{ "id": "R43357", "type": "CRS Report", "typeId": "R", "number": "R43357", "active": true, "source": "CRSReports.Congress.gov, EveryCRSReport.com, University of North Texas Libraries Government Documents Department", "versions": [ { "source_dir": "crsreports.congress.gov", "title": "Medicaid: An Overview", "retrieved": "2023-03-13T04:03:25.320322", "id": "R43357_17_2023-02-08", "formats": [ { "filename": "files/2023-02-08_R43357_7cd86765a193fef8ebe3876ad3c5cab048b2dd57.pdf", "format": "PDF", "url": "https://crsreports.congress.gov/product/pdf/R/R43357/17", "sha1": "7cd86765a193fef8ebe3876ad3c5cab048b2dd57" }, { "format": "HTML", "filename": "files/2023-02-08_R43357_7cd86765a193fef8ebe3876ad3c5cab048b2dd57.html" } ], "date": "2023-02-08", "summary": null, "source": "CRSReports.Congress.gov", "typeId": "R", "active": true, "sourceLink": "https://crsreports.congress.gov/product/details?prodcode=R43357", "type": "CRS Report" }, { "source_dir": "crsreports.congress.gov", "title": "Medicaid: An Overview", "retrieved": "2023-03-13T04:03:25.319130", "id": "R43357_15_2021-02-22", "formats": [ { "filename": "files/2021-02-22_R43357_a5486a96fc9ecb9bb95039bfa78bba7036b4df7f.pdf", "format": "PDF", "url": "https://crsreports.congress.gov/product/pdf/R/R43357/15", "sha1": "a5486a96fc9ecb9bb95039bfa78bba7036b4df7f" }, { "format": "HTML", "filename": "files/2021-02-22_R43357_a5486a96fc9ecb9bb95039bfa78bba7036b4df7f.html" } ], "date": "2021-02-22", "summary": null, "source": "CRSReports.Congress.gov", "typeId": "R", "active": true, "sourceLink": "https://crsreports.congress.gov/product/details?prodcode=R43357", "type": "CRS Report" }, { "source": "EveryCRSReport.com", "id": 603027, "date": "2019-06-24", "retrieved": "2019-08-12T22:15:52.278880", "title": "Medicaid: An Overview", "summary": "Medicaid is a means-tested entitlement program that finances the delivery of primary and acute medical services as well as long-term services and supports (LTSS) to an estimated 75 million people at a cost to states and the federal government of $616 billion in FY2018. Medicaid is one of the largest payers in the U.S. health care system, representing 17% of national health care spending in CY2017; in that year, private health insurance and Medicare accounted for 34% and 20% of national health care spending, respectively.\nParticipation in Medicaid is voluntary for states, though all states, the District of Columbia, and the territories choose to participate. The federal government requires states to cover certain mandatory populations and services, but the federal government also allows states to cover other optional populations and services. Due to this flexibility, there is substantial variation among the states in terms of factors such as Medicaid eligibility, covered benefits, and provider payment rates. \nHistorically, Medicaid eligibility generally has been limited to low-income children, pregnant women, parents of dependent children, the elderly, and individuals with disabilities; however, since 2014, states have had the option to cover nonelderly adults with income up to 133% of the federal poverty level (FPL) under the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) Medicaid expansion.\nMedicaid coverage includes a variety of primary and acute-care services as well as LTSS. Not all Medicaid enrollees have access to the same set of services. An enrollee\u2019s eligibility pathway determines the available services within a benefit package. Federal law provides two primary benefit packages for state Medicaid programs: (1) traditional benefits and (2) alternative benefit plans (ABPs). Beneficiary cost sharing (e.g., premiums and co-payments) is limited under the Medicaid program.\nMedicaid enrollees generally receive benefits via one of two service delivery systems: fee-for-service (FFS) or managed care. Under FFS, health care providers are paid by the state Medicaid program for each service provided to a Medicaid enrollee. Under managed care, Medicaid enrollees get most or all of their services through an organization under contract with the state. Most states use a combination of FFS and managed care.\nThe federal government and the states jointly finance Medicaid. The federal government reimburses states for a portion of each state\u2019s Medicaid program costs. Federal Medicaid funding is an open-ended entitlement to states, which means there is no upper limit or cap on the amount of federal Medicaid funds a state may receive.\nThe Social Security Act authorizes several waiver and demonstration authorities that allow states to operate their Medicaid programs outside of federal rules. The primary Medicaid waiver authorities include Section 1115, Section 1915(b), and Section 1915(c).\nMedicaid provider payment rates are set by states within federal rules. In some cases, states make supplemental payments to Medicaid providers that are separate from, and in addition to, the payment rates for services rendered to Medicaid enrollees. Also, Medicaid program integrity initiatives are designed to combat fraud, waste, and abuse in the Medicaid program.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "https://www.crs.gov/Reports/R43357", "sha1": "ce698e4f54efbbe3ec72d820796255cf85d80736", "filename": "files/20190624_R43357_ce698e4f54efbbe3ec72d820796255cf85d80736.html", "images": { "/products/Getimages/?directory=R/html/R43357_files&id=/2.png": "files/20190624_R43357_images_85c05307ba75e5e6ba1cb52ba46997ec4c000bc9.png", "/products/Getimages/?directory=R/html/R43357_files&id=/1.png": "files/20190624_R43357_images_5b4afa4c8037697a98e0f61d3dab02cc6b42d295.png", "/products/Getimages/?directory=R/html/R43357_files&id=/4.png": "files/20190624_R43357_images_2b79b4df613f0c4945f79b101751f9b8e66f3050.png", "/products/Getimages/?directory=R/html/R43357_files&id=/0.png": "files/20190624_R43357_images_8138a90a6cdfb019c6f4fc5913e019b3364d8bee.png", "/products/Getimages/?directory=R/html/R43357_files&id=/3.png": "files/20190624_R43357_images_cae045cb5905f4bfe3581278419d9bcfaf1752f8.png" } }, { "format": "PDF", "encoding": null, "url": "https://www.crs.gov/Reports/pdf/R43357", "sha1": "87e7c34b700afbbfa673fac8116eb00e1ee50725", "filename": "files/20190624_R43357_87e7c34b700afbbfa673fac8116eb00e1ee50725.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4795, "name": "Disability Benefits" }, { "source": "IBCList", "id": 4819, "name": "Medicaid & CHIP" } ] }, { "source": "EveryCRSReport.com", "id": 443601, "date": "2015-08-03", "retrieved": "2016-04-06T18:41:04.140214", "title": "Medicaid: An Overview", "summary": "Medicaid is a means-tested entitlement program that finances the delivery of primary and acute medical services as well as long-term services and supports (LTSS) to an estimated 65 million people at a cost to states and the federal government of $498 billion in FY2014. In comparison, the Medicare program provided health care benefits to nearly 54 million seniors and certain individuals with disabilities in that same year at a cost of roughly $606 billion to the federal government. Because Medicaid represents a large component of federal mandatory spending, Congress is likely to continue its oversight of Medicaid\u2019s eligibility, benefits, and costs.\nParticipation in Medicaid is voluntary for states, though all states, the District of Columbia, and the territories choose to participate. The federal government requires states to cover certain mandatory populations and benefits, but the federal government also allows states to cover other optional populations and services. Due to this flexibility, there is substantial variation among the states in terms of factors such as Medicaid eligibility, covered benefits, and provider payment rates. In addition, there are several waiver and demonstration authorities that allow states to operate their Medicaid programs outside of federal rules.\nHistorically, Medicaid eligibility generally has been limited to low-income children, pregnant women, parents of dependent children, the elderly, and individuals with disabilities; however, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) included the ACA Medicaid expansion, which expands Medicaid eligibility to individuals under the age of 65 with income up to 133% of the federal poverty level (FPL) (effectively 138% of FPL) at state option.\nThe ACA makes a number of other changes, which together represent the most significant reform to the Medicaid program since its establishment in 1965. In addition to the ACA Medicaid expansion, the ACA expands Medicaid eligibility for children aged 6 to 18 and former foster care children; transitions to the modified adjusted gross income (MAGI) counting methodology to determine eligibility for most non-elderly Medicaid enrollees; requires alternative benefit plan (ABP) coverage for certain Medicaid enrollees; provides enhanced federal matching funds for the ACA Medicaid expansion; increases uniformity among Medicare, Medicaid, and the State Children\u2019s Health Insurance Program (CHIP) program integrity activities; and provides the Centers for Medicare & Medicaid Services (CMS) with the ability to test methods to improve coordination of care for dual-eligible beneficiaries, among other changes.\nThis report describes the basic elements of Medicaid, focusing on who is eligible, what services are covered, how enrollees share in the cost of care, how the program is financed, and how providers are paid. The report also explains waivers, program integrity activities, and the dual-eligible population. In addition, it describes the following selected issues: the ACA Medicaid expansion, the impact of the ACA health insurance annual fee on Medicaid, and the ACA maintenance of effort (MOE) requirement with respect to Medicaid eligibility.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R43357", "sha1": "b2d25ae8ebbd06ec6aeb8cf15e51526b3db78fb6", "filename": "files/20150803_R43357_b2d25ae8ebbd06ec6aeb8cf15e51526b3db78fb6.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R43357", "sha1": "3f72428cda68b780d876e71160397a398e182b7a", "filename": "files/20150803_R43357_3f72428cda68b780d876e71160397a398e182b7a.pdf", "images": null } ], "topics": [ { "source": "IBCList", "id": 2912, "name": "Disability Rights and Benefits" }, { "source": "IBCList", "id": 4326, "name": "Benefits and Services for Low-Income Households" }, { "source": "IBCList", "id": 594, "name": "Medicaid and CHIP" } ] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc821879/", "id": "R43357_2014Jan10", "date": "2014-01-10", "retrieved": "2016-03-19T13:57:26", "title": "Medicaid: An Overview", "summary": null, "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20140110_R43357_a9fd58fd3a4aa2a5aab2757b759806354b28f9da.pdf" }, { "format": "HTML", "filename": "files/20140110_R43357_a9fd58fd3a4aa2a5aab2757b759806354b28f9da.html" } ], "topics": [] } ], "topics": [ "Aging Policy", "Health Policy" ] }