To be eligible for Medicaid, an individual must be within one of the following three groups:
Historically, Medicaid eligibility for this group was tied to eligibility for cash welfare grants under the Aid to Families with Dependent Children program. However, the changes included in the welfare reform that was enacted in 1996 broke this link. Currently, all children in families with incomes that fall below the federal poverty level are eligible to receive Medicaid coverage. In addition, children under the age of 6 who are in families that earn up to 133 percent of the poverty level are eligible for Medicaid. The unemployed parents of low-income children are eligible only if the family income is extremely low, typically 40–50 percent of the poverty level.However, pregnant women in families that earn up to 133 percent of the poverty level are eligible for Medicaid coverage for medical care during pregnancy and immediately after birth. In 2001, Medicaid covered 23.4 million low-income children and 11.5 million low-income adults.
People over 65 whose income is below a level established by the federal government (typically about 75% of the poverty level) qualify for supplemental cash payments under the Supplemental Security Income (SSI) program. People eligible for SSI are also eligible for Medicaid. Some elderly people have income that is higher than the allowable Medicaid limit but they face larger medical expenses than they can pay. Before these people become eligible for Medicaid, they must first use most of their personal savings to pay for their medical care. After they "spend down" their savings to a certain level (usually a few thousand dollars), they then become eligible for Medicaid.Most people eligible for Medicaid in this manner are confined to a nursing home. In 2001, approximately 5.1 million elderly people were enrolled in Medicaid. Medicare provides little in the way of coverage for nursing home care. Nonetheless, a growing number of elderly people are facing the prospect of nursing home care without the means to pay for it. They turn to the Medicaid program as the payer of last resort to pay for their care.
People under the age of 65 with long-term disabilities qualify for Medicaid in the same manner as elderly people.Nonelderly, disabled people who receive cash payments from SSI are also eligible for Medicaid. In addition, disabled people not covered by SSI but incurring large medical expenses are eligible for Medicaid after they meet the "spend down" requirements. In 2001, Medicaid covered approximately 7 million individuals with disabilities. As with elderly people, many of these individuals are confined to hospitals, nursing homes, or other institutional care facilities on a long-term basis. All Medicaid beneficiaries must meet certain other general requirements, including in most cases being a U.S. citizen. Certain legal immigrants are eligible, depending on their date of entry into the country. Those immigrants who enter the country illegally are ineligible for Medicaid, except for emergency care. In certain cases, a woman who has entered the country illegally will have a baby at a hospital in the United States. The baby will automatically be a U.S. citizen and thus will be eligible for Medicaid (assuming the family meets the income requirements), while the mother will remain ineligible. For a state to qualify for federal reimbursement, all members of these three groups within the state must be eligible for Medicaid. In addition, states have the option of covering other groups and receiving federal reimbursement. The additional groups include
Finally, each state has the option of covering individuals who are not in one of the above groups but whose income falls below a level set by the state. These people are the "medically needy," and most of them are low-income single adults or families without children. Because each state establishes its own cutoff level for eligibility, and because general economic conditions vary substantially from state to state, there is a wide range of eligibility levels among the states. Few states cover all poor people.Most states have established income eligibility levels that are a fraction of the federal poverty level, often as low as 30–40 percent.
In 2001, Medicaid spent an average of $4,011 per beneficiary. Because the states administer the program and can offer a wide range of options in eligibility and coverage, the average level of Medicaid spending per eligible beneficiary varies widely among states. In 2001, spending per beneficiary ranged from $2,325 in California and $2,545 in Tennessee to $6,670 in Connecticut and $7,817 in New York.
Poor people who are eligible for care in one state will often be ineligible in another. Treatments covered in one state may not be covered in another. The wide latitude left to states in creating their Medicaid programs and the resulting wide range of eligibility and coverage among the states has created a system of medical care for poor people that is distinctly different from our system of care for elderly people.Medicare is essentially government-sponsored, taxpayer-supported, universal care for elderly people. Medicaid is a program intended to cover certain segments of the low-income population while leaving other segments without the means to pay for medical care.
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