What Is Medicaid?
Let me explain Medicaid directly: it's a public health insurance program that gives health care coverage to low-income families and individuals across the United States. The federal government and individual states fund it together, and each state runs its own version, so what you get and how it works can differ a lot depending on where you live. You only qualify if you meet certain income requirements, and you have to be a U.S. citizen, permanent resident, or legal immigrant. As of September 2020, about 70.6 million people were enrolled.
Key Takeaways
Here's what you need to know upfront: Medicaid operates as a partnership between federal and state governments to cover health care for those with low incomes. The feds match what states spend, but states handle the design and day-to-day running. Your eligibility hinges on how your income stacks up against the federal poverty level. Studies show that access to Medicaid boosts coverage rates and improves overall health for enrollees.
Understanding Medicaid
I want to dive into the basics here. President Lyndon B. Johnson signed Medicaid into law in 1965 under Title XIX of the Social Security Act, right alongside Medicare. It's designed for people of any age who can't afford health care due to limited income and resources. Medicaid doesn't hand out medical services itself; it pays for things like doctor visits, hospital stays, long-term care, custodial care, and other health expenses.
Each state sets its own rules on who qualifies, what coverage includes, and how providers get paid, since they're in charge of managing their programs. The federal government matches state spending at rates from 50% to 83%, depending on the state, and while participation isn't mandatory, every state is in. This makes Medicaid the biggest funder of health services for low-income folks in the U.S., with $613.5 billion spent in 2019—that's 16% of the national health care total. The feds covered 64.5% of that, states the rest.
Coverage traditionally goes to low-income children and parents, pregnant women, people with disabilities, and those over 65. The Affordable Care Act bumped it up to include adults under 65 with incomes up to 133% of the federal poverty level. Kids make up 38% of enrollees but only 18% of costs, while disabled folks are 14% of enrollees but 36% of costs.
Special Conditions
To get in, you apply through the Health Insurance Marketplace or your state's Medicaid agency. Eligibility comes down to your income relative to the federal poverty level—generally, if you're under 100% to 200% of it and you're disabled, a child, pregnant, or elderly, you'll qualify for something. Under 138% might work too. They look at your modified adjusted gross income, which includes taxable income plus things like Social Security benefits and tax-exempt interest.
Remember, check the Medicaid website for the latest on eligibility and program details, as things can change.
Trump's Changes to Eligibility
Under the Trump administration, states could strip Medicaid from people not meeting work requirements or logging enough work hours monthly. Arkansas tried it first, and 18,000 lost coverage, but federal courts blocked it repeatedly, leading Arkansas to suspend the rules.
Medicaid vs. the Patient Protection and Affordable Care Act (PPACA)
President Obama signed the Affordable Care Act in 2010, often called Obamacare, which says legal residents and citizens with incomes up to 138% of the poverty line qualify for Medicaid in participating states. It aimed to expand federal funding and eligibility, but the Supreme Court ruled states don't have to join the expansion to keep their existing funding. As of March 2021, 12 states haven't expanded: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming.
Advantages of Medicaid
Medicaid has cut down the uninsured population, and the ACA amplified that. In 2013, before key ACA parts kicked in, 44 million lacked insurance; by 2017, it was 27.4 million. Without Medicaid, many low-income people would have no coverage at all, since job-based insurance isn't always available and private plans are too pricey. It provides access to basic care like doctor visits and meds, leading to proven improvements in health and well-being.
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