Medicaid

For updates on Actions & Proposals to Balance the FY 2010 Budget: Health Care click here.

For updates on the federal Economic Stimulus Package, including increases in Medicaid FMAP click here.

For updates on CHIP Reauthorization click here.

Medicaid is the nation's largest publicly funded health financing program for low-income people. As a federal/state partnership, states have the option to participate or not. All states currently participate. Even though the program has extensive federal requirements and restrictions, states administer the program with many options to tailor their programs to meet individual state's medical assistance needs.

Medicaid plays a major role in our health care system, funding an estimated $339 billion in services in 2008 including paying for nearly half of nursing home care.

Medicaid is really three programs in one:

A health insurance program for low-income parents (mostly mothers) and children—more than one-third of all births are covered by Medicaid.
A long-term care program for the elderly—nearly 60 percent of nursing home residents are Medicaid beneficiaries; and
A funding source for services to people with disabilities—paying for about one-third of the nation's bill for this population.

To qualify for Medicaid, an individual must meet financial criteria and belong to a "category" that is eligible for the program, mainly children, parents of dependent children, pregnant women, people with disabilities and the elderly. Federal law sets the minimum requirements for eligibility but states have broad optional authority to extend Medicaid beyond these minimum standards. Because of this, Medicaid eligibility and coverage differ from state to state.

Medicaid Resources

Featured Links

Long-Term Care

Long-term care accounts for more than 35 percent of Medicaid budgets. States are reforming their long-term care systems and seeking higher quality, cost efficiency and consumer satisfaction. This webpage includes information about state efforts to reform this area of health care.

Children's Health Insurance Program (CHIP)

The Children's Health Insurance Program (CHIP), formerly the State Childrens's Health Insurance Program created by the Balanced Budget Act of 1997, continues to receive considerable attention as states continue to refine their initial CHIP plans. In Febuary 2009, CHIP was reauthorized under the Obama administration. CHIP plans have been approved in all 50 states, the District of Columbia and five territories. In an effort to provide information on state actions involving CHIP, the CHIP menu page contains several resources about general SCHIP issues as well as more detailed information about implementation topics such as outreach plans and specialized coverage.

Access to Health Care

CMS Awards Demonstration Grants to 17 States
Access to Health Care and The Uninsured
Access to Health Care Bills
Medicaid to cover the uninsured
Submit a question to NCSL (Legislators & staff only)

Ticket to Work (2003 Archive)

Under the 1999 Ticket to Work Act, states have the option of creating new Medicaid eligibility categories for people with disabilities who work. To provide continued Medicaid coverage when people with disabilities enter the workforce, states may establish income and asset standards for this group that differ from other categories. If they wish, states may require newly eligible people to share in the cost of Medicaid coverage ("buy-in") through premiums or other cost-sharing charges. States may elect to extend the new coverage to people with disabilities or to both people with disabilities and people whose medical condition has improved. The ticket-to-work menu page contains several resources about general ticket-to-work issues.

State Medicaid Reforms

State Medicaid Reforms In the past five years, Medicaid enrollment grew when more people became eligible for the program because of the economic downturn and the reduction in employer sponsored insurance. At the same time, health care costs were rising--in fact Medicaid spending across the country grew faster than all other state programs. These and other factors forced states to address Medicaid reform. This menu page provides updates about recent Medicaid waivers and some Medicaid state plan amendments.

Employers Disclosure (2006 Archive) Increasing concerns surrounding the Medicaid budget have caused policymakers to take on the role of "sleuth." State lawmakers are interested in determining if Medicaid beneficiaries have the option of employer-sponsored health insurance. If Medicaid beneficiaries do not have this option, policymakers want to know which employers are not offering health insurance. This menu pages contains information about state actions that require Medicaid departments to collect and report data about the beneficiaries of public assistance programs.

HIFA The U.S. Department of Health and Human Services invited states to participate in the Health Insurance Flexibility and Accountability demonstration initiative beginning August 4, 2001. The purpose of the initiative is to expand health insurance coverage to the uninsured within currently available Medicaid and State Children's Health Insurance Program (SCHIP) resources.

Federal Medicaid Issues

Resources and Guidance for Provisions in the Deficit Reduction Act Of 2005 The federal Medicaid menu page contains a summary of and links to information about the Deficit Reduction Act Of 2005 and its health provisions, including information on the following topics: Medicaid prescription drug reforms; long-term care reforms and transfer of assets; long-term care reforms with home and community-based care; eliminating fraud, waste and abuse; flexibility in cost-sharing and benefits; state financing; family opportunity act provisions; State Children's Health Insurance; hurricane Katrina assistance; state high-risk pool funding; low income home energy assistance program; and Medicare.

CMS Guidance Regarding Citizenship Documentation Requirements for Medicaid Applicants The DRA imposed new requirements on states in verifying citizenship or nationality of Medicaid recipients. Effective July 1, 2006, this prohibits states from receiving federal reimbursement for medical assistance provided under the Medicaid program to any individual who has not provided satisfactory documentary evidence of his or her citizenship or nationality. The documentation requirements do not apply to an immigrant who is (1) eligible for Medicaid and is entitled to or enrolled for Medicare benefits, (2) eligible for Medicaid on the basis of receiving Supplemental Security Income benefits, or (3) eligible for Medicaid as specified by the secretary under which satisfactory documentary evidence of citizenship or nationality had been previously presented.

Prescription Drugs
Relentless increases in public spending for medications (averaging almost 15% annually since 2000) led states to a widespread focus on policy changes, including varied cost containment plans in all 50 states. The federal Medicare benefit, launched in January 2006, mandated a major shift of elders and residents with disabilities away from Medicaid and into Medicare. But states now pay for both Medicaid and Medicare drug coverage. They remain active players in balancing access and cost effectiveness. NCSL has more than a dozen reports and presentation detailing current trends.

Medicaid Prescription Drug Laws & Strategies States are considering or have enacted a variety of changes in their Medicaid programs to respond to the challenges arising from increased demand for and higher costs of prescription drugs. Recent state legislation related to Medicaid prescription drugs generally is designed around new or expanded applications of management tools already available to states through federal law. Among the strategies receiving legislative attention are use of: preferred drug lists (PDL) or formularies, generic substitution, cost-sharing or co-payments, multi-state purchasing, pharmacy benefit managers (PBMs), prior authorization, drug utilization review (DUR), dispensing fees, ingredient fees, and supplemental rebates from manufacturers. This prescription drug menu page contains information about these strategies. Updated 2009.

Pharmaceuticals: Overview and NCSL Resources

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