What exactly is Medicaid?
Medicaid is a public health insurance program in the United States that provides health care coverage to low-income families and individuals. The federal government and individual states both contribute to the program’s funding. It is run at the state level, so coverage and administration differ significantly from one state to the next. It is only available to individuals and families who meet specific income requirements.
Recognizing Medicaid
President Lyndon B. Johnson signed Title XIX of the Social Security Act, which also established Medicare, into law in 1965. 2 It is a government-sponsored insurance program for people of any age whose resources and income are insufficient to cover medical expenses. Medicaid does not provide direct health care to individuals. Instead, it pays for their doctor visits, hospital stays, long-term medical care, custodial care, and other medical expenses.
Individual states determine who is eligible for coverage, what coverage is provided, and how healthcare workers and hospitals are paid. Each state is responsible for managing and administering its own Medicaid program. The federal government matches state spending, and the rate varies by state, ranging from a statutory minimum of 50% to a maximum of 83%. Although all states participate in Medicaid, states are not required to do so.
The program is the largest funding source for low-income individuals in the United States. In 2019, total Medicaid spending was $613.5 billion, accounting for 16% of the nation’s healthcare bill. The federal government footed 64.5% of the bill, with individual states picking up the remaining 35.6%.
Recipients are citizens, permanent residents, or legal immigrants in the United States. Medicaid covered approximately 70.6 million people as of September 2020.
Medicaid has traditionally covered the following groups:
- Children from low-income families and their parents
- Women who are pregnant
- Disabled individuals
- Adults aged 65 and up
According to the Patient Protection and Affordable Care Act, adults under 65 who earn less than 133% of the federal poverty level (FPL) are eligible. Children account for 38% of enrollees and approximately 18% of total costs. People with disabilities, on the other hand, account for 14% of enrollees and 36% of total costs.8
Conditions Unique
Filling out an application for Medicaid through the Health Insurance Marketplace website or directly through your state’s Medicaid agency determines eligibility.
Income from the FPL determines your eligibility. The FPL is used to determine whether or not a family’s or individual’s income qualifies them for federal benefits. In general, if an individual’s income is between 100% and 200% of the FPL and they are disabled, a child, pregnant, or elderly, a program will be available. They may be eligible for a program if their income is less than 138% of the FPL. An individual’s modified adjusted gross income (MAGI) is used to determine eligibility. This includes taxable income and certain deductions, such as Social Security benefits and tax-free interest.
Trump’s Eligibility Changes
The Trump administration authorized states in the United States to terminate Medicaid coverage for people who do not meet specific work requirements or engage in work activities for a certain number of hours per month. Arkansas was the first state to implement this policy, which resulted in the loss of health care coverage for 18,000 people. This policy, however, has been repeatedly blocked in federal courts, and Arkansas has suspended the requirements.
The Patient Protection and Affordable Care Act (PPACA) vs. Medicaid
In 2010, President Obama signed the Affordable Care Act (ACA) into law.13 The law, known as Obamacare, states that all legal residents and citizens of the United States with incomes up to 138% of the poverty line are eligible for Medicaid coverage in participating states.9 While the law aimed to increase federal funding and Medicaid eligibility, the United States Supreme Court ruled that states are not required to participate in the expansion to receive previously established levels of Medicaid funding.
Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming had not expanded coverage as of March 2021.
Medicaid’s Benefits
Medicaid has reduced the number of people without health insurance, and the ACA has contributed even more. An estimated 44 million people lacked health insurance in 2013, the year before major provisions of the ACA went into effect. By 2017, the figure had fallen to 27.4 million.16
Without Medicaid, many Americans would be without health insurance. This is because low-income people frequently do not have access to insurance through their jobs, and purchasing private health insurance in the marketplace is not affordable. Medicaid has provided access to health care, resulting in statistically significant improvements in the overall well-being of individuals who would not otherwise be covered for routine doctor visits or medication.
Conclusion
- Medicaid is a program run by the federal government and the states that helps low-income people get health care.
- The federal government doubles what states spend on Medicaid, but it is up to the states to make the program work and run it.
- Your income must be less than the government poverty line to be eligible.
- As more people get access to Medicaid, their health improves generally.
