The Truth about Medicaid

Medicaid provides health coverage for low-income children and adults, medical and long-term care coverage for people with disabilities, and assistance with health and long-term care expenses for low-income seniors. More than 58 million people rely on Medicaid services.

Medicaid is jointly funded by the federal government and the states. Each state administers its own program, and the federal Centers for Medicare and Medicaid Services (CMS) monitors the programs and sets quality, funding, and eligibility standards.

This section of our Web site provides resources on Medicaid laws and regulations and keeps you up-to-date on the battle to sustain and improve this important program.

Children receive health coverage through Medicaid and the state Children’s Health Insurance Program (CHIP). To learn more about CHIP, see the Children’s Health section.

The Latest on Medicaid

The U.S. Supreme Court takes a pass on a question of Medicaid providers’ and beneficiaries’ right to sue over Medicaid cuts: On February 22, 2010, the Supreme Court issued a decision in Douglas v. Independent Living Center, vacating a lower court’s ruling and sending the case back to be argued again. The Supreme Court did not decide the question of whether Medicaid providers or beneficiaries have a right to sue to enforce federal Medicaid requirements when they believe a state has violated those requirements. Click here for more explanation and the opinion.

On February 9, CMS denied two amendments in Florida’s waiver proposal. The amendments sought to allow the state to: 1) charge all Medicaid beneficiaries a monthly premium of $10 and 2) charge a $100 copayment for non-emergency use of an ER. CMS determined that these proposals violated the Medicaid law’s cost-sharing provisions (1916A of the Social Security Act) and the Affordable Care Act’s maintenance of effort provisions. CMS stated that it wanted to work with the state to find other ways to promote cost-effective use of ER services. Florida’s proposal to move most of its Medicaid program into managed care is still pending. (February 9, 2012)

On February 6, 2012, CMS rejected a request California had made on June 30, 2011, to amend its Section 1115 “Bridge to Reform” waiver. The state sought to impose mandatory Medicaid copayments for a wide range of services, including emergency room services (for both emergency and non-emergency care), prescription drugs, hospital care, and outpatient care. Cost-sharing in Medicaid places a heavy burden on low-income families, making it more likely that they will skip needed care. (February 6, 2012)

On January 26, 2012, Kansas submitted a concept paper to CMS to start the process of requesting a waiver to substantially change its Medicaid program. The waiver has two parts: the first seeks approval to place Medicaid recipients who need long-term care into managed care. The second part, which has a longer time-frame, would fundamentally alter the Medicaid program. In that part, Kansas will ask for substantial flexibility in its Medicaid program in exchange for a fixed federal per capita payment. Both parts are extremely concerning. The second part would pose considerable risks to beneficiaries’ access to care.  Families USA will be developing materials for advocates to counter this potentially harmful proposal and others like it as they arise. (January 26, 2012)

From Families USA:

Key Issues in the Final and Interim Final Rules on Establishing Exchanges and Expanding Medicaid under the Affordable Care Act (April 2012)

Medicaid Cuts Will Hurt Illinois’ Economy explains how the governor’s proposed cuts would damage the state’s economy and hurt Illinoisans who depend on Medicaid. (April 2012)

Republicans Again Propose Slashing Funding for Medicaid, Medicare, and Other Health Programs details how the Republican proposal would affect the states. It provides state-level data on the federal funding each state would lose, the additional burden on taxpayers, and the rise in the number of uninsured residents. (April 2012)

How the Affordable Care Act Makes the Section 1115 Waiver Process More Transparent: An Advocate’s Guide explains the new rules that will give advocates and consumers a bigger voice in the waiver process. It describes when advocates can comment on waivers, and it offers tips on how to take advantage of all the opportunities the new rules provide. (April 2012)

Making the Most of Accountable Care Organizations (ACOs): What Advocates Need to Know provides an overview of ACOs; the promise they hold; and how they could change Medicare, Medicaid, and the health care landscape. It also identifies key challenges in their development and suggests how advocates can get involved in ways that benefit patients. (Updated February 2012)

Medicaid: Essential to America’s Hospitals and Communities provides state-level data highlighting how important hospitals are to state residents at every stage of life, whether or not they are covered by Medicaid. It also explains that hospitals are vital economic engines and that federal Medicaid cuts could harm many communities. (February 2012)

Implementing the Patient Protection and Affordable Care Act: A 2012 State To-Do List for Exchanges, Private Coverage, and Medicaid gives state advocates an in-depth blueprint for action in 2012, outlining issues to start thinking about and tasks that deserve immediate attention. (February 2012)

2012 Federal Poverty Guidelines are now available from HHS, and Families USA has calculated the figures for various household sizes by percentage of the federal poverty level.

From the Alliance for Health Reform:

Implementing Health Reform in the States discusses key elements of the Affordable Care Act that states must address and offers an update on the status of implementation. It also discusses the issues of whether states will aggressively promote the Medicaid expansion to those who will be eligible and what will happen if the Supreme Court rules the expansion unconstitutional. (March 2012)

From the Center for Health Care Strategies, the National Academy for State Health Policy, and the Robert Wood Johnson Foundation:

Implications of Health Reform for American Indian and Alaska Native Populations outlines provisions of the Affordable Care Act that uniquely affect these populations, including expanded coverage through Medicaid and the exchanges, outreach to tribal groups, and improved organization and financing of care. (February 2012)

From the Center on Budget and Policy Priorities:

Claimed State Savings from Rhode Island’s Medicaid Cap Heavily Overblown, Report Shows: Rhode Island Does Not Provide Support for Proposals to Convert Medicaid to a Block Grant explains that the state’s savings were modest and unrelated to the cap on federal funding. Instead, the savings came from policy changes like reducing provider payments, cutting waste, and emphasizing home- and community-based services for people who need long-term care. (March 2012)

Federal Government Will Pick Up Nearly All Costs of Health Reform’s Medicaid Expansion refutes the claim that states will face a heavy financial burden as a result of the Medicaid expansion. It also notes that the expansion will reduce costs for uncompensated care, which will offset the added Medicaid costs. (March 2012)

State Considerations on Adopting Health Reform’s ‘Basic Health’ Option: Federal Guidance Needed for States to Fully Assess Option describes the Basic Health option, the issues states should consider, and the areas in which states need federal guidance in order to decide whether the option is appropriate for them. (March 2012)

From the Kaiser Commission on Medicaid and the Uninsured:

A Guide to the Medicaid Appeals Process describes how the appeals process works for applicants and beneficiaries, including the fair hearing process and the appeals process that’s required for managed care organizations. (March 2012)

From the Kaiser Family Foundation:

Policy and Political Implications of the Supreme Court Case on the Affordable Care Act is a webcast that includes a release of new polling data on the public’s view about the case and the health care law. It also considers the case’s potential implications for the future of the law and for federal and state health policy. (March 2012)

The Role of the Basic Health Program in the Coverage Continuum: Opportunities, Risks, and Considerations for States provides a framework for assessing the Basic Health Program option and exploring the associated advantages and risks, including the ability to improve continuity of coverage for low-income residents and the costs of implementation. (March 2012)

From the National Health Law Program:

Top Ways Health Reform Helps provides the top five ways the Affordable Care Act helps the following groups: Medicaid beneficiaries, older adults and people with disabilities, women, and children and young adults. It also explains how the health care law addresses disparities and helps people get coverage. The lists are divided into provisions that are already in effect and those that are coming soon. (March 2012)

From the Robert Wood Johnson Foundation and the Urban Institute:

The Individual Mandate in Perspective estimates the number of Americans who would be subject to this provision in the Affordable Care Act, identifies their insurance status without the law, and simulates their eligibility for Medicaid or premium tax credits. It finds that 94 percent of people would not be required to newly purchase coverage or pay a fine. (March 2012)