How Much Does Medicaid Cost How Is It Financed
Together, states and the federal government spent about $630 billion on Medicaid services in fiscal year 2018. State policies have a substantial impact on the amount the federal government spends on Medicaid, not only because states are guaranteed federal Medicaid matching funds for the costs of covered services furnished to eligible individuals, but also because states have broad discretion to determine who is eligible, what services they will cover, and what they will pay for covered services, as discussed above.
It costs Medicaid substantially less than private insurance to cover people of similar health status due primarily to Medicaids lower payment rates to providers and lower administrative costs.
The federal government contributes at least $1 in matching funds for every $1 a state spends on Medicaid. The fixed percentage the federal government pays, known as the FMAP, varies by state, with poorer states receiving larger amounts for each dollar they spend than wealthier states. In the poorest states, the federal government pays 73 percent of Medicaid service costs the national average is between 57 and 60 percent. As noted above, the federal government pays an enhanced 90 percent of service costs on a permanent basis for low-income adults covered by the ACA Medicaid expansion.
Healthcare For Older Adults
Medicaid for older adults people age 65 and older offered by the Rhode Island Executive Office of Health and Human Services takes many forms including:
- Comprehensive health coverage for services like doctor visits, prescriptions, and hospital stays
- Help paying Medicare premiums
- Long-term services and supports in a nursing home, assisted living or shared living residence or at home
We also offer many other health services and supports to older adults who do not qualify for Medicaid.
If Your Income Is Low And Your State Hasnt Expanded Medicaid
If your state hasnt expanded Medicaid, your income is below the federal poverty level, and you don’t qualify for Medicaid under your state’s current rules, you wont qualify for either health insurance savings program: Medicaid coverage or savings on a private health plan bought through the Marketplace.
- Find out why
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- When the health care law was passed, it required states to provide Medicaid coverage for all adults 18 to 65 with incomes up to 133% of the federal poverty level, regardless of their age, family status, or health.
- The law also provides premium tax credits for people with incomes between 100% and 400% of the federal poverty level to buy private insurance plans in the Health Insurance Marketplace®.
- The U.S. Supreme Court later ruled that the Medicaid expansion is voluntary with states. As a result, some states havent expanded their Medicaid programs.
- Adults in those states with incomes below 100% of the federal poverty level, and who dont qualify for Medicaid based on disability, age, or other factors, fall into a gap.
- Their incomes are too high to qualify for Medicaid in their states.
- Their incomes are below the range the law set for savings on a Marketplace insurance plan.
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States are continuing to make coverage decisions. They could expand Medicaid in the future.
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How Many Uninsured People Who Could Have Been Eligible For Medicaid Are In The Coverage Gap
Nationally, more than two million3 poor uninsured adults fell into the coverage gap that results from state decisions not to expand Medicaid , meaning their income was above Medicaid eligibility but below the lower limit for Marketplace premium tax credits. These individuals would be eligible for Medicaid had their state chosen to expand coverage. Reflecting limits on Medicaid eligibility outside ACA pathways, most people in the coverage gap are adults without dependent children.4
Adults left in the coverage gap are spread across the states not expanding their Medicaid programs but are concentrated in states with the largest uninsured populations. More than a third of people in the coverage gap reside in Texas, which has both a large uninsured population and very limited Medicaid eligibility . Nineteen percent of people in the coverage gap live in Florida, twelve percent in Georgia, and ten percent in North Carolina. There are no uninsured adults in the coverage gap in Wisconsin because the state is providing Medicaid eligibility to adults up to the poverty level under a Medicaid waiver.
Figure 2: Distribution of Adults in the Coverage Gap, by State and Region, 2019
Alternative Policies For Medicaid Expansion Populations
Some states use Section 1115 research and demonstration waivers to test policies not allowed under traditional Medicaid, such as imposing higher cost sharing for some expansion enrollees or placing limitations on certain mandatory benefits.
Specifically, most of the states with these types of demonstrations have implemented beneficiary contributions programs, which involve changes to the premium and cost sharing schedules. Several states restrict retroactive eligibility. A small number of states place limitations on the non-emergency medical transportation benefit. One state, Arkansas, is using premium assistance to purchase plans on the exchange under its demonstration. Although several states planned to implement work and community engagement requirements, such requirements are not currently in effect in any state.
In 2021, the Centers for Medicare & Medicaid Services notified many of these states that certain elements of their demonstrations were being withdrawn, and that other elements of their demonstrations would be reviewed.
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Other Ways To Get Medicare Coverage At Age 65
If you dont qualify for premium-free Medicare Part A coverage, you may be eligible to buy coverage. However, you must still be a U.S. citizen or a permanent resident for at least five years to qualify.
Other Medicare Eligibility Options
- You can pay premiums for Medicare Part A hospital insurance. Premium costs vary based on how long you have worked and paid into Medicare.
- You can pay monthly premiums for Medicare Part B medical services insurance. Youll pay the same premiums as anyone else enrolled in Part B.
- You can pay monthly premiums for Medicare Part D prescription drug coverage. Your premium will be the standard rate and would depend upon the plan you choose.
You will not be able to purchase a Medicare Advantage plan or Medigap supplemental insurance unless you are enrolled in Original Medicare Medicare Parts A and B.
State Option To Adopt Streamlined Renewal Procedures For Pathways Based On Old Age Or Disability
Nearly all states have adopted at least one of the ACAs streamlined processes for Medicaid beneficiaries renewing coverage through an age or disability-related pathway, and over 60% have adopted both options . Aside from the Medicaid expansion, the ACA introduced other reforms that simplify and modernize Medicaid eligibility and enrollment processes. All states must adopt these reforms for poverty-related coverage pathways, and states can choose whether to apply them to age and disability-related pathways.105 Streamlined renewal polices can facilitate continuous coverage among eligible individuals, which helps prevent gaps in care and protects individuals from out-of-pocket costs that might be incurred if they experience a break in coverage. We surveyed states about whether they opt to send pre-populated eligibility renewal forms and whether they offer reconsideration periods for eligibility renewals in pathways related to old age or disability. The states that have not adopted either of these options are Alaska, New Hampshire, and Oregon.106
Figure 11: State Adoption of ACA Streamlined Renewal Options for Age and Disability-Related Pathways, 2018
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Medicaid For The Elderly & People With Disabilities
Seniors, adults with disabilities and some children with disabilities who don’t have health insurance might be able to get health coverage through the Medicaid for the Elderly and People with Disabilities program.
You might be able to get Medicaid even if you’re already on Medicare. If you need help paying your Medicare premiums, click here.
To learn more about all your options, contact your local Aging and Disability Resource Center or call 2-1-1.
To get MEPD, you must be a Texas resident and a U.S. citizen or qualified non-citizen. When you apply, we’ll ask about your income, your age, and your disability to see if you qualify.
MEPD covers health care services, including:
- Regular checkups at the doctor.
- Medicine and vaccines.
- Access to medical specialists and mental health care.
- Treatment of special health needs and pre-existing conditions.
MEPD also covers long-term services and supports, including:
- Home care and personal care, like having someone help monitor your health and help you with daily activities.
- Having somebody take your child to their medical appointments.
- Nursing home care.
- A hospital for mental illnesses.
- A place of care for people with intellectual disabilities.
Pathways To Full Medicaid Eligibility Based On Old Age Or Disability
SSI Beneficiaries
States generally must provide Medicaid to people who receive federal Supplemental Security Income benefits.7 To be eligible for SSI, beneficiaries must have low incomes, limited assets, and an impaired ability to work at a substantial gainful level as a result of old age or significant disability. The SSI federal benefit rate is $750 per month for an individual and $1,125 for a couple8 in 2018,9 which is 74 percent of the federal poverty level . The effective SSI income limit is somewhat higher than 74% FPL in four states, due to state supplemental payments and/or additional income disregards: 80% FPL in Idaho, 83% FPL in New York and Wisconsin, and 87% FPL in Missouri . Box 1 provides more information about disregards. SSI beneficiaries also are subject to an asset limit of $2,000 for an individual and $3,000 for a couple.
Optional Pathways
Seniors and people with disabilities up to 100% FPL
Over 40 percent of states elect the option to expand Medicaid to seniors and people with disabilities whose income exceeds the SSI limit but is below the federal poverty level 12 .13 Eighteen of these states set the income limit at 100% FPL, the federal maximum for this pathway. In the other three states electing this option, the eligibility limit is 80% FPL in Arkansas, 81% FPL in Virginia, and 88% FPL in Florida. Twenty of the 21 states electing this option cover both seniors and people with disabilities, while Arkansas only covers seniors.
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Emergence Of New Benefits
Perhaps the most significant consequence of Medicare and Medicaid entitlement for people with disability has been the rapid development of an entirely new and unique array of benefits and services designed to promote independence and autonomy. Medicaid became the primary engine for this development. Today, despite limitations, variability, and cost pressures, the State Medicaid programs function as the Nations only formed disability and LTC insurance program. Over the past 25 years, through the flexibility that States have had in the design and elaboration of optional benefits and the 2176 home and community-based waivers, a de facto benefits policy for people with disability has evolved where none existed before. Examples of these new benefits include: expanded home health aide services for people with chronic disability and/or personal care attendant services in 29 States, licensed residential care facilities in lieu of intermediate care facilities for the mentally retarded and nursing homes for the mentally retarded in 41 States, an array of 2176 case-management, residential, and home care services in lieu of institutional care in 50 States and Washington, DC, and adult day health services in 30 States . The availability of these services by State and their expenditures are summarized in Table 2.
Getting Additional Coverage For Medicare Before 65
Getting Medicare before 65 can be a lifesaver if you have a qualifying ailment. Unfortunately, Medicare alone wont cover everything 100%. Thats why getting a Medicare Supplemental plan can be smart to get the most comprehensive coverage you can afford.
Our licensed insurance agents are standing by to share their wealth of knowledge about Medicare and all the Medigap plans available to you. Their time is of no charge to you, so any questions you have will receive answers.
So when youre ready to talk to our agents, call us. Or complete our online rate form to be connected with the best rates in your area.
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Get Important News & Updates
Sign up for email and/or text notices of Medicaid and other FSSA news, reminders, and other important information. When registering your email, check the category on the drop-down list to receive notices of Medicaid updates check other areas of interest on the drop-down list to receive notices for other types of FSSA updates.
Oppose Cuts To Medicaid
More than ten million people with disabilities receive health coverage, acute care, long-term services and supports , and home and community based services through Medicaid. The ACA repeal bills last year and the White House this year proposed changing how Medicaid is structured, leading to massive cuts. Instead of the current federal-state funding partnership, states would instead receive a set amount of money from the federal government in the form of block grants or per capita caps. This means that Medicaid funding would no longer be directly linked to the services that people need and, in all proposals, the funding will be slowly reducedMedicaid programs would have to limit the amount of services they provide per individual, limit the number of people who receive services, eliminate optional services , or some combination of the two. Either way, this change would result in major funding cuts and fewer services for fewer people. The disability community opposes repeal of the ACA and consumer protections for people with pre-existing conditions.
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Effective Date Of Coverage
Once an individual is determined eligible for Medicaid, coverage is effective either on the date of application or the first day of the month of application. Benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.
When To Use This Option
When your physician or nurse practitioner has referred you for physiotherapy after experiencing:
- a recent illness, injury, accident or surgery that led to a decline in function or movement
- a flare-up or worsening of symptoms from a previous fall, accident, surgery, or chronic condition that led to a decline in function or movement
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How Do I Enroll In Medicaid In Florida
Review Floridas eligibility criteria, and if you believe you are eligible to enroll in Medicaid you have several options:
- Enroll at Healthcare.gov .
- Apply online at ACCESS Florida, or fill out a paper form. Use this application for low-income children, pregnant women, families, and aged or disabled individuals who are not currently receiving Supplemental Security Income .
- Use this application to apply for food or cash assistance in addition to Medicaid. You should also use this form if you currently receive SSI or if you are applying for home-based and community services, hospice care, or nursing home care.
- Submit a paper application submitted by mail, fax or in person to a local service center.
For help with the application process, call 1-866-762-2237.
Who Qualifies For Medicaid
Medicaid qualification is different in every state. You must be a resident of the state in which you are applying for benefits and must be a U.S. citizen or otherwise qualified non-citizen such as a lawful permanent resident.
Federal law requires every state to provide Medicaid to the following mandatory eligibility groups that meet certain income and asset requirements:
As you can see from the federal guidelines, the only reference to age is in regards to children. Each state governs its own Medicare program in adherence to federal regulations. Some states may have an age requirement in order to qualify for its Medicaid program while other states may not.
You can find your states Medicaid eligibility requirements to learn more.
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What If I Already Have Health Insurance Through My Employer
- If you have health insurance coverage through your employer you should keep the insurance and talk with your local social services district worker. Medicaid may cover the cost of the premium for that insurance coverage. If you have family coverage through your employer you may wish to keep that coverage as the Medicaid BuyIn program for Working People with Disabilities does not offer family coverage.
Health Care Programs Eligibility
Health care coverage is available to individuals and families who meet certain eligibility requirements. The goal of these health care programs is to ensure that essential health care services are made available to those who otherwise do not have the financial resources to purchase them.
It is very important that individuals and families obtain health care coverage. In Michigan, there are many health care programs available to children, adults, and families. Specific coverages may vary depending on the program and the applicant’s citizenship status . The Michigan Department of Health and Human Services determines eligibility for most of the health care programs that are administered by the State of Michigan).
All of the health care programs in Michigan have an income test, except Children’s Special Health Care Services, and some of the programs also have an asset test. These income and asset tests may vary with each program. For some of the programs, the applicant may have income that is over the income limit and still be able to obtain health care benefits when their medical expenses equal or exceed their deductible amount.
CHILDREN
Pregnant Women
Maternity Outpatient Medical Services
ADULTS
Healthy Michigan Plan
Medicare Savings Program The Medicare Savings Program pays for certain Medicare costs. There is an asset test. The Michigan Department of Health and Human Services may help pay the following, depending on the persons income:
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