Medicaid: Health Coverage, Mental Health Services, and Long-Term Care for Low-Income Americans

Recent Medicaid News:

Fri, March 7, 2025:
Republican voters support Medicaid but want work requirements, poll finds: More than 60 percent of all voters — and 47 percent of Democrats — supported a work requirement for Medicaid, the country’s largest health insurance program. – NYT
Large majorities don’t want cuts to Medicaid funding, including Trump voters and rural residents – KFF

Wed, March 5, 2025:
CBO letter to Ranking Members of the House Budget and Energy & Commerce Committees examining the mandatory spending base of the Energy & Commerce Committee, from which the House Budget Resolution seeks to cut $880 billion over 10 years. According to CBO, in response to the questions posed to them, if Medicare is excluded, 93% of the remaining mandatory spending under Energy & Commerce jurisdiction is spending on Medicaid. In addition, CBO found that the Committee’s outlays, from which budget cuts could be achieved–if Medicare, Medicaid, and Children’s Health Insurance are excluded—amount to only $135 billion over 10 years–not remotely close to the $880 billion in cuts assigned to the Committee by the Budget Resolution. Consequently, as a mathematical fact, the $880 billion in cuts assigned to the Committee could not be achieved without cutting Medicaid–or some combination of Medicaid, Medicare, and Children’s health insurance.

Sun, March 2, 2025:
As GOP eyes Medicaid cuts, Trump tries to avoid the political third rail – WP

Thurs, Feb 27, 2025:
Medicaid work rules have increased coverage loss, not employment – Roll Call

Wed, Feb 26, 2025:
Switching Medicaid to per capita cap financing could cause as many as 15 million people to lose Medicaid coverage – KFF
The House Republican budget leaves states holding the bag on Medicaid; states would face ugly choices–dropping people, slashing benefits, or cutting other spending – WP/Tumulty
Senators grapple with potential Medicaid cuts in budget blueprint – AP

Tues, Feb 25, 2025:
As GOP eyes Medicaid cuts, states could be left with vast shortfalls – NYTimes

Mon, Feb 24, 2025:
Republicans’ plans for Medicaid have a political problem: GOP lawmakers expected to vote soon on slashing the insurance program for low-income people represent tens of millions reliant on it. – Politico

Thurs, Feb 20, 2025:
Can Medicaid’s popularity shield it from the budget ax? – KFF health news

Tues, Feb 18, 2025:
Republicans consider cuts and work requirements for Medicaid, jeopardizing care for millions – AP

Fri, Feb 14, 2025:
As States Mull Medicaid Work Requirements, Two With Experience–GA & AR–Scale Back – KFF

Thurs, Feb 13, 2025:
Eliminating the ACA Medicaid expansion match could reduce total Medicaid spending up to $1.9 trillion over 10 years and end coverage for 20 million people. – KFF
Eliminating the Medicaid Expansion Federal Match Rate: State-by-State Estimates – KFF

Mon, Feb 10, 2025:
GOP fight over scope of Medicaid cuts stalls Trump budget bill in House – CNN

Fri, Feb 7, 2025:
Medicaid and work: analysis finds that 92% of Medicaid adults in 2023 were working full- or part-time, or were not working due to caregiving responsibilities, illness or disability, or school attendance — reasons that counted as qualifying exemptions from work requirements – KFF

Wed, Feb 5, 2025:
DOGE targets Centers for Medicare and Medicaid (CMS) for what they consider “waste” – Bloomberg

Tues, Jan 28, 2025: Confusion reigns for states trying to secure Medicaid dollars – WashPost
“At least 20 states were unable to draw funds from an HHS payment system hours after the White House ordered a pause on the disbursement of grants and loans.”

Tues, Jan 21, 2025: Advocates move to protect Medicaid ahead of looming changes – WashPost

Wed, Jan 15, 2025: Affordable Care Act marketplace and Medicaid expansion enrollment reached a combined 44 million in 2024 – KFF

Fri, Dec 6, 2024:
With or without ACA repeal, ACA and Medicaid cuts are looming – KFF

Wed, Dec 4, 2024: 3.7 million adults in nine states (Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah, and Virginia) would be at immediate risk of losing their health coverage if Republicans cut the extra federal Medicaid funding that’s enabled those states to widen eligibility – KFF

Thurs, Nov 21, 2024: Medicaid cuts in crosshairs as Trump, GOP take control – The Hill

Fri, Nov 15, 2024: What Trump’s victory means for Medicaid – KFF

Fri, Sept 20, 2024: “As Medicaid Unwinding Concludes, 25 Million Lost Medicaid Coverage But Enrollment is 10 Million Higher Than Pre-Pandemic Levels” –KFF

Tues, Apr. 16, 2024:
NPR: Why Homeless People Are Losing Health Coverage in Medicaid Mix-Ups.

Fri, Apr. 12, 2024: KFF reports that “nearly a quarter of people who say they were disenrolled from Medicaid during the “unwinding” (post-Covid) are now uninsured.”

Fri, May 26, 2023: NYTimes: Hundreds of Thousands Have Lost Medicaid Coverage Since Pandemic Protections Expired

Medicaid Overview

Medicaid is a joint federal-state program that pays for primary and acute health care services, and long-term care for 85 million low-income Americans (near or below the Federal poverty level).
Unlike Medicare, in Medicaid premiums are generally prohibited, although states can impose nominal copayments, coinsurance, or deductibles. For most enrollees, cost sharing is limited to 5% of income.
Jointly financed and state administered: While the Federal government pays more than half the cost of Medicaid services, the program itself is administered by the States—subject to minimum Federal requirements on basic benefits that must be provided and populations that must be covered.
Medicaid is voluntary for all states and all states have opted to participate. By opting in, States agree to to cover certain mandatory populations and services; however, federal Medicaid waivers grant states flexibility to design their own programs.
Medicaid is an open-ended entitlement to states which receive reimbursements for costs ranging from from 50% (for high per capita income states) to 78% (low per capita income). The federal contribution is called the “federal medical assistance percentage (FMAP).
Prior to enactment of the Affordable Care Act (ACA), Medicaid was generally limited to low-income families with children, pregnant women, seniors, and people with mental or physical disabilities.
The Affordable Care Act (P.L. 111-148) gave states the option to expand Medicaid eligibility to all low-income adults with incomes up to 133% of the FPL, with the federal government paying nearly the entire cost of the expansion.
Benefits:For traditional Medicaid benefits, states are required to cover a wide array of services including inpatient hospital, physician, and nursing facility care. States may cover additional services, such as prescription drugs and physical therapy. There is an Alternative Benefit Plan with more flexibility for enrollees in the Medicaid expansion.
Delivery of care: Medicaid enrollees generally receive benefits through managed care or fee-for-service (FFS). Under FFS, health care providers are paid by the state Medicaid program for each service. Under managed care, Medicaid enrollees get some or all of their services through an organization under contract with the state. Most Medicaid enrollees are now covered by some form of managed care.
Required Medicaid services include inpatient and outpatient hospital services, services provided by physicians and laboratories, and nursing home and home health care.
Expenditures: Highest portion of expenditures are for low-income disabled (34%), followed by low-income adults (28%), low-income seniors (22%), and low-income children (16%).
Medicaid provider payment rates are set by states within federal rules, but some states make supplemental payments. An ongoing challenge is low provider participation due to low payment rates.

Nonpartisan Reports on Medicaid

Medicare v. Medicaid

Medicare is an entitlement based on age (65 or older) or disability without regard to income; Medicaid is a means-tested entitlement where eligibility is based on being at or near the Federal poverty level.
Medicare is a health insurance program similar to private sector health insurance, with specified coverage, premiums, and beneficiary cost-sharing; Medicaid is a health coverage program where States pay healthcare providers for services to beneficiaries, usually without any cost-sharing.
Medicaid assists millions of low-income Medicare enrollees (called “dual eligibles”) by paying Medicare premiums, deductibles and coinsurance.
Medicare is funded by federal payroll (HI) taxes, general tax revenues, and premiums; Medicaid is funded jointly by the federal and state governments.
Medicare is national health insurance administered by the federal Centers for Medicare and Medicaid Services (CMS), while Medicaid is administered by the States.