Medicaid
Medicaid provides health coverage for low-income children and adults, medical and long-term care coverage for people with disabilities, and assistance with health and long-term care expenses for low-income seniors. Nearly 59 million people rely on Medicaid services.
Medicaid is jointly funded by the federal government and the states. Each state administers its own program, and the federal Centers for Medicare and Medicaid Services (CMS) monitors the programs and sets quality, funding, and eligibility standards.
This section of our Web site provides resources on Medicaid laws and regulations and keeps you up-to-date on the battle to sustain and improve this important program.
Children receive health coverage through Medicaid and the State Children’s Health Insurance Program (CHIP). To learn more about CHIP, see the Children’s Health section.
The Latest
Medicaid and the Economic Recovery Package
Summary of Medicaid Provisions
- $87 billion for increased federal Medicaid matching rates through December 31, 2010;
- Every state receives a 6.2 percentage point increase in their federal Medicaid matching rate for expenditures between October 1, 2008, and December 31, 2010;
- States will also receive an additional boost in their matching rate based on their unemployment rate;
- States must maintain Medicaid eligibility and enrollment policies that were in place as of July 1, 2008, in order to qualify for the increased matching rate after July 1, 2009;
- Extends the moratoria on the following Medicaid regulations until June 30, 2009: targeted case management, provider taxes, school-based administration and transportation services. Also adds a moratorium on the hospital outpatient services Medicaid regulation through June 30, 2009, and includes a Sense of Congress that the Secretary of HHS should not promulgate regulations concerning payments to public providers, graduate medical education, and rehabilitative services;
- Extends Transitional Medical Assistance until December 31, 2010;
- Extends the Qualified Individual (QI) program (which helps certain low-income individuals pay their Medicare Part B premiums) until December 31, 2010;
- Increases funding to Disproportionate Share Hospitals (DSH) by 2.5 percentage points in FY 2009 and another 2.5 percentage points in FY 2010.
Rhode Island Submits Waiver Proposal to CMS
Rhode Island has submitted its Global Consumer Choice Compact Waiver to CMS for approval. The waiver asks for the authority to become the first state “to use global budgeting as a financing mechanism for all Medicaid populations and services.” Rhode Island proposes a number of fundamental changes to its Medicaid program in order to be able to work within its proposed scheme and asserts that “the most significant changes . . . are on the long-term care side.”
The National Senior Citizens Law Center has written an analysis of the proposed long-term care changes, The Long-Term Care Proposals in Rhode Island’s Global Consumer Compact Waiver. Issues that are raised in the paper include the fact that Rhode Island has not availed itself of important long-term care opportunities that do not require waivers, that it has only recently implemented other programs that may produce favorable results, and, most importantly, that it does not appear to be fully embracing the purpose of Vermont’s Choices for Care program, the central feature of which Rhode Island has borrowed for its own proposal.
For more information on Medicaid waivers, click on the Waiver Tool Box button above.
From Families USA:
CHIPRA: The Children's Health Insurance Program Reauthorization Act - A Series of Issue Briefs. In February 2009, after a protracted political fight, Congress enacted, and President Obama signed, legislation that renewed CHIP through the end of 2013 and expanded its scope. These issue briefs examine the new provisions that were included in the reauthorization and how they will affect implementation in the coming months.
CMS Guidance on Increased Medicaid Funding Provides Important Protections for Medicaid Consumers discusses two important aspects of the guidance, the maintenance of effort (MOE) requirement, and how the enhanced FMAP will be applied to states that expanded Medicaid eligibility after July 1, 2008. (April 2009)
Health Care Must Be Affordable for All Families, Regardless of Income presents crucial arguments for why health reform must ensure that health care is truly affordable. It proposes placing reasonable limits on out-of-pocket costs and providing subsidies, especially for those with low and moderate incomes. (April 2009)
Covering the Uninsured in Medicaid describes the critical role Medicaid must play in ensuring coverage for all low-income Americans as part of health care reform. (April 2009)
From the Kaiser Commission on Medicaid and the Uninsured:
Low-Income Adults under Age 65—Many Are Poor, Sick, and Uninsured examines the characteristics and insurance coverage of this group, which numbers more than 50 million. People in this group are more likely to be in poor health than other Americans and are the least likely to have health insurance. And because Medicaid coverage is extremely limited for adults without dependent children, a large share of low-income adults with significant health needs is uninsured. (June 2009)
The Coverage and Cost Impacts of Expanding Medicaid analyzes several options for covering more low-income uninsured people through Medicaid. It also explains how reductions in spending by firms and individuals for uncompensated care will help mitigate the costs associated with a Medicaid expansion. (May 2009)
Medicaid as a Platform for Broader Health Reform: Supporting High-Need and Low-Income Populations summarizes the problems that low-income individuals face in today's health care system and explores policy options for expanding Medicaid to cover more of this population as a base for broader health reform efforts. The report finds that Medicaid can provide a strong foundation that can help ensure the success of broader reform efforts by maintaining coverage for the poor and sick while providing a vehicle to reach low-income adults. (May 2009)
Where Does the Burden Lie?: Medicaid and Medicare Spending for Dual Eligible Beneficiaries fills in gaps in information about dual eligibles by analyzing their demographic and health characteristics, as well as their patterns of service utilization and spending under both Medicare and Medicaid. These seniors are generally low-income, in poor health, and have considerable health care needs, making them one of the most costly populations to be covered by public insurance. (April 2009)
From the Robert Wood Johnson Foundation and the Urban Institute:
Health Reform: Cost of Failure examines three different scenarios that could occur if the U.S. does not reform its health care system. It concludes that in the best case scenario, inaction could increase family and individual spending by at least 46 percent and nearly double government expenditures as more U.S. residents become eligible for programs such as Medicaid and CHIP. (May 2009)
From the Urban Institute:
Express Lane Eligibility and Beyond: How Automated Enrollment Can Help Eligible Children Receive Medicaid and CHIP explores how automated enrollment strategies have achieved remarkable results, dramatically increasing program participation while lowering administrative costs and reducing erroneous eligibility determinations. The paper also addresses operational details about implementing some of the strategies described in this report. (April 2009)
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