Medicaid

Overview of Benefits

Medicaid is administered by the states and territories of the United States. Each of the state Medicaid programs is financed jointly by the state and the federal government through a system of matching rate expenditures, as well as an allocation of federal funds to certain hospitals that treat a large number of Medicaid patients. Although the funding of the program is partly federal, the states have some control over how their particular program is structured and which health care services are covered by the program. Under the statute of Title XIX, each state has the ability to structure a Medicaid benefits package and payment system that fits their particular population needs.

While states are charged with designing and implementing their particular Medicaid program, all states must cover certain basic services. These core services include inpatient and outpatient care, visits to a physician, laboratory and imaging services, home health services, skilled nursing services, family planning, and general checkup and treatment services for children. Medicaid will also cover services provided in a nursing home or long-term care facility for those persons who have exhausted most of their financial assets. In addition to these services, states have the option to cover other services under Medicaid. These optional services include hospice care, other home and community-based services, dental care, physical and occupational therapy, rehabilitative services, coverage for eyeglasses, and prescription drug coverage. It is at the discretion of the state whether to include these optional services as part of the standard Medicaid benefits package.

Eligibility and Enrollment

Beneficiaries of the program include the categorically needy (families with children or certain groups of adults who meet specific income criteria), the medically needy (those who are blind and/or disabled), certain Medicare beneficiaries, the elderly, and persons who have very high medical bills. In recent years, federal legislation has expanded the traditional eligibility criteria to include additional groups that may receive Medicaid benefits.

Two pieces of legislation, in particular, give states the option of providing coverage to certain young adults; these eligible youth include those who are either in the foster care system or who are able to demonstrate financial independence. The Foster Care Independence Act of 1999 allows the state the ability to cover those individuals below the age of 21 who were in foster care on their 18th birthday. The other piece of legislation, the Benefits and Improvement Act of 2000, enables states to expand their eligibility criteria to include children below the age of 19 who qualify as Medicaid eligible based on information given to a school, homeless shelter, tribal program, or other qualified organization.

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