Medicaid
Meaning of Medicaid: Fifty separate programs under one name, which is why Medicaid enrollment alone says little about what a given person is covered for.
Definition of Medicaid
Medicaid is a public health insurance program in the United States for people with low income or limited resources. Federal and state governments share the cost, and each state runs its own program inside federal rules, so who qualifies and what is covered differ from state to state. Some enrollees pay a small share of certain costs.
Who does it cover?
The program reaches well beyond low-income working-age adults. Children make up the largest group of enrollees, covered through Medicaid itself or through the closely linked Children's Health Insurance Program. Pregnancy is a separate route to eligibility, as are certain disabilities and blindness. Older adults enter through low income, and many of them are also enrolled in Medicare, a combination described as dual eligibility, in which Medicaid covers premiums, cost sharing and services the other program omits. Medicaid is the largest single payer for long-term care in nursing homes, which is a role most people do not associate with it, and it also funds a substantial share of births.
How is it different from Medicare?
| Medicaid | Medicare | |
|---|---|---|
| Who qualifies | Income and resources, plus a qualifying category | Age, long-term disability or specific conditions |
| Who funds it | Federal and state governments jointly | Federal government |
| Who runs it | Each state, within federal rules | Federal, uniform across states |
| Long-term care | Covers nursing home care for those who qualify | Only limited skilled nursing after a hospital stay |
| Cost to the enrollee | Little or nothing, with small charges in some states | Premiums, deductibles and coinsurance |
What varies between states?
Federal rules set a floor of mandatory benefits, including inpatient and outpatient hospital care, laboratory and imaging services, primary care and screening for children. Above that floor states choose. Adult dental care, vision, hearing aids, physical therapy and prescription drug arrangements are optional benefits that some states cover generously and others barely at all. Income thresholds differ, as does whether a state has taken up the expansion that extends eligibility to more low-income adults. States also brand their programs separately, so the same coverage appears as Medi-Cal, MassHealth or TennCare depending on where a person lives. That variation is why a clinician cannot infer from the word Medicaid alone what a given patient is covered for.
Used in a sentence
The clinic verified the patient's Medicaid coverage before scheduling the outpatient procedure.
Good to know
Medicaid eligibility and covered benefits vary by state, so a person's specific coverage cannot be assumed from Medicaid enrollment alone without knowing the rules of the state administering the program.