Medicaid—a federal/state partnership with shared authority and financing—is a health insurance program for low-income individuals, children, their parents, the elderly and people with disabilities. Although participation is optional, all 50 states participate in the Medicaid program with significant variation across states in spending, eligibility, covered services and other program features. Once certain minimum federal standards are met, each state determines how its program is administered, who to cover, what services to cover, and how providers are paid.
Over its 50-year history, Medicaid has represented a critical and evolving issue for state policymakers. Approximately one in five Americans received coverage through Medicaid in 2015, making it the largest source of coverage for low-income children, adults and people with disabilities. In 2016, Medicaid accounted for 21.5 percent of expenditures from state general funds. Across the nation, state spending on Medicaid totaled $509 billion in 2015, of which 62 percent was financed by the federal government and 38 percent by states.
Medicaid in the States:
The Affordable Care Act (ACA) expanded both eligibility for, and federal funding of Medicaid and gave states the option of expanding Medicaid eligibility for all low-income adults with incomes up to 133 percent of federal poverty guidelines. Given this choice, many states have been weighing the costs and savings associated with expanding Medicaid. As of May 2017, 32 states and the District of Columbia had expanded Medicaid, most recently Virginia. Maine expanded Medicaid by citizen's ballot initiative, but it has not been implemented to date, and several states negotiated variations on expansion by waivers or state plan amendments.
States also have adopted various strategies to improve the value and outcomes of their Medicaid programs. To improve quality, states have aligned incentives with their desired outcomes and experimented with new payment models, such as attaching provider payments to patients’ health outcomes. They have also adopted new delivery systems by creating medical homes and streamlining services for those eligible for both Medicaid and Medicare.
Recent developments: As of June, 2018 CMS had approved four states for work requirements: AR, KY, IN and NH. This included a community engagement requirement for certain adult beneficiaries ages 19 to 64. Additional information on Section 1115 waivers is available here.
Additional NCSL Medicaid Resources
- 10 State Strategies for Improving Medicaid, 2018
- Understanding Medicaid Section 1115 Waivers: A Primer for State Legislators, 2017
- Actions Toward Health System Change, 2017
- Medicaid: A Changing Federal/State Partnership, 2017 blog
- Medicaid and the Safety Net, 2013
- Health Care Dollars from Data, 2016 magazine article
- Health Innovations State Law Database, 2017
- States Affected by the Medicaid Managed Care Rule, 2016 postcard
- The State of Health Insurance, 2017 webinar
- Tracking State Innovations in Medicaid, 2017 blog
Other Recent Medicaid Resources
- Building Blocks: Block Grants, Per Capita Caps, and Medicaid Reform, Milliman, January 2017
- Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies, Kaiser Family Foundation, January 2017
- Medicaid and CHIP: Strengthening Coverage, Improving Health, CMS, January 2017
- Medicaid and CHIP Enrollment Data Highlights, CMS, 2016
- Medicaid Enrollment and Spending Growth: FY 2016 and 2017, Kaiser Commission on Medicaid and the Uninsured, October 2016
- Medicaid: Key Issues Facing the Program, GAO, 2015
- State Medicaid Operations Survey, National Association of Medicaid Directors, 2017