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Medicaid Law Information
What Is Medicaid?
Medicaid in the United States is a program managed by the
states and funded jointly by the states and federal government to provide health
insurance for the indigent (that is, it pays for medical assistance for certain
individuals and families with low incomes and resources). Medicaid is the
largest source of funding for medical and health-related services for people
with limited income. Among the groups of people served by Medicaid are eligible
low-income parents, children, seniors, and people with disabilities.
Medicaid was created on July 30, 1965 through Title XIX of the Social Security
Act. Each state administers its own Medicaid program while the federal Centers
for Medicare and Medicaid Services (CMS) (formerly the Health Care Financing
Administration) in the United States Department of Health and Human Services
monitors the state-run programs and establishes requirements for service
delivery, quality, funding, and eligibility standards.
Medicaid policies for eligibility, services, and payment are complex and vary
considerably, even among states of similar size or geographic proximity. Thus, a
person who is eligible for Medicaid in one state may not be eligible in another
state, and the services provided by one state may differ considerably in amount,
duration, or scope from services provided in a similar or neighboring State. In
addition, state legislatures may change Medicaid eligibility, services, and/or
reimbursement during the year.
State participation in Medicaid is voluntary; however, all states have
participated since 1982. In some states Medicaid pays private health insurance
companies that contract with the state Medicaid program, while other states pay
providers (i.e., doctors, clinics and hospitals) directly to ensure that
individuals receive proper medical attention. The State Children's Health
Insurance Program (SCHIP) was established in 1997.
In addition, other programs may exist in some localities that are funded by the
states or their political subdivisions to provide health coverage for indigents
and minors. There is also general confusion about the differences between
Medicaid and Medicare (United States), which is an entirely federal health
insurance program available for people age 65 or older, younger people with
disabilities, and a few other groups. While Medicaid and Medicare cover similar
groups, they are entirely different programs. For example, Medicaid covers a
wider range of health care services than Medicare and does not have premiums or
deductibles like Medicare. About 6.5 million Americans are enrolled in both
Medicare and Medicaid.
Medicaid has become a major budgetary issue for many states over the last few
years, with the program, on average, taking up a quarter of each state's budget.
Medicaid currently covers 53 million Americans, paying for nearly 60 percent of
all nursing home residents and about 37 percent of all births in the United
States.
In 2005, Medicaid became a major focus of lawmakers, as Congress debated funding
cuts for the program. The budget reforms called for $10 billion in cuts over
five years.
Important Medicaid Legislation
* 1965 PL 89-97 Medicaid
* 1997 PL 105-33 Balanced Budget Act (Children’s Health Insurance Program)
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