Medicaid

Medicaid is a joint federal and state health insurance program for low-income eligible children, adults, the elderly, and people with disabilities. This federal entitlement program was established in 1965 as Title XIX of the Social Security Act. The nation's largest publicly financed health care program of its kind, it funds nearly half of nursing home care and a significant percentage of prescription coverage in the United States. Federal regulations provide broad coverage guidelines, but the states determine specific services. The program's broad range of medical services include inpatient and outpatient care; rehabilitation services for people with mental and physical disabilities; primary care to women, families, elders, and children; prescription benefits; and long-term care for the aged. Title XIX is administered federally by the Centers for [Page 565]Medicare and Medicaid Services (CMS) but operated by individual state systems.

Each state establishes distinct eligibility standards, defines what type and length of medical care will be available, and also sets its own reimbursements rates to providers. As such, Medicaid eligibility does not cross state lines; anyone who moves from one state to another must seek eligibility anew. The insurance application process is a lengthy one, requiring documentation of citizenship, living situation, and financial assets.

More than 55 million individuals receive care under the Medicaid program, and at least 40 percent of Medicaid expenses are for long-term care in nursing homes. The governmental cost of caring for elders in long-term care is a major social issue because of the rapidly increasing numbers of the population who are aging and concerns about who will pay for their care.