Medicaid is a government-provided health insurance program designed to help citizens or legal permanent residents of all ages receive health care at a discount or for free when they do not have the resources to afford health care insurance from the private market. This widely used social program, where eligibility requirements are determined by the states, receives funding from both the state and the federal governments. Falling below a certain percentage of the Federal Poverty Line is not the only requirement for Medicaid, as each state has its own requirements based on the income, age and disabilities of the applicants. All states, while not required to participate in the Medicaid program, do offer these opportunities to their eligible residents.
Recent legislation under the Patient Protection and Affordable Care Act have opened up the requirement of Medicaid to now include all United States citizens and legal residents whose income is up to 133 percent of the Federal Poverty Line. This opens up eligibility to adults without dependent children who would have previously been disqualified from most Medicaid programs. The states are not required to participate in the changes outlined in the new legislation, and have the option to stay with their current Medicaid levels of funding. Many states have opted to stick with their current funding and eligibility standards disregarding the Affordable Care Act’s changes regardless of the Federal Government’s three-year 100 percent cost coverage for all newly qualified beneficiaries. Others have already started creating their own Insurance Marketplaces, as well as planning for the increase in beneficiaries and funding.
Originally instated in 1963, Medicaid was designed to help low-income families with children provide the health care needed to raise the next generation of American citizens. Originally called Title XIX of the Social Security Act, the legislation sought to help those disabled, blind, aged and with dependent children. As time passed, Medicaid was updated to incorporate the option to include preventative screening and pregnant women. The addition of the Medicaid Drug Rebate Program and the Health Insurance Premium Payment Program were set up to monitor the costs of outpatient prescription drugs and established an estate recovery program to recoup medical costs paid out by Medicaid.
Organizations such as the federal Centers for Medicare and Medicaid Services (CMS) and the state Children’s Health Insurance Programs establish standards for funding and eligibility, though states tend to vary based on their specific needs. Each state submits its own State Plan, that once approved, establishes the agreement between the state and federal governments regarding Federal Fund Matching and maintaining the Federal standards for health care services. In general, Medicaid covers emergency room visits, prenatal care, doctor visits and some prescription medication, which is either fully covered by the program and paid directly to the care provider, or requires a small co-payment which varies by state. The average cost per adult on Medicaid is just under $7,000 while the average cost per child is just under $2,000 for the over 39 million people enrolled. Of that 39 million enrollees, around 28 million are children and that number continues to grow.