaid increased the economic security of individuals and provided greater access to [[Substance abuse prevention|treatment for substance abuse]] or [[behavioral disorder]]s.{{Cite journal|last1=He|first1=Qiwei|last2=Barkowski|first2=Scott|date=2020|title=The effect of health insurance on crime: Evidence from the Affordable Care Act Medicaid expansion|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.3977|journal=Health Economics|language=en|volume=29|issue=3|pages=261–277|doi=10.1002/hec.3977|issn=1099-1050|pmid=31908077|s2cid=210042112}}{{cite journal|last1=Wen|first1=Hefei|last2=Hockenberry|first2=Jason M.|last3=Cummings|first3=Janet R.|date=October 2017|title=The effect of Medicaid expansion on crime reduction: Evidence from HIFA-waiver expansions|journal=Journal of Public Economics|volume=154|pages=67–94|doi=10.1016/j.jpubeco.2017.09.001}} A 2022 study found that Medicaid eligibility during childhood reduced the likelihood of criminality during early adulthood.{{Cite journal |last1=Hendrix |first1=Logan |last2=Stock |first2=Wendy A. |date=2022 |title=Investing in Health and Public Safety: Childhood Medicaid Eligibility and Later Life Criminal Behavior |url=http://jhr.uwpress.org/content/early/2022/05/02/jhr.1119-10549R5 |journal=Journal of Human Resources |page=1119 |language=en |doi=10.3368/jhr.1119-10549R5 |s2cid=213273777 |issn=0022-166X}} [219] => [220] => === Oregon Medicaid health experiment and controversy === [221] => {{Main|Oregon Medicaid health experiment}} [222] => [223] => In 2008, Oregon decided to hold a randomized lottery for the provision of Medicaid insurance in which 10,000 lower-income people eligible for Medicaid were chosen by a randomized system. The lottery enabled studies to accurately measure the impact of health insurance on an individual's health and eliminate potential selection bias in the population enrolling in Medicaid. [224] => [225] => A sequence of two high-profile studies by a team from the [[Massachusetts Institute of Technology]] and the [[Harvard School of Public Health]]{{Cite journal|last1=Baicker|first1=Katherine|last2=Taubman|first2=Sarah L.|last3=Allen|first3=Heidi L.|last4=Bernstein|first4=Mira|last5=Gruber|first5=Jonathan H.|last6=Newhouse|first6=Joseph P.|last7=Schneider|first7=Eric C.|last8=Wright|first8=Bill J.|last9=Zaslavsky|first9=Alan M.|date=2013-05-02|title=The Oregon Experiment — Effects of Medicaid on Clinical Outcomes|journal=New England Journal of Medicine|language=en|volume=368|issue=18|pages=1713–1722|doi=10.1056/NEJMsa1212321|issn=0028-4793|pmc=3701298|pmid=23635051}} found that "Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years", but did "increase use of health care services, raise rates of diabetes detection and management, lower rates of [[Depression (mood)|depression]], and reduce financial strain." [226] => [227] => The study found that in the first year:{{cite web|url=http://journalistsresource.org/studies/society/health/oregon-health-insurance-experiment/|title=Oregon Health Insurance Experiment: Evidence from the First Year|last=Olver|first=Christopher|date=2011-07-11|website=journalistsresource.org}} [228] => [229] => # Hospital use increased by 30% for those with insurance, with the length of hospital stays increasing by 30% and the number of procedures increasing by 45% for the population with insurance; [230] => # Medicaid recipients proved more likely to seek preventive care. Women were 60% more likely to have [[Mammography|mammograms]] and recipients overall were 20% more likely to have their [[cholesterol]] checked; [231] => # In terms of self-reported health outcomes, having insurance was associated with an increased probability of reporting one's health as "good", "very good", or "excellent"—overall, about 25% higher than the average; [232] => # Those with insurance were about 10% less likely to report a diagnosis of depression. [233] => #Patients with catastrophic health spending (with costs that were greater than 30% of income) dropped. [234] => #Medicaid patients had cut in half the probability of requiring loans or forgoing other bills to pay for medical costs.{{Cite news|url=https://www.economist.com/blogs/democracyinamerica/2013/05/medicaid|title=More study needed|date=2013-05-06|newspaper=The Economist|access-date=2017-06-27}} [235] => [236] => The studies spurred a debate between proponents of expanding Medicaid coverage and fiscal conservatives challenging the value of this expansive government program.{{Cite web|last=Fung|first=Brian|date=2012-06-26|title=What Actually Happens When You Expand Medicaid, as Obamacare Does?|url=https://www.theatlantic.com/health/archive/2012/06/what-actually-happens-when-you-expand-medicaid-as-obamacare-does/258989/|access-date=2019-04-18|website=The Atlantic|language=en-US}}{{Cite web|url=https://www.forbes.com/sites/theapothecary/2013/05/02/oregon-study-medicaid-had-no-significant-effect-on-health-outcomes-vs-being-uninsured/|title=Oregon Study: Medicaid 'Had No Significant Effect' On Health Outcomes vs. Being Uninsured|last=Roy|first=Avik|website=Forbes|language=en|access-date=2019-04-18}} [237] => [238] => == See also == [239] => {{Portal|United States|Medicine}} [240] => * [[Center for Medicare and Medicaid Innovation]] [241] => * [[Enhanced Primary Care Case Management Program]] [242] => * [[Medicaid estate recovery]] [243] => * [[Medicaid Home and Community-Based Services Waivers]] [244] => * [[Medicare for All Act]] [245] => * [[State Children's Health Insurance Program]] (SCHIP/CHIP) [246] => [247] => == References == [248] => {{Reflist}} [249] => [250] => == Further reading == [251] => * [[House Ways and Means Committee]], [https://www.oregonadvocates.org/geo/search/attachment.62016 ''2004 Green Book – Overview of the Medicaid Program''], United States House of Representatives, 2004. [252] => [253] => == External links == [254] => * [http://cms.hhs.gov/ CMS official web site] [255] => ** [http://www.medicaid.gov/ Medicaid information] [256] => *** [http://www.healthcare.gov/ Healthcare information for consumers] [257] => *** [http://www.insurekidsnow.gov/ Insurance information for consumers] [258] => * [https://www.govinfo.gov/content/pkg/COMPS-8765/uslm/COMPS-8765.xml Social Security Act - Title XIX Grants to States for Medical Assistance Programs] ([https://www.govinfo.gov/content/pkg/COMPS-8765/pdf/COMPS-8765.pdf PDF]/[https://www.govinfo.gov/app/details/COMPS-8765/ details]) as amended in the [[United States Government Publishing Office|GPO]] [https://www.govinfo.gov/help/comps Statute Compilations collection] [259] => * [https://web.archive.org/web/20120107012004/http://www.hapnetwork.org/ship-locator/ Health Assistance Partnership] [260] => * [http://aspe.hhs.gov/health/reports/06/trendsinmedicaid/report.pdf Trends in Medicaid, October 2006.] Staff Paper of the Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services [261] => * [https://web.archive.org/web/20080415185952/http://digital.library.unt.edu/govdocs/crs/search.tkl?q=medicaid&search_crit=fulltext&search=Search&date1=Anytime&date2=Anytime&type=form Read Congressional Research Service (CRS) Reports regarding Medicaid] [262] => * [http://ccf.georgetown.edu/index/federal-medicaid-policy "Medicaid Research"] and [http://ccf.georgetown.edu/index/about-medicaid "Medicaid Primer"] from Georgetown University Center for Children and Families. [263] => * [http://www.kff.org/medicaid/ KFF (formerly Kaiser Family Foundation)] – Substantial resources on Medicaid including federal eligibility requirements, benefits, financing and administration. [264] => ** [http://kff.org/medicaid/issue-brief/the-role-of-medicaid-in-state-economies-and-the-aca/ "The Role of Medicaid in State Economies: A Look at the Research,"] [[Kaiser Family Foundation]], November 2013 [265] => ** [http://kff.org/state-category/medicaid-chip/ State-level data] on health care spending, utilization, and insurance coverage, including details extensive Medicaid information. [266] => ** [http://kff.org/medicaid/timeline/medicaid-timeline/ History of Medicaid] {{Webarchive|url=https://web.archive.org/web/20171003124026/http://kff.org/medicaid/timeline/medicaid-timeline/ |date=October 3, 2017 }} in an interactive timeline of key developments. [267] => * [http://www.statecoverage.org/coverage Coverage By State] – Information on state health coverage, including Medicaid, by the Robert Wood Johnson Foundation & AcademyHealth. [268] => * [http://www.familiesusa.org/issues/medicaid/ Medicaid] information from [[Families USA]] [269] => * [https://web.archive.org/web/20061008200250/http://www.tcf.org/Publications/HealthCare/medicaidbasics.htm Medicaid Reform – The Basics] from The Century Foundation [270] => * [http://www.nasmd.org/ National Association of State Medicaid Directors] Organization representing the chief executives of state Medicaid programs. [271] => * [http://www.citizen.org/hrg1807 Ranking of state Medicaid programs by eligibility, scope of services, quality of service and reimbursement] {{Webarchive|url=https://web.archive.org/web/20170306134122/http://www.citizen.org/hrg1807 |date=March 6, 2017 }} from Public Citizen. 2007. [272] => * [http://www.chcs.org/ Center for Health Care Strategies, CHCS] Extensive library of tools, briefs, and reports developed to help state agencies, health plans and policymakers improve the quality and cost-effectiveness of Medicaid. [273] => [274] => {{ssusa}} [275] => {{Lyndon B. Johnson}} [276] => {{Authority control}} [277] => [278] => [[Category:Medicare and Medicaid (United States)| ]] [279] => [[Category:Child poverty]] [280] => [[Category:Federal assistance in the United States]] [281] => [[Category:Healthcare reform in the United States]] [282] => [[Category:Presidency of Lyndon B. Johnson]] [] => )
good wiki

Medicaid

Medicaid is a joint federal and state program in the United States that aims to provide healthcare coverage to low-income individuals and families. Established in 1965 through the Social Security Amendment Act, Medicaid is administered by the states within certain federal guidelines and is funded through a combination of federal and state taxes.

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Established in 1965 through the Social Security Amendment Act, Medicaid is administered by the states within certain federal guidelines and is funded through a combination of federal and state taxes. The program primarily targets low-income individuals, pregnant women, children, elderly adults, and people with disabilities. Medicaid covers a wide range of medical services, including doctor visits, hospital stays, prescription drugs, and long-term care. It also offers additional benefits such as preventive care, mental health services, and dental and vision coverage in some cases. Eligibility for Medicaid varies by state, with each state setting its income limits and determining the specific criteria for qualification. The Affordable Care Act expanded Medicaid eligibility to include adults with incomes up to 138% of the federal poverty level in states that opted to expand the program. As of 2021, Medicaid serves approximately 80 million Americans, making it one of the largest sources of health coverage in the country. Its importance lies in providing healthcare access to vulnerable populations who may otherwise be unable to afford medical services. The Wikipedia page on Medicaid provides comprehensive information about the program's history, administration, funding, coverage, eligibility requirements, and impact. It also discusses controversies and criticisms surrounding the program, such as concerns about its cost and potential fraud or abuse. Overall, the page serves as a valuable resource for anyone seeking more knowledge about Medicaid and its role in the U. S. healthcare system.

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