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Medicaid fact sheet

Medicaid fact sheet - k aios e ri s s i o n c mm M E D I C...

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a n d t h e uninsured kaiser commission o n M E D I C A I D F A C T S 1 3 3 0 G S T R E E T , N W , W A S H I N G T O N , D C 2 0 0 0 5 P H O N E : ( 2 0 2 ) 3 4 7 - 5 2 7 0 , F A X : ( 2 0 2 ) 3 4 7 - 5 2 7 4 W W W . K F F . O R G / K C M U medicaid May 2006 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 illnesses. In the absence of the Medicaid program, the vast majority of its beneficiaries would join the ranks of the 46 million uninsured Americans. 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). Figure 1 17% 17% 44% 19% 12% Total Personal Health Care Hospital Care Professional Services Nursing Home Care Prescription Drugs SOURCE: Smith, et al, 2006. Based on National Health Care Expenditure Data, CMS, Office of the Actuary. Total National Spending (billions) $1,560 $571 $587 $115 $189 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. The 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. Federal 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
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