![]() States could opt to provide coverage at income levels above cash assistance. Under the original 1965 Medicaid law, Medicaid eligibility was tied to cash assistance (either Aid to Families with Dependent Children (AFDC) or federal Supplemental Security Income (SSI) starting in 1972) for parents, children and the poor aged, blind and people with disabilites. The match rate for most Medicaid enrollees is determined by a formula in the law that provides a match of at least 50% and provides a higher federal match rate for poorer states (Figure 2).įigure 2: The basic foundations of Medicaid are related to the entitlement and the federal-state partnership. The Medicaid entitlement is based on two guarantees: first, all Americans who meet Medicaid eligibility requirements are guaranteed coverage, and second, states are guaranteed federal matching dollars without a cap for qualified services provided to eligible enrollees. ![]() Because of this flexibility, there is significant variation across state Medicaid programs. States can also obtain Section 1115 waivers to test and implement approaches that differ from what is required by federal statute but that the Secretary of HHS determines advance program objectives. Subject to federal standards, states administer Medicaid programs and have flexibility to determine covered populations, covered services, health care delivery models, and methods for paying physicians and hospitals. Medicaid is structured as a federal-state partnership The Centers for Medicare and Medicaid Services (CMS) within the Department of Health and Human Services (HHS) is responsible for implementing Medicaid (Figure 1).įigure 1: Medicaid plays a central role in our health care system. Title XIX of the Social Security Act and a large body of federal regulations govern the program, defining federal Medicaid requirements and state options and authorities. Medicaid finances nearly a fifth of all personal health care spending in the U.S., providing significant financing for hospitals, community health centers, physicians, nursing homes, and jobs in the health care sector. Medicaid covers a broad array of health services and limits enrollee out-of-pocket costs. The vast majority of Medicaid enrollees lack access to other affordable health insurance. The program is the principal source of long-term care coverage for Americans. The Medicaid program covers 1 in 5 Americans, including many with complex and costly needs for care. Medicaid is the nation’s public health insurance program for people with low income. Medicaid is the nation’s public health insurance program for people with low income
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