Medicaid: What You Need to Know
What is Medicaid, and how is it different from Medicare?
Medicaid is a government health insurance program for people with low incomes and adults and children with disabilities. Medicare, on the other hand, generally covers individuals 65 or older. While Medicare is a federal program, Medicaid is a joint federal-state program, with the federal government paying a portion of the costs to states.
Who is on Medicaid?
More than 79 million people in the United States receive services from Medicaid or the Children’s Health Insurance Program (CHIP). This represents about 20% of the total population. Most enrollees qualify due to low incomes. Medicaid also covers pregnant people, people with disabilities, and individuals with complex medical needs.
What are the income qualifications?
Eligibility generally depends on whether a person is low-income, and states have different ways of defining that. For a four-adult household without dependent children, the current national median coverage level is $44,367.
What are the services covered by Medicaid?
Medicaid covers a wide range of services, including:
- Routine checkups
- Vaccinations
- Hospital stays
- Nursing and home health services
- Mental health and long-term care services
- Medication-assisted treatment for opioid use disorder
- Prescription drugs
- Eyeglasses
- Some dental care
- Physical therapy
How does Medicaid work?
The federal government pays most of the cost of Medicaid by matching a portion of what states spend. The federal government matches at least 50% of state spending and offers states more money for some services and enrollees, such as children and pregnant women. Less wealthy states receive a higher match, translating to a higher percentage of federal dollars.
What’s going to happen to Medicaid?
It’s unclear. Republicans in Washington are pushing for major changes, which could include cuts to federal funding, reducing the number of people who qualify, or limiting the services available. A similar push to repeal and replace the Affordable Care Act (ACA) in 2017 was unsuccessful. The program’s popularity may be an obstacle to changing Medicaid, as 77% of Americans view it favorably.
Frequently Asked Questions
- What is Medicaid called in my state?
- Medicaid programs can go by many different names, even within the same state, due to the use of private insurance companies to run the program. For example, in New York, Medicaid plans are offered by major companies like Anthem Blue Cross Blue Shield and UnitedHealthcare.
- How does Medicaid affect hospitals and doctors in my state?
- Medicaid generally pays health care providers less money for services than Medicare or private insurance does. However, it can be more money than they’d get for caring for people who are uninsured.
- What does the money to pay for Medicaid come from?
- The federal government pays most of the cost of Medicaid by matching a portion of what states spend. The federal government matches at least 50% of state spending and offers states more money for some services and enrollees, such as children and pregnant women. Less wealthy states receive a higher match, translating to a higher percentage of federal dollars.
