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Medicaid

Not to be confused with Medicare (United States).

Medicaid
Agency overview
FormedJuly 30, 1965 (1965-07-30)
Agency executive
Parent departmentCenters for Medicare and Medicaid Services
Websitewww.medicaid.gov

Medicaid is a government program in the United States that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by 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. States are not required to participate in the program, although all have since 1982.

Medicaid was established in 1965, part of the Great Society set of programs during President Lyndon B. Johnson’s Administration, and was significantly expanded by the Affordable Care Act (ACA), which was passed in 2010. In most states, any member of a household with income up to 138% of the federal poverty line qualifies for Medicaid coverage under the provisions of the ACA.[1] A 2012 Supreme Court decision established that states may continue to use pre-ACA Medicaid eligibility standards and receive previously established levels of federal Medicaid funding;[2] which led some Republican-controlled states to not expand Medicaid coverage.[3]

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;[4] in 2019, the program paid for half of all U.S. births.[5] In 2023, the total (federal and state) annual cost of Medicaid was $870 billion, with an average cost per enrollee of $7,600 for 2021.[6][7] 37% of enrollees were children, but they only accounted for 15% of the spending, ($3,000 per person) while seniors and disabled persons accounted for 21% of enrollees and 52% of spending (more than $18,000 per person).[7] In general, Medicaid recipients must be U.S. citizens or qualified non-citizens, and may include low-income adults, their children, and people with certain disabilities.[8] 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.[9] Of the 7.7 million Americans who used long-term services and supports in 2020, about 5.6 million were covered by Medicaid.[10]

Along with Medicare, Tricare, ChampVA, and CHIP, Medicaid is one of the several Federal Government-sponsored medical insurance programs in the United States.[citation needed] Medicaid covers healthcare costs for people with low incomes; Medicare is a universal program providing health coverage for the elderly; and the CHIP program covers uninsured children in families with incomes that are too high to be covered by Medicaid. 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.[11]

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.[12][13][14][15] In American politics, the Democratic Party tends to support Medicaid while the Republican Party is divided on reductions in Medicaid spending.[3][16][17]

  1. ^ "Medicaid, Children's Health Insurance Program, & Basic Health Program Eligibility Levels". Medicaid. Retrieved February 14, 2021.
  2. ^ "Eligibility". Medicaid. Archived from the original on April 2, 2018. Retrieved April 12, 2018.
  3. ^ a b Barrilleaux, Charles; Rainey, Carlisle (2014). "The Politics of Need: Examining Governors' Decisions to Oppose the "Obamacare" Medicaid Expansion". State Politics & Policy Quarterly. 14 (4): 437–460. doi:10.1177/1532440014561644. ISSN 1532-4400.
  4. ^ "December 2022 Medicaid & CHIP Enrollment Data Highlights". Retrieved April 10, 2023. 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.
  5. ^ Cite error: The named reference Franco was invoked but never defined (see the help page).
  6. ^ Cite error: The named reference NPR_2025-02-10 was invoked but never defined (see the help page).
  7. ^ a b Euhus, Rhiannon; Chidambaram, Priya (August 16, 2024). "A Look at Variation in Medicaid Spending Per Enrollee by Group and Across States". Kaiser Family Foundation.
  8. ^ "Coverage for lawfully present immigrants". Healthcare.gov. Retrieved January 9, 2019.
  9. ^ Priya Chidambaram and Alice Burns (September 15, 2022). "10 Things About Long-Term Services and Supports (LTSS)". KFF. Retrieved September 24, 2023.
  10. ^ Priya Chidambaram and Alice Burns (August 14, 2023). "How Many People Use Medicaid Long-Term Services and Supports and How Much Does Medicaid Spend on Those People?". KFF. Retrieved September 24, 2023.
  11. ^ "Medicare & Medicaid". HHS.gov U.S. Department of Health & Human Services. Retrieved February 17, 2021.
  12. ^ Gottlieb JD, Shepard M (July 2, 2017). "Evidence on the Value of Medicaid". Econofact. Retrieved July 5, 2017.
  13. ^ Antonisse, Larisa; Guth, Madeline (August 15, 2019). "The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review". The Henry J. Kaiser Family Foundation. Retrieved September 26, 2019.
  14. ^ "The evidence on Medicaid expansion" (PDF). American Medical Association.
  15. ^ Cite error: The named reference :8 was invoked but never defined (see the help page).
  16. ^ Hertel-Fernandez, Alexander; Skocpol, Theda; Lynch, Daniel (April 1, 2016). "Business Associations, Conservative Networks, and the Ongoing Republican War Over Medicaid Expansion". Journal of Health Politics, Policy and Law. 41 (2): 239–286. doi:10.1215/03616878-3476141. ISSN 0361-6878.
  17. ^ Hooper, Kelly (February 24, 2025). "Republicans' plans for Medicaid have a political problem". POLITICO.

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