Below are some important facts about America’s Medicaid program, brought to you by the Modern Medicaid Alliance (MMA). Click here for a downloadable version of MMA Medicaid Fast Facts.
- Medicaid is a joint health care program administered by states and the federal government that provides coverage to 73 million Americans, roughly 20% of the U.S. population.[i]
- Eligibility standards for Medicaid vary by state, but federal law requires coverage for certain populations, including qualified pregnant women and children, low-income families, newborns, and others who meet eligibility guidelines.[ii]
- Since the passage of the Affordable Care Act, states may choose to expand Medicaid coverage to people with incomes up to 138% of the federal poverty level. 31 states and DC have chosen to expand the program.[iii]
- One out of three children in the U.S. receives coverage through Medicaid or the Children’s Health Insurance Program (CHIP).[iv]
- Some people who receive Medicaid benefits are eligible for both Medicaid and Medicare; they are referred to as dual-eligibles.[v]
- Medicaid covers more than 60% of all nursing home residents and 40% of costs for long-term care services and supports.[vi]
- More than half of Medicaid is managed by 3rd party companies to deliver more comprehensive care and save money for states.[vii] Managed care has proven successful not only for delivering more comprehensive care to beneficiaries, but also saving money for states.[viii], [ix]
- Because states can determine the design of their own Medicaid programs, they have many opportunities to test innovative payment and service delivery models that reduce inpatient hospital admissions[x], enhance care and monitoring[xi], and create better care in many other ways.
- Medicaid benefits are divided into two categories – federally mandated benefits and optional benefits that states may choose to incorporate.[xii]
- Prescription drug coverage is determined by states, but all states cover outpatient medicines for patients.[xiii]
Full Sources
[i] http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/
[ii] https://www.medicaid.gov/medicaid-chip-program-information/by-topics/eligibility/eligibility.html
[iii] http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
[iv] http://kff.org/health-reform/issue-brief/childrens-health-coverage-medicaid-chip-and-the-aca/
[v] https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Medicare_Beneficiaries_Dual_Eligibles_At_a_Glance.pdf
[vi] Center on Budget and Policy Priorities: http://www.cbpp.org/research/health/policy-basics-introduction-to-medicaid
[vii] http://kff.org/data-collection/medicaid-managed-care-market-tracker/
[viii] Medicaid Managed Care Cost Savings – A Synthesis of 24 Studies, The Lewin Group, March 2009.
[ix] Comparison of Medicaid Pharmacy Costs and Usage in Carve-In Versus Carve-Out States, The Menges Group, April 2015.
[x] https://www.dshs.wa.gov/sites/default/files/SESA/rda/documents/research-9-100.pdf
[xi] Lòpez-DeFede, A., Hardin, J., Mayfield-Smith, K., Liu, Q., Payne, T., Stewart, J. E., & Brantley, V. (2011). Does health plan type contribute to difference in diabetes care? Journal of South Carolina Medical Association, 107(1), 17-20.
[xii] https://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/medicaid-benefits.html
[xiii] https://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/prescription-drugs/prescription-drugs.html