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THE MEDICAID PROGRAM AT A GLANCE
Medicaid is the nation's major public health insurance program for
low-income Americans, financing health and long-term care
services for over 55 million people, including children and many of
the sickest and poorest in our nation.
In general, private health
insurance is not an option for many Medicaid enrollees; low-income
workers often do not have access to coverage through their
employers, or cannot afford it even if it is offered, and private
insurers often exclude individuals with disabilities and chronic
In the absence of the Medicaid program, the vast
majority of its beneficiaries would join the ranks of the 46 million
Since its enactment in 1965, Medicaid has improved access to
health care for low-income individuals, financed innovations in
health care delivery, and functioned as the nation’s primary source
of long-term care financing.
Medicaid plays a major role in the U.S.
health care system, accounting for 1 of every 6 dollars spent on
personal health care and more than 40% of all spending on nursing
home care (Figure 1).
SOURCE: Smith, et al, 2006.
Based on National Health Care Expenditure Data, CMS, Office of the Actuary.
Medicaid as a share of national
personal health care spending:
Medicaid’s Role in the Health System, 2004
The federal and state governments jointly finance Medicaid, and
the states administer it within broad federal guidelines.
federal contribution to Medicaid spending ranges from 50% to
76%, depending on state per capita income.
Overall, the federal
government financed 57% of all Medicaid spending.
Who Is Covered by Medicaid?
To qualify for Medicaid, an individual must meet financial criteria
and also belong to one of the groups that are “categorically eligible”
for the program, including children, parents of dependent children,
pregnant women, people with disabilities, and the elderly.
law guarantees Medicaid eligibility for individuals within these
groups who fall below specified income levels.
At the same time,
states have broad optional authority to extend Medicaid eligibility
beyond these minimum standards. States have expanded Medicaid