Medicaid is a health insurance program for low-income people jointly funded and regulated by states, territories and the federal government.
Nationally, the Medicaid program:
- Funds one quarter of all mental health and substance use treatment
While Congress provides substantial funding and establishes federal program requirements for Medicaid, each state and territory manages and administers its own Medicaid program through a state or territorial Medicaid agency. Federal program requirements are set forthestablished by Congress in Title XIX of the Social Security Act; and regulations and guidance are issued by the Centers for Medicare and Medicaid Services (CMS).
States are obligated to meet federal requirements to receive federal matching funds and but 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 in the Medicaid program.
Not to be confused, the Medicare program is financed and administered solely by the federal government and provides 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, Medicare does not pay for long-term care like 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 both Medicare and Medicaid.
The Medicaid program is also distinct from the Children’s Health Insurance Program (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, states and territories administer the CHIP program according to federal requirements, and each program is funded and regulated jointly by states, territories 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 provides state and territorial lawmakers with information about program fundamentals components of the program – like eligibility, benefits, costs and financing, and more – as well as in-depth information on current trending topics in Medicaid policy so lawmakers can make informed decisions.