Medicaid is a joint federal and state program in the United States that provides health coverage to eligible low-income individuals and families. Established in 1965 as part of the Social Security Amendments, Medicaid operates alongside Medicare, focusing primarily on populations such as children, pregnant women, elderly adults, and individuals with disabilities who meet specific income requirements. The federal government sets basic standards for Medicaid, but each state administers its own program with varying eligibility criteria, benefits, and delivery systems.

Eligibility and Coverage

Eligibility for Medicaid is determined by several factors including income, household size, disability status, and other circumstances. The Patient Protection and Affordable Care Act (ACA) of 2010 expanded Medicaid eligibility in participating states to cover nearly all low-income adults up to 138% of the federal poverty level. States that opted out of expansion maintain stricter eligibility criteria.

Medicaid covers a broad array of health services, including hospital care, physician visits, long-term care, preventive services, prescription drugs, and certain home and community-based services. State flexibility allows for variation in the scope of coverage, although all states must cover mandatory benefits set by federal law.

Funding and Administration

Medicaid funding is shared between the federal government and individual states using a matching formula based on states' per capita income. The federal share—known as the Federal Medical Assistance Percentage (FMAP)—ranges from 50% to over 75% for lower-income states. States administer their own Medicaid programs, set payment rates, and can apply for waivers to innovate or restrict coverage within federal guidelines.

Importance and Impact

Medicaid is the largest source of health insurance in the United States, insuring more than 80 million Americans as of 2023. It plays a crucial role in funding long-term care, particularly for the elderly and people with disabilities, and supports hospitals, clinics, and other healthcare providers serving low-income populations.

Recent Policy Debates

Medicaid has been central in U.S. policy debates, especially regarding state and federal spending, healthcare access, and social safety-net reform. Proposals have included implementing work requirements, block-granting funds, and changing eligibility or benefit levels. Supporters argue Medicaid is vital for vulnerable groups, while critics express concerns about sustainability, program integrity, and federal spending.

Legal and Political Context

Decisions about Medicaid expansion, eligibility adjustments, and benefit reductions often become focal points of state and federal legislative action. Changes to the program are closely tracked by policymakers, advocacy groups, and analysts, given the potential impact on millions of Americans' healthcare coverage and the broader state and federal budgets.