Medicaid
Medicaid is generally a means-tested health care entitlement program financed by States and the Federal Government that provides health care coverage to low-income families with dependent children, pregnant women, children, and aged, blind and disabled individuals. States have considerable flexibility in structuring their Medicaid programs within broad Federal guidelines governing eligibility, provider payment levels, and benefits. As a result, Medicaid programs vary widely from State to State. Medicaid covers a broad range of services to meet the health needs of eligible beneficiaries. Federally-mandated services include hospital inpatient and outpatient services, comprehensive health screening, diagnostic and treatment services to children, home health care, laboratory and x-ray services, physician services, and nursing home care. Commonly offered optional services include prescription drugs, dental care, eyeglasses, prosthetic devices, hearing aids, and services in intermediate care facilities for individuals with a mental illness. In addition, States may elect to offer an array of home and community-based services to individuals with disabilities, individuals who are aging or individuals with chronic conditions.
The passage of the Affordable Care Act will make nearly all people living below 133 percent of the Federal poverty level eligible for Medicaid beginning in 2014, regardless of family composition or disability status. In addition to coverage expansions, the ACA makes substantive changes that will help Medicaid enrollees, such as chronically homeless individuals, gain improved access to coordinated home and community-based services and supports. A new Medicaid Health Homes State plan option will improve coordination of health and social services for individuals with complex conditions, including severe and persistent mental illnesses. Through the home and community-based State plan option, the ACA also opens up opportunities for supported employment and assertive community treatment for people with severe and persistent mental illness. Improving access to Medicaid and other mainstream benefits for eligible individuals is one of the objectives of Opening Doors as people with unmet medical needs and/or high medical bills have more trouble maintaining employment and stability and are more likely to face homelessness.
Eligible Beneficiaries:
Low-income families with dependent children, pregnant women, children, and aged, blind and disabled individuals are eligible to receive Medicaid benefits. States structure their Medicaid programs within broad Federal guidelines for eligibility, provider payment levels, and benefits. Beginning in FY 2014, Medicaid eligibility will be expanded to include most people with incomes below 133 percent of poverty regardless of family composition or disability status. To determine eligibility and enroll in benefits, individuals and families should contact their State Medicaid Agency.
Funding Mechanism:
Medicaid is a joint federal-state program. Federal funds are disbursed to State Medicaid offices at a matching rate that is determined by formula with wealthier states receiving a lower percentage match. State Medicaid offices may also apply for competitive grant funding for demonstration projects, transformation grants, and other initiatives.
