All states offer some form of health insurance for low-income populations. Medicaid is a jointly state and federally funded health insurance program for low-income individuals and families. However, individual states determine Medicaid eligibility criteria and coverage (working within federal guidelines), so eligibility and benefits, including copays, approved procedures and prescriptions, vary greatly from state to state.
Overview of Medicaid (and Medicare)
Medicaid is a means-tested social welfare program providing health insurance for low-income people. Eligibility requirements and benefits vary by state, and all states have tightened requirements and reduced benefits in recent years. Furthermore, in 2008 a law was passed enabling states to charge larger copays to Medicaid recipients, and this is being phased in through 2012 (several states, including California and New York, have already announced upcoming Medicaid copay increases). Medicare is a fully federally funded program that provides health insurance for those over age 65 or disabled individuals. Medicare is not income-dependent, so some people are eligible for both Medicaid and Medicare (Medicare dual eligibles).
General Eligibility Requirements and Benefits for Medicaid
Eligibility for Medicaid includes a low income and fitting into one of the following categories: pregnant women, children and teenagers, aged/blind/disabled or a family in certain transitional situations. Note that in general, able-bodied men and women are not eligible for Medicaid despite a low income. Benefits vary dramatically from state to state, but federal guidelines assure that Medicaid patients receive customary medical care for their conditions. CHIP (Children's Health Insurance Program) is a federally administered but state-run adjunct health and dental insurance program that is available for all low-income children.
States With Most Generous Medicaid Benefits
The ten states that provided the most Medicaid benefits per enrollee in 2005 were: District of Columbia, $7,941; New York, $7,733; Alaska, $7,699; Maine, $7,691; North Dakota, $7,496; Rhode Island, $7,464; Connecticut, $7,212; New Jersey, $7,022; Minnesota, $6,974; and Massachusetts, $6,837.
Public Citizen's Ranking of State Medicaid Programs, 2007
The nonprofit organization Public Citizen produced a report in 2007 that ranked the Medicaid programs of all 50 states on eligibility, scope of services, quality of care and reimbursement. Massachusetts, Nebraska, Vermont, Alaska, Wisconsin were the top five, and Mississippi, Idaho, Texas, Oklahoma, South Dakota were the bottom five.
References
- Centers for Medicare & Medicaid Services: Medicaid
- Centers for Medicare & Medicaid Services: CHIP
- EMax Health: Best & Worst States in Providing Medicaid Funds
- Public Citizen: Unsettling Scores: A Ranking of State Medicaid Programs, 2007
- U.S. Centers for Medicare & Medicaid Services. "Financial Management." Accessed Aug. 27, 2020.
- U.S. Centers for Medicare & Medicaid Services. "Medicaid - Eligibility." Accessed Aug. 27, 2020.
- U.S. Centers for Medicare & Medicaid Services. "Medicaid." Accessed Aug. 27, 2020.
- U.S. Centers for Medicare & Medicaid Services. "NHE Fact Sheet." Accessed Aug. 27, 2020.
- U.S. Centers for Medicare & Medicaid Services. "Federal Poverty Level (FPL)." Accessed Aug. 27, 2020.
- Lyndon B. Johnson Presidential Library. "Medicare and Medicaid." Accessed Aug. 27, 2020.
- Kaiser Family Foundation. "Federal and State Share of Medicaid Spending." Accessed Aug. 27, 2020.
- Congressional Research Service. "Medicaid’s Federal Medical Assistance Percentage (FMAP)," pages 2, 16 and 17. Accessed Aug. 27, 2020,
- U.S. Centers for Medicare & Medicaid Services. "How Much Do States Spend Per Medicaid Enrollee?" Accessed Aug. 27, 2020.
- Kaiser Family Foundation. "Medicaid Enrollees by Enrollment Group." Accessed Aug. 27, 2020.
- Kaiser Family Foundation. "Medicaid Spending by Enrollment Group." Accessed Aug. 27, 2020.
- U.S. Centers for Medicare & Medicaid Services. "Medicaid, Children's Health Insurance Program, & Basic Health Program Eligibility Levels." Accessed Aug. 27, 2020.
- U.S. Centers for Medicare & Medicaid Services. "What to include as income." Accessed Aug. 27, 2020.
- U.S. Centers for Medicare & Medicaid Services. "RE: Opportunities to Promote Work and Community Engagement Among Medicaid Beneficiaries," pages 1-10. Accessed Aug. 27, 2020.
- U.S. District Court of Appeals in the District of Columbia. "Charles Gresham v. Alex Azar, II, 19-5094 (D.C. Cir. 2020)," pages 16-19. Accessed Aug. 27, 2020.
- U.S. Centers for Medicare & Medicaid Services. "Read the Affordable Care Act." Accessed Aug. 27, 2020.
- U.S. Supreme Court. "National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012)," pages 522-524 and 575-588. Accessed Aug. 27, 2020.
- Kaiser Family Foundation. "The Uninsured and the ACA: A Primer," page 7. Accessed Aug. 27, 2020.
Writer Bio
Clayton Browne has been writing professionally since 1994. He has written and edited everything from science fiction to semiconductor patents to dissertations in linguistics, having worked for Holt, Rinehart & Winston, Steck-Vaughn and The Psychological Corp. Browne has a Master of Science in linguistic anthropology from the University of Wisconsin-Milwaukee.