A simplified explanation of Medicaid
Some questions we all ask about Medicaid and the program’s expansion under the federal health care reform law Find answers to the following questions below.
- HOW DID EXPANSION UNDER THE AFFORDABLE CARE ACT CHANGE MEDICAID?
- HOW IS MEDICAID FUNDED, AND DO ANY OF THE RECIPIENTS PAY ANYTHING IN TERMS OF PREMIUMS OR COPAYS?
- DO RELATIVELY LOW REIMBURSEMENTS TO DOCTORS AFFECT ACCESS TO CARE FOR MEDICAID RECIPIENTS?
WHAT IS MEDICAID AND HOW LONG HAS IT BEEN AROUND?
Medicaid is a federal-state healthcare program for low-income and disabled people, including nursing home residents.
HOW DID EXPANSION UNDER THE AFFORDABLE CARE ACT CHANGE MEDICAID?
A key component of the federal health care reform passed in 2010 was an expansion of existing Medicaid to include all non-disabled adults under the age of 65 with incomes at or below 138 percent of the federal poverty level, which is currently $16,243 for an individual. After the U.S. Supreme Court ruled that states could not be compelled to expand Medicaid, a number of states did not.
HOW IS MEDICAID FUNDED, AND DO ANY OF THE RECIPIENTS PAY ANYTHING IN TERMS OF PREMIUMS OR COPAYS?
States are allowed to charge premiums and modest copayments for some groups of Medicaid recipients, but that is fairly limited.
DO RELATIVELY LOW REIMBURSEMENTS TO DOCTORS AFFECT ACCESS TO CARE FOR MEDICAID RECIPIENTS?
Some private-practice doctors do not accept Medicaid. Many Medicaid recipients are in private, managed-care plans designed specifically to serve them – just like DentalSave. Hospitals — particularly children’s hospitals — rely on Medicaid for a substantial portion of their budgets.
WHAT CHANGES TO THE PROGRAM ARE IN THE WORKS AT THE STATE OR FEDERAL LEVEL?
At the moment, states are the main drivers of changes to Medicaid. It is a constant process, and the higher-than-anticipated enrollments and costs under the expansion could prompt some expansion states to consider changes.
