Medicaid

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Obamacare glossary • Effect of Obamacare • Centers for Medicare and Medicaid Services

The Medicaid program provides medical insurance to groups of low-income people and individuals with disabilities. It is the largest source of financing for the healthcare services they need. Medicaid is a nationwide program jointly funded by the federal government and the states. Medicaid eligibility, benefits, and administration are managed by the states within federal guidelines. A program related to Medicaid is the Children's Health Insurance Program (CHIP), which covers low-income children above the poverty line and is sometimes operated in conjunction with a state's Medicaid program. Medicaid is a separate program from Medicare, which provides health coverage for the elderly.

This page provides a general overview about the Medicaid program, including the history behind the program and its structure.
To view information on Medicaid in your state, click here.

## Contents

* 1 Background
* 2 Administration
* 2.1 Reimbursement rates
* 2.2 Benefits
* 2.3 Eligibility
* 2.3.1 Dual eligibility
* 2.4 Spending
* 2.4.1 Total spending
* 2.4.2 Spending details
* 3 History
* 4 Recent news
* 5 See also
* 5.1 Medicaid in the 50 states
* 6 Footnotes

## Background[edit]

Established in 1965, Medicaid is the primary source of health insurance coverage for low-income and disabled individuals and the largest source of financing for the healthcare services they need. In 2014, about 80 million individuals were enrolled in Medicaid, or 25.9 percent of the total United States population. According to the Kaiser Family Foundation, Medicaid accounted for one-sixth of healthcare spending in the United States during that year.[1][2][3]

The federal Centers for Medicare and Medicaid Services (CMS) monitors state Medicaid programs and establishes requirements for service delivery, quality, funding, and eligibility standards. Medicaid does not provide healthcare directly. Instead, it pays hospitals, physicians, nursing homes, health plans, and other healthcare providers for covered services that they deliver to eligible patients.[3][4]

The Patient Protection and Affordable Care Act of 2010, also known as Obamacare, provided for the expansion of Medicaid to cover all individuals earning incomes up to 138 percent of the federal poverty level, which amounted to $16,643 for individuals and $33,948 for a family of four in 2017. A 2012 United States Supreme Court decision made the Medicaid expansion voluntary on the part of the states.[5][6]

## Administration[edit]

Medicaid is administered through matching grants, in which the federal government matches a percentage of state funding. States maintain some discretion over determining eligibility and benefits for the program.

Medicaid was originally administered by the Social Security Administration (SSA), which was a part of the Department of Health, Education, and Welfare (renamed the Department of Health and Human Services in 1980). In 1977, the program was transferred from the SSA to the Health Care Financing Administration, later renamed the Centers for Medicare and Medicaid Services (CMS). CMS is an agency within the Department of Health and Human Services. Each state also has its own Medicaid agency, responsible for such day-to-day activities as enrolling new members, processing claims, and determining benefits. States are also responsible for administering the Children's Health Insurance Program (CHIP), either through Medicaid or a separate program.[7][8]

### Reimbursement rates[edit]

The Affordable Care Act required Medicaid programs to pay physicians for primary care services at Medicare rates during 2013 and 2014 and provided federal funding for the purpose. States were not required to maintain the higher reimbursement rates after 2014. According to the Urban Institute, in 2016, state Medicaid programs reimbursed doctors at about 72 percent of the rates paid by Medicare. For primary care services, Medicaid reimbursement rates were 66 percent of Medicare rates.[9][10]

According to the Centers for Disease Control and Prevention, 68.9 percent of physicians accepted new Medicaid patients in 2013, while 83.7 percent accepted new Medicare patients. By comparison, 84.7 percent of physicians accepted new patients with private insurance. 2013 was the most recent year for which such data was available as of July 2017.[11]

### Benefits[edit]

In large part, the states "determine the type, amount, duration, and scope" of benefits offered to individuals enrolled in Medicaid, according to the Centers for Medicare and Medicaid Services. However, benefits are subject to federal minimum standards. The federal government has outlined 16 benefits that are required of all Medicaid programs:[12][13][14]

* Hospital services for inpatients
* Hospital services for outpatients
* Health screenings for individuals and children under age 21
* Nursing facility care
* Home healthcare
* Physician checkups and other services
* Rural health clinic visits
* Visits to federally qualified health centers
* Laboratory tests and X-rays
* Family planning
* Nurse midwife care
* Maternity and newborn care
* Visits to pediatric and family nurse practitioners
* Visits to licensed freestanding birth centers
* Emergency and non-emergency medical transportation
* Tobacco cessation programs for pregnant women

In addition, the Affordable Care Act established a requirement for Medicaid programs to provide coverage for prescription drugs, substance abuse treatment, and mental health treatment to all Medicaid enrollees who became eligible under expanded programs. Beyond the required benefits, there are several other optional benefits states may choose to offer enrollees, such as dental care and physical therapy. Other services may be offered with approval from the secretary of the United States Department of Health and Human Services. Benefits offered may not differ from person to person due to diagnoses or condition of health.[12][14][15]

### Eligibility[edit]

Eligibility for each state's Medicaid program is subject to minimum federal standards, both in the population groups states must cover and the maximum amount of income enrollees can make. States may set the income levels higher if they choose--which would have the effect of increasing the number of individuals eligible for the program--but they cannot set them lower. States are required to cover the following population groups and income levels:[6][16]

* states must cover pregnant women up to at least 138 percent of the federal poverty level ($16,643 for an individual, $33,948 for a family of four in 2017)
* states must cover preschool-age children up to at least 138 percent of the federal poverty level ($16,643 for an individual, $33,948 for a family of four in 2017)
* states must cover school-age children up to at least 100 percent of the federal poverty level ($12,060 for an individual, $24,600 for a family of four in 2017)
* states must cover elderly and disabled individuals up to at least 75 percent of the federal poverty level ($9,045 for an individual, $18,450 for a family of four in 2017)
* states must cover working parents up to at least 28 percent of the federal poverty level ($3,376 for an individual, $6,888 for a family of four in 2017)

The Affordable Care Act authorized states to expand their Medicaid programs to offer coverage to childless adults up to 138 percent of the federal poverty level. It provided 100 percent of funding to cover the new recipients for the first few years and phased down such funding to 90 percent by 2020. The United States Supreme Court ruling in National Federation of Independent Business v. Sebelius (2012) made expansion of the program voluntary on the part of the states.

Maine became the first state to expand via citizen initiative in November 2017. In November 2018, Idaho, Nebraska, and Utah approved ballot initiatives concerning Medicaid expansion and funding for expanded coverage. In November 2018, Montana voters defeated an initiative to extend Montana's Medicaid expansion. Gov. Steve Bullock (D) subsequently signed legislation extending Medicaid expansion.[17][18][19]

As of January 2022, a total of 38 states and Washington, D.C., had expanded or voted to expand Medicaid, while 12 states had not. The map below provides information on Medicaid expansions by state; for states that expanded, hover over the state to view the political affiliation of the governor at the time of expansion.[20]

Click [show] on the bar below the map to view eligibility levels for each enrollee category by state.

Medicaid eligibility by population category, 2016

State  | Children  | Pregnant women  | Adults
Medicaid ages 0-1  | Medicaid ages 1-5  | Medicaid ages 6-18  | Separate CHIP  | Medicaid  | CHIP  | Parent  | Childless adults
Alabama | 141% | 141% | 141% | 312% | 141% | N/A | 13% | No
Alaska | 203% | 203% | 203% | N/A | 200% | N/A | 142% | 138%
Arizona | 147% | 141% | 133% | 200% | 156% | N/A | 106% | 138%
Arkansas | 142% | 142% | 142% | 211% | 209% | N/A | 17% | 138%
California | 261% | 261% | 261% | 317% | 208% | N/A | 109% | 138%
Colorado | 142% | 142% | 142% | 260% | 195% | 260% | 68% | 138%
Connecticut | 196% | 196% | 196% | 318% | 258% | N/A | 150% | 138%
Delaware | 212% | 142% | 133% | 212% | 212% | N/A | 87% | 138%
Florida | 206% | 140% | 133% | 210% | 191% | N/A | 29% | No
Georgia | 205% | 149% | 133% | 247% | 220% | N/A | 34% | No
Hawaii | 308% | 308% | 308% | N/A | 191% | N/A | 105% | 138%
Idaho | 142% | 142% | 133% | 185% | 133% | N/A | 24% | No
Illinois | 142% | 142% | 142% | 313% | 208% | N/A | 133% | 138%
Indiana | 208% | 158% | 158% | 250% | 208% | N/A | 19% | 138%
Iowa | 375% | 167% | 167% | 302% | 375% | N/A | 54% | 138%
Kansas | 166% | 149% | 133% | 238% | 166% | N/A | 33% | No
Kentucky | 195% | 159% | 159% | 213% | 195% | N/A | 23% | 138%
Louisiana | 212% | 212% | 212% | 250% | 133% | N/A | 19% | 138%
Maine | 191% | 157% | 157% | 208% | 209% | N/A | 100% | No
Maryland | 317% | 317% | 317% | N/A | 259% | N/A | 123% | 138%
Massachusetts | 200% | 150% | 150% | 300% | 200% | N/A | 133% | 138%
Michigan | 212% | 212% | 212% | N/A | 195% | N/A | 54% | 138%
Minnesota | 283% | 275% | 275% | N/A | 278% | N/A | 133% | 200%
Mississippi | 194% | 143% | 133% | 209% | 194% | N/A | 23% | No
Missouri | 196% | 150% | 150% | 300% | 196% | 300% | 18% | No
Montana | 143% | 143% | 143% | 261% | 157% | N/A | 24% | 138%
Nebraska | 213% | 213% | 213% | N/A | 194% | N/A | 58% | No
Nevada | 160% | 160% | 133% | 200% | 160% | N/A | 32% | 138%
New Hampshire | 318% | 318% | 318% | N/A | 196% | N/A | 68% | 138%
New Jersey | 194% | 142% | 142% | 350% | 194% | 200% | 32% | 138%
New Mexico | 300% | 300% | 240% | N/A | 250% | N/A | 46% | 138%
New York | 218% | 149% | 149% | 400% | 218% | N/A | 133% | 200%
North Carolina | 210% | 210% | 133% | 211% | 196% | N/A | 44% | No
North Dakota | 147% | 147% | 133% | 170% | 147% | N/A | 52% | 138%
Ohio | 206% | 206% | 206% | N/A | 200% | N/A | 90% | 138%
Oklahoma | 205% | 205% | 205% | N/A | 133% | N/A | 41% | No
Oregon | 185% | 133% | 133% | 300% | 185% | N/A | 40% | 138%
Pennsylvania | 215% | 157% | 133% | 314% | 215% | N/A | 33% | 138%
Rhode Island | 261% | 261% | 261% | N/A | 190% | 253% | 116% | 138%
South Carolina | 208% | 208% | 208% | N/A | 194% | N/A | 62% | No
South Dakota | 182% | 182% | 182% | 204% | 133% | N/A | 57% | No
Tennessee | 195% | 142% | 133% | 250% | 195% | N/A | 103% | No
Texas | 198% | 144% | 133% | 201% | 198% | N/A | 15% | No
Vermont | 312% | 312% | 312% | N/A | 208% | N/A | 53% | 138%
Virginia | 143% | 143% | 143% | 200% | 143% | 200% | 49% | No
Washington | 210% | 210% | 210% | 312% | 193% | N/A | 40% | 138%
West Virginia | 158% | 141% | 133% | 300% | 158% | N/A | 19% | 138%
Wisconsin | 301% | 186% | 151% | 301% | 301% | N/A | 95% | No
Wyoming | 154% | 154% | 133% | 200% | 154% | N/A | 55% | No
Note: Figures represent household income as a percentage of the federal poverty level.

#### Dual eligibility[edit]

Some individuals, such as low-income seniors, are eligible for both Medicare and Medicaid; these individuals are known as dual-eligible beneficiaries. For those enrolled in Medicare who are eligible, enrolling in Medicaid may provide some benefits not covered by Medicare, such as stays longer than 100 days at nursing facilities, prescription drugs, eyeglasses, and hearing aids. Medicaid may also be used to help pay for Medicare premiums. As of 2010, one in five Medicare beneficiaries were also enrolled in Medicaid.[21]

### Spending[edit]

According to the Medicaid and CHIP Payment and Access Commission, states dedicated on average 28.6 percent of their budgets to Medicaid in 2016 compared to 21.5 percent in 2006. Total state and federal spending on the program amounted to $553.4 billion nationwide. Hover over the graph below to view total Medicaid spending over time in relation to spending on Medicare and all other health spending, which includes private insurance.[22][23]

#### Total spending[edit]

During fiscal year 2016, Medicaid spending nationwide amounted to nearly $553.5 billion. Total Medicaid spending grew by 33 percent between fiscal years 2012 and 2016. Click [show] on the red bar below to view total Medicaid spending by state for fiscal years 2012 through 2016. Total spending figures include both sate and federal spending.[24][25][26][27][28]

Total Medicaid spending, fiscal years 2012 - 2016

State  | 2012  | 2013  | 2014  | 2015  | 2016  | Percentage change
Alabama | $5,027,020,046 | $5,038,553,636 | $5,241,269,869 | $5,264,823,220 | $5,461,151,125 | 8.64%
Alaska | $1,348,227,744 | $1,356,288,090 | $1,427,318,378 | $1,405,373,754 | $1,798,434,564 | 33.39%
Arizona | $7,904,776,123 | $8,437,589,720 | $9,238,879,857 | $10,617,725,498 | $11,112,248,057 | 40.58%
Arkansas | $4,159,900,817 | $4,206,830,398 | $4,896,343,079 | $5,469,511,577 | $6,009,822,333 | 44.47%
California | $50,165,335,340 | $61,903,522,460 | $63,941,985,764 | $84,983,400,530 | $81,963,494,431 | 63.39%
Colorado | $4,723,953,276 | $5,092,237,084 | $5,959,722,512 | $7,301,117,099 | $7,934,761,868 | 67.97%
Connecticut | $6,759,240,720 | $6,725,505,223 | $7,231,192,158 | $7,183,360,060 | $7,886,642,781 | 16.68%
Delaware | $1,484,593,447 | $1,562,622,464 | $1,726,180,013 | $1,860,130,571 | $1,888,440,200 | 27.20%
Washington, D.C. | $2,110,863,709 | $2,288,326,022 | $2,380,846,860 | $2,369,871,903 | $2,773,098,123 | 31.37%
Florida | $17,906,910,735 | $18,561,488,841 | $20,425,755,781 | $21,320,462,370 | $21,841,384,373 | 21.97%
Georgia | $8,525,953,526 | $8,960,367,262 | $9,485,829,472 | $9,664,791,833 | $9,837,218,481 | 15.38%
Hawaii | $1,492,674,686 | $1,630,194,621 | $1,995,172,756 | $1,957,983,075 | $2,205,594,725 | 47.76%
Idaho | $1,451,713,522 | $1,672,080,653 | $1,608,317,929 | $1,715,448,736 | $1,710,240,712 | 17.81%
Illinois | $13,392,553,588 | $15,658,168,078 | $16,726,311,174 | $16,938,472,430 | $19,298,315,096 | 44.10%
Indiana | $7,486,196,206 | $7,967,961,434 | $9,129,913,143 | $9,249,771,996 | $10,446,713,815 | 39.55%
Iowa | $3,495,120,094 | $3,709,298,321 | $4,038,005,449 | $4,476,316,992 | $4,797,453,707 | 37.26%
Kansas | $2,667,413,390 | $2,578,232,394 | $2,764,679,297 | $3,010,910,864 | $3,274,359,345 | 22.75%
Kentucky | $5,701,684,085 | $5,822,414,805 | $7,907,494,806 | $9,423,467,372 | $9,664,001,530 | 69.49%
Louisiana | $7,358,261,947 | $7,146,504,122 | $7,358,578,753 | $7,863,181,815 | $8,637,261,244 | 17.38%
Maine | $2,413,167,313 | $2,887,138,817 | $2,457,176,578 | $2,477,405,878 | $2,581,657,130 | 6.98%
Maryland | $7,686,649,117 | $7,781,124,159 | $9,372,761,056 | $9,410,240,087 | $10,478,883,019 | 36.33%
Massachusetts | $12,925,713,343 | $13,166,355,820 | $14,602,722,338 | $15,378,247,995 | $17,121,704,904 | 32.46%
Michigan | $12,460,330,219 | $12,386,366,120 | $13,581,206,280 | $15,867,358,420 | $16,881,112,468 | 35.48%
Minnesota | $8,893,764,778 | $8,918,872,234 | $10,056,174,660 | $10,704,500,992 | $11,163,948,754 | 25.53%
Mississippi | $4,465,933,337 | $4,736,086,751 | $4,884,227,315 | $5,136,317,498 | $5,413,140,387 | 21.21%
Missouri | $8,726,534,192 | $8,951,131,687 | $8,924,174,353 | $9,518,489,904 | $9,904,675,663 | 13.50%
Montana | $972,565,512 | $1,007,145,361 | $1,085,468,758 | $1,132,392,709 | $1,381,900,546 | 42.09%
Nebraska | $1,721,721,025 | $1,833,587,705 | $1,816,793,313 | $1,846,405,999 | $2,006,615,023 | 16.55%
Nevada | $1,738,903,012 | $1,823,482,681 | $2,300,129,644 | $3,105,613,113 | $3,363,512,975 | 93.43%
New Hampshire | $1,186,815,817 | $1,202,784,581 | $1,343,718,320 | $1,716,225,884 | $1,975,716,666 | 66.47%
New Jersey | $10,388,704,680 | $10,605,791,985 | $12,574,194,894 | $14,049,422,255 | $14,546,679,583 | 40.02%
New Mexico | $3,430,059,436 | $3,294,911,999 | $4,181,527,866 | $4,920,345,001 | $5,364,140,357 | 56.39%
New York | $53,305,797,436 | $54,420,497,814 | $54,204,075,597 | $57,896,956,615 | $62,858,761,866 | 17.92%
North Carolina | $12,282,452,337 | $11,915,039,901 | $12,097,786,918 | $13,212,668,475 | $12,382,079,896 | 0.81%
North Dakota | $744,160,777 | $784,117,048 | $654,709,673 | $533,643,617 | N/A | -28.29%
Ohio | $16,352,195,540 | $16,803,466,430 | $19,582,062,348 | $21,423,012,674 | $21,744,648,983 | 32.98%
Oklahoma | $4,642,035,524 | $4,795,886,340 | $4,965,898,204 | $4,703,038,531 | $4,813,304,816 | 3.69%
Oregon | $4,587,105,504 | $5,110,832,973 | $6,831,542,103 | $8,027,137,262 | $8,398,103,515 | 83.08%
Pennsylvania | $20,393,353,134 | $21,091,585,036 | $23,622,494,930 | $23,223,615,661 | $27,562,165,896 | 35.15%
Rhode Island | $1,855,780,111 | $1,920,145,481 | $2,448,256,487 | $2,584,840,295 | $2,424,403,571 | 30.64%
South Carolina | $4,847,913,428 | $4,906,583,617 | $5,552,937,136 | $5,767,691,574 | $6,240,129,313 | 28.72%
South Dakota | $749,271,225 | $766,382,971 | $784,945,933 | $805,740,131 | $839,857,490 | 12.09%
Tennessee | $8,797,895,567 | $8,716,487,022 | $9,263,093,195 | $9,094,051,961 | $9,517,026,811 | 8.17%
Texas | $28,285,538,853 | $28,338,942,175 | $32,202,713,428 | $34,691,253,016 | $40,329,673,422 | 42.58%
Utah | $1,903,197,459 | $2,130,007,800 | $2,093,941,709 | $2,147,978,557 | $2,140,678,188 | 12.48%
Vermont | $1,353,425,573 | $1,473,569,964 | $1,534,774,141 | $1,632,611,663 | $1,679,754,722 | 24.11%
Virginia | $6,906,432,609 | $7,291,109,038 | $7,611,531,956 | $8,032,760,161 | $8,564,487,079 | 24.01%
Washington | $7,560,049,390 | $8,171,329,895 | $10,403,319,036 | $10,494,138,618 | $10,935,089,585 | 44.64%
West Virginia | $2,789,587,443 | $3,024,226,160 | $3,349,005,677 | $3,646,548,197 | $3,693,853,210 | 32.42%
Wisconsin | $7,096,309,146 | $7,105,874,963 | $7,494,803,035 | $7,893,501,866 | $7,741,793,637 | 9.10%
Wyoming | $528,478,993 | $554,122,142 | $547,711,059 | $558,961,575 | $580,911,047 | 9.92%
United States | $415,154,234,831 | $438,233,172,298 | $475,910,000,000 | $523,709,237,879 | $553,453,647,756 | 33.31%
Note: Expenditures include both state and federal expenditures. Expenditures do not include administrative costs. Percentages calculated by Ballotpedia.

#### Spending details[edit]

Spending per enrollee amounted to $7,067 in fiscal year 2013, the most recent year for which per-enrollee figures were available as of June 2017. Enrollment in the Medicaid program is tracked month-to-month, and as of March 2017, total enrollment nationwide amounted to 74.6 million individuals. According to the Kaiser Family Foundation, prior to the implementation of the Medicaid expansion, average monthly enrollment amounted to 56.8 million individuals. On average, states paid 37 percent of total Medicaid costs in 2016, while the federal government paid the remaining 63 percent. Click [show] on the bar below to view Medicaid spending details by state.[29][30][31][32][33][34]

Medicaid spending details

State  | Total spending (2016)  | Enrollment (March 2017)  | Per enrollee spending (2013)  | FMAP percentage (2018)*  | Federal share (2016)  | State share (2016)  | Percent of state budget (2015)
Alabama | $5,461,151,125 | 874,193 | $4,717 | 71.44% | 70.4% | 29.6% | 24.1%
Alaska | $1,798,434,564 | 184,081 | $12,061 | 50.00% | 64.9% | 35.1% | 11.6%
Arizona | $11,112,248,057 | 1,741,301 | $5,582 | 69.89% | 75.5% | 24.5% | 30.3%
Arkansas | $6,009,822,333 | 912,043 | $6,890 | 70.87% | 78.3% | 21.7% | 25.5%
California | $81,963,494,431 | 12,288,131 | $6,156 | 50.00% | 64.1% | 35.9% | 33.5%
Colorado | $7,934,761,868 | 1,388,472 | $6,819 | 50.00% | 61.6% | 38.4% | 22.5%
Connecticut | $7,886,642,781 | 771,588 | $8,830 | 50.00% | 58.2% | 41.8% | 23.6%
Delaware | $1,888,440,200 | 244,571 | $7,272 | 56.43% | 62.1% | 37.9% | 19.2%
Washington, D.C. | $2,773,098,123 | 271,511 | $10,366 | 70.00% | 74.5% | 25.5% | –
Florida | $21,841,384,373 | 4,360,830 | $5,090 | 61.79% | 60.9% | 39.1% | 31.7%
Georgia | $9,837,218,481 | 1,736,905 | $5,355 | 68.50% | 67.7% | 32.3% | 21.9%
Hawaii | $2,205,594,725 | 348,406 | $6,046 | 54.78% | 65.1% | 34.9% | 15.1%
Idaho | $1,710,240,712 | 294,453 | N/A | 71.17% | 71.3% | 28.7% | 27.8%
Illinois | $19,298,315,096 | 3,062,978 | $5,683 | 50.74% | 59.8% | 40.2% | 27.1%
Indiana | $10,446,713,815 | 1,504,273 | $7,409 | 65.59% | 71.5% | 28.5% | 31.2%
Iowa | $4,797,453,707 | 632,571 | $7,078 | 58.48% | 62.4% | 37.6% | 22.7%
Kansas | $3,274,359,345 | 393,881 | $6,944 | 54.74% | 56.2% | 43.8% | 21.7%
Kentucky | $9,664,001,530 | 1,246,349 | $7,279 | 71.17% | 78.7% | 21.3% | 30.9%
Louisiana | $8,637,261,244 | 1,447,315 | N/A | 63.69% | 63.6% | 36.4% | 27.6%
Maine | $2,581,657,130 | 267,252 | $8,856 | 64.34% | 62.8% | 37.2% | 32.8%
Maryland | $10,478,883,019 | 1,293,753 | $7,937 | 50.00% | 61.1% | 38.9% | 24.2%
Massachusetts | $17,121,704,904 | 1,631,999 | $9,541 | 50.00% | 54.1% | 45.9% | 23.8%
Michigan | $16,881,112,468 | 2,341,524 | $6,394 | 64.78% | 73.1% | 26.9% | 30.2%
Minnesota | $11,163,948,754 | 1,038,663 | $9,843 | 50.00% | 57.4% | 42.6% | 29.9%
Mississippi | $5,413,140,387 | 676,073 | $6,904 | 75.65% | 74.4% | 25.6% | 24.8%
Missouri | $9,904,675,663 | 977,708 | $8,993 | 64.61% | 63.4% | 36.6% | 36.1%
Montana | $1,381,900,546 | 254,112 | $8,712 | 65.38% | 67.2% | 32.8% | 17.4%
Nebraska | $2,006,615,023 | 239,729 | $8,415 | 52.55% | 51.3% | 48.7% | 16.9%
Nevada | $3,363,512,975 | 631,128 | $5,471 | 65.75% | 76.5% | 23.5% | 25.6%
New Hampshire | $1,975,716,666 | 186,941 | $8,560 | 50.00% | 60.2% | 39.8% | 29.7%
New Jersey | $14,546,679,583 | 1,777,465 | $9,394 | 50.00% | 60.6% | 39.4% | 24.2%
New Mexico | $5,364,140,357 | 787,110 | $5,781 | 72.16% | 79.4% | 20.6% | 30.3%
New York | $62,858,761,866 | 6,437,968 | $9,845 | 50.00% | 54.7% | 45.3% | 31.7%
North Carolina | $12,382,079,896 | 2,037,941 | $6,864 | 67.61% | 66.3% | 33.7% | 31.5%
North Dakota | N/A | 93,474 | $12,053 | 50.00% | N/A | N/A | 14.0%
Ohio | $21,744,648,983 | 2,807,525 | $7,307 | 62.78% | 69.5% | 30.5% | 37.4%
Oklahoma | $4,813,304,816 | 810,816 | $6,377 | 58.57% | 62.3% | 37.7% | 24.0%
Oregon | $8,398,103,515 | 973,271 | $7,649 | 63.62% | 76.5% | 23.5% | 23.4%
Pennsylvania | $27,562,165,896 | 2,927,904 | $9,377 | 51.82% | 60.2% | 39.8% | 37.0%
Rhode Island | $2,424,403,571 | 306,959 | N/A | 51.45% | 57.0% | 43.0% | 25.1%
South Carolina | $6,240,129,313 | 1,010,715 | $4,803 | 71.58% | 71.2% | 28.8% | 27.5%
South Dakota | $839,857,490 | 120,189 | $7,117 | 55.34% | 55.7% | 44.3% | 21.4%
Tennessee | $9,517,026,811 | 1,552,167 | $5,771 | 65.82% | 65.6% | 34.4% | 32.6%
Texas | $40,329,673,422 | 4,764,366 | $5,982 | 56.88% | 57.5% | 42.5% | 30.6%
Utah | $2,140,678,188 | 308,957 | $7,356 | 70.26% | 70.3% | 29.7% | 19.0%
Vermont | $1,679,754,722 | 168,961 | $8,427 | 53.47% | 59.3% | 40.7% | 28.5%
Virginia | $8,564,487,079 | 991,571 | $7,603 | 50.00% | 50.2% | 49.8% | 17.5%
Washington | $10,935,089,585 | 1,807,908 | $6,679 | 50.00% | 61.7% | 38.3% | 19.4%
West Virginia | $3,693,853,210 | 564,408 | $8,332 | 73.24% | 77.7% | 22.3% | 22.1%
Wisconsin | $7,741,793,637 | 1,046,217 | $6,775 | 58.77% | 58.5% | 41.5% | 19.3%
Wyoming | $580,911,047 | 61,635 | $8,142 | 50.00% | 51.1% | 48.9% | 7.1%
United States | $553,453,647,756 | 74,600,261 | $7,067 | 50.00% | 63.0% | 37.0% | 28.2%
Note: FMAP stands for Federal Medical Assistance Percentage and represents the percentage of state Medicaid spending that is eligible for federal matching funds.

## History[edit]

See also: History of healthcare policy in the United States

Lyndon Johnson signing the Medicaid bill with Harry Truman on July 30, 1965

In 1960, the Kerr-Mills Act was passed to provide assistance to poor, medically needy individuals, and elderly individuals; the law was the precursor to Medicaid. It created a program called Medical Assistance for the Aged, which provided grants to states to establish medical assistance programs for the elderly poor.[35]

In 1965, President Lyndon Johnson (D) cooperated with Representative Wilbur Mills (D), chairman of the House of Ways and Means Committee and co-sponsor of the Kerr-Mills bill, to pass Medicare legislation. Initially, there were several plans proposed by various congressmen. Rep. Mills cobbled three of them into a single bill, composed of Medicare Part A (hospital insurance), Medicare Part B (outpatient insurance) and Medicaid (medical aid to the needy). The bill was passed by Congress, and President Johnson signed Title XIX of the Social Security Act into law on July 30, 1965, which established Medicaid.[36][37]

Medicaid was designed as an expansion of the original Kerr-Mills program for the elderly and poor. It also included people with disabilities as well as children and pregnant women eligible for the Aid to Families with Dependent Children (AFDC) program. Unlike Medicare, it was a means-tested program, meaning eligibility was based on income. Medicaid's payment mechanisms were initially adopted from Medicare, which was a fee-for-service program that used third-party entities to make payments to doctors and hospitals. However, the 1967 Social Security Amendments authorized states to experiment with different Medicaid payment mechanisms. By 2011, nearly 75 percent of Medicaid recipients were enrolled in health maintenance organizations, rather than the traditional fee-for-service program.[38][39]

Medicaid was created as an optional program for states. Thirty-seven states established programs within the first two years, and by 1982, all states had chosen to participate in Medicaid. Arizona was the last state to establish a Medicaid program. The map to the left displays the establishment of state Medicaid programs over time. Click [show] on the red bar below to view the data for each state.[40][41][42]

Medicaid program implementation dates

State  | Medicaid start date
Alabama | January 1970
Alaska | July 1972
Arizona | October 1982
Arkansas | January 1970
California | March 1966
Colorado | January 1969
Connecticut | July 1966
Delaware | October 1966
Florida | January 1970
Georgia | October 1967
Hawaii | January 1966
Idaho | July 1966
Illinois | January 1966
Indiana | January 1970
Iowa | July 1967
Kansas | June 1967
Kentucky | July 1966
Louisiana | July 1966
Maine | July 1966
Maryland | July 1966
Massachusetts | September 1966
Michigan | October 1966
Minnesota | January 1966
Mississippi | January 1970
Missouri | October 1967
Montana | July 1967
Nebraska | July 1966
Nevada | July 1967
New Hampshire | July 1967
New Jersey | January 1970
New Mexico | December 1966
New York | May 1966
North Carolina | January 1970
North Dakota | January 1966
Ohio | July 1966
Oklahoma | January 1966
Oregon | July 1967
Pennsylvania | January 1966
Rhode Island | July 1966
South Carolina | July 1968
South Dakota | October 1967
Tennessee | January 1969
Texas | September 1967
Utah | July 1966
Vermont | July 1966
Virginia | July 1969
Washington | July 1966
West Virginia | July 1966
Wisconsin | July 1966
Wyoming | July 1967
Source: Henry J. Kaiser Family Foundation

## Recent news[edit]

The link below is to the most recent stories in a Google news search for the terms Medicaid. These results are automatically generated from Google. Ballotpedia does not curate or endorse these articles.

Medicaid - Google News

## See also[edit]

* Healthcare policy in the United States

* Impact of the ACA in the United States

* Children's Health Insurance Program

### Medicaid in the 50 states[edit]

Click on a state below to read more about the Medicaid program in that state.

Choose your state...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington, D.C.West VirginiaWisconsinWyoming

http://ballotpedia.org/Medicaid spending_in_STATE

## Footnotes[edit]

1. ↑ The Kaiser Commission on Medicaid and the Uninsured, "Medicaid Enrollment in 50 States," February 2010 (Note 1)
2. ↑ Center on Budget and Policy Priorities, "Policy Basics: Introduction to Medicaid," June 19, 2015
3. ↑ 3.0 3.1 The Henry J. Kaiser Family Foundation, "Medicaid Financing: How Does it Work and What are the Implications?" May 20, 2015
4. ↑ Centers for Medicare and Medicaid Services
5. ↑ Kaiser Health News, "Consumer’s Guide to Health Reform," April 13, 2010
6. ↑ 6.0 6.1 Office of The Assistant Secretary for Planning and Evaluation, "Poverty Guidelines," accessed June 9, 2017
7. ↑ Social Security Administration, "Administering Social Security: Challenges Yesterday and Today," 2010
8. ↑ TheHenry J. Kaiser Family Foundation, "Medicaid Administration," May 2013
9. ↑ Henry J. Kaiser Family Foundation, "Medicaid-to-Medicare Fee Index," accessed July 21, 2017
10. ↑ Urban Institute, "Medicaid Physician Fees after the ACA Primary Care Fee Bump," March 5, 2017
11. ↑ Centers for Disease Control and Prevention, "Acceptance of New Patients With Public and Private Insurance by Office-based Physicians: United States, 2013," accessed July 21, 2017
12. ↑ 12.0 12.1 Medicaid.gov, "Benefits," accessed June 8, 2017
13. ↑ The Commonwealth Fund, "Medicaid Benefit Designs for Newly Eligible Adults: State Approaches," May 11, 2015
14. ↑ 14.0 14.1 The Henry J. Kaiser Family Foundation, "KCMU Medicaid Benefits Database: General Benefits and Cost-Sharing Notes," January 2014
15. ↑ The Henry J. Kaiser Family Foundation, "Medicaid Benefits Data Collection," accessed September 24, 2015
16. ↑ The Henry J. Kaiser Family Foundation, "Federal Core Requirements and State Policy Options in medicaid: Current Policies and Key Issues," accessed May 13, 2017
17. ↑ The Henry J. Kaiser Family Foundation, "The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid Coverage," April 17, 2015
18. ↑ The Henry J. Kaiser Family Foundation, "Status of State Action on the Medicaid Expansion Decision," accessed December 23, 2015
19. ↑ Montana Public Radio, "Governor Signs Montana Medicaid Expansion Renewal Bill," May 9, 2019
20. ↑ HealthInsurance.org, "Medicaid," accessed January 10, 2020
21. ↑ The Henry J. Kaiser Family Foundation, "A Primer on Medicare," March 20, 2015
22. ↑ MACPAC, "Medicaid as a Share of State Budgets Including and Excluding Federal Funds by State," accessed May 26, 2017
23. ↑ National Association of State Budget Officers, "State Expenditure Report: 2006," accessed July 21, 2017
24. ↑ The Henry J. Kaiser Family Foundation, "Total Medicaid Spending - 2012," accessed July 17, 2015
25. ↑ Kaiser Family Foundation, "Total Medicaid Spending - 2013," accessed May 31, 2017
26. ↑ Kaiser Family Foundation, "Total Medicaid Spending - 2014," accessed May 31, 2017
27. ↑ MACPAC, "Medicaid Spending by State, Category, and Source of Funds," accessed May 31, 2017
28. ↑ Kaiser Family Foundation, "Total Medicaid Spending - 2016," accessed May 31, 2017
29. ↑ MACPAC, "Medicaid Benefit Spending Per Full-Year Equivalent (FYE) Enrollee by State and Eligibility Group," accessed May 26, 2017
30. ↑ MACPAC, "Medicaid as a Share of State Budgets Including and Excluding Federal Funds by State," accessed May 26, 2017
31. ↑ Kaiser Family Foundation, "Federal and State Share of Medicaid Spending," accessed May 26, 2017
32. ↑ Kaiser Family Foundation, "Federal Medical Assistance Percentage (FMAP) for Medicaid and Multiplier," accessed May 26, 2017
33. ↑ Medicaid.gov, "March 2017 Medicaid and CHIP Enrollment Data Highlights," accessed May 26, 2017
34. ↑ Kaiser Family Foundation, "Total Monthly Medicaid and CHIP Enrollment," accessed July 31, 2017
35. ↑ Journal of the History of Medicine and Allied Sciences, "The Kerr-Mills Act: Medical Care for the Indigent in Michigan, 1960—1965," accessed December 23, 2015
36. ↑ Jansson, B. (2001). The Reluctant Welfare State: American Social Welfare Policies. Wadsworth: Belmont, CA. (pages 249-250)
37. ↑ The New Yorker, "How Medicare Was Made," February 15, 2015
38. ↑ Eldridge, G. (2007) The Medicaid Evolution: The Political Economy of Medicaid Federalism. (page 108)
39. ↑ Centers for Medicare and Medicaid Services, "Medicaid Managed Care Enrollment Report," July 2011
40. ↑ National Conference of State Legislatures, "Medicaid and the Safety Net," accessed December 3, 2016
41. ↑ The Henry J. Kaiser Family Foundation, "Medicaid Timeline," March 24, 2015
42. ↑ Henry J. Kaiser Family Foundation, "A Historical Review of How States Have Responded to the Availability of Federal Funds for Health Coverage," accessed July 20, 2017

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