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Medicaid Coverage Explained

Who does Medicaid cover?

Medicaid is a joint federal-state program that provides health care coverage for low-income people — primarily children, pregnant women, parents, the disabled and the elderly. About 60 million people receive Medicaid benefits at some point during the year. Children account for about half of those enrolled, and about one-quarter are elderly or disabled.

In addition, another national health insurance program, the Children's Health Insurance Program (CHIP), covers more than 7 million uninsured children from low-income families who are not eligible for Medicaid. That program is expected to grow to cover 11 million children by 2013.

Medicaid is administered by the states, although the federal government sets minimum eligibility standards and provides at least half of the funding.

What is the current state of Medicaid?

The recession has undermined the budgets of many states at the same time that millions more people who have been hard hit by job cuts are enrolling in Medicaid and CHIP. Congress included $87 billion in the stimulus funding legislation to help states pay for Medicaid through 2010. But the aid is temporary and further cuts are expected in programs.

How much does Medicaid spend?

In fiscal year 2006, Medicaid spent an average of $4,575 per person: $1,708 per child, $10,691 for each elderly person enrolled and $12,874 for each disabled person. Total spending in fiscal year 2007 was $330 billion.

While most people enrolled in Medicaid are children and parents, most of the money — 68 percent in 2006 — is spent on the elderly and disabled.

How might a health overhaul affect Medicaid?

Democrats see the Medicaid program as an important means of covering the uninsured. The bills differ on details, but all of the pending Democratic measures would increase the maximum amount a person could earn as income and still be eligible for the program.

And all of these bills would extend Medicaid coverage to a new category of individuals: adults without children who fall below the income thresholds. Twenty-four states have some childless adult coverage now. And, although details vary, all of the proposals would provide more federal funds to states to help pay for this new coverage category.

Depending on the proposal, children who currently are enrolled in the CHIP program could remain in it, enroll in a new regulated marketplace called an "exchange" or "gateway," or be enrolled in Medicaid.

Additionally, the House legislation would boost payment rates for doctors and other practitioners to the same level as Medicare payments. Right now, Medicaid physician fees are 72 percent of the fees Medicare pays to doctors. If rates aren't raised, analysts say, there won't be enough doctors to take care of the increased number of people entering the Medicaid program.

This story was produced through collaboration between NPR and Kaiser Health News (KHN), an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.

Copyright 2023 Kaiser Health News. To see more, visit Kaiser Health News.

Andrew Villegas