Medicaid is a health insurance program for low-income people jointly funded and regulated by states and the federal government. Medicaid provides health insurance for millions of low-income Americans, including adults, children, pregnant women, older adults and people with disabilities. In recent years, over 20% of the United States population had Medicaid or Children’s Health Insurance Program (CHIP) coverage, and Medicaid is consistently one of the largest spending categories for states.
While Congress provides substantial funding and establishes requirements for Medicaid, each state manages and administers its own Medicaid program through a state Medicaid agency. Federal program requirements are set forth in Title XIX of the Social Security Act, and regulations and guidance are issued by the Centers for Medicare & Medicaid Services.
States must meet federal requirements to receive matching funds and have significant flexibility to decide who is eligible for services, what services are offered and how those services are paid through state plan design, waiver programs and programs funded solely with state dollars. States legislatures help fund, regulate, oversee and innovate the Medicaid programs.
Medicaid should not be confused with Medicare, a program financed and administered solely by the federal government, providing health insurance coverage to people over 65 years old and people who have certain permanent disabilities. While Medicare covers some types of inpatient, outpatient and prescription drug care for older adults, it does not pay for long-term care such as nursing homes, assisted living or care provided in community settings. This makes Medicaid the only public program that covers long-term care services. Some people are dually eligible for Medicare and Medicaid.
The Medicaid program is also distinct from CHIP, although the two often work in concert to provide health insurance coverage to children in families with low incomes. CHIP covers uninsured children under 19 years old with family incomes too high to qualify for Medicaid. Like Medicaid, CHIP is administered by states according to federal requirements, and each program is funded and regulated jointly by states and the federal government.
| |
Who is covered? |
Who pays? |
Who regulates? |
Pays for long-term care? |
| Medicaid |
Eligibility by income and population:
Children, pregnant women, parents, older adults, people with disabilities, childless adults. |
State and federal governments |
Yes |
| Children's Health Insurance Program (CHIP) |
Eligibility by income and population:
Uninsured children up to age 19 in families with incomes too high to qualify for Medicaid, some pregnant women.
|
State and federal governments |
No |
| Medicare |
Eligibility by age or disability:
Adults ages 65 and older, people with certain permanent disabilities. |
Federal government only |
No |
Since the Medicaid program was created in 1965, it has grown in size, scope and complexity to become one of the primary sources of health coverage in the United States. The NCSL Medicaid toolkit covers fundamental components of the program (eligibility, benefits, costs and financing, etc.) and details trending policy topics so lawmakers can make informed decisions.