6 Medicaid FAQs

1. Who is covered by Medicaid?

Roughly 60 million low-income Americans. The eligible groups are children, parents with dependent children, pregnant women, people with severe disabilities, and seniors. The breakdown is:

* 29 million children
* 15 million adults under age 65 (primarily parents)
* 6 million seniors
* 9 million people with disabilities (roughly half are children)

2. How does spending map to these groups?

15 million seniors and disabled patients represent about $250B of Medicaid's $400B annual spending. Using round numbers, here is how spending maps to groups:

* Children: 50% of enrollees, 20% of costs ($80B)
* Adults: 25% of enrollees, 12% of costs ($48B)
* Seniors: 10% of enrollees, 25% of costs ($125B)
* Disabled: 15% of enrollees, 42% of costs ($168B)

3. What is the average annual per capita spending per group?

* Children: $2,135
* Adults: $2,541
* Seniors: $12,499 (about 80% in Long Term Care costs)
* Disabled: $14,481 (about 40% in Long Term Care costs)

4. How concentrated is the spending?

Roughly 5% of enrollees account for over 50% of Medicaid spending -- mainly driven by 2.5 million seniors and disabled people

5. How is Medicaid financed?

Costs are shared between the federal and state governments. The federal share ("Federal Medical Assistance Percentage") is at least 50% and can reach 76% in poorer states. Overall, the federal government covers about 57% of Medicaid costs.

6. How will Medicaid be impacted by health reform?

Beginning in 2014, roughly 16 million people will become eligible for Medicaid. If you are under the age of 65 and have an income that is at or below 133% of the federal poverty level, you will likely be eligible for Medicaid under health reform. This means that non-disabled adults that do not have dependent children will no longer be categorically excluded. Eligibility rules for the elderly and disabled will not change.

The federal government will cover 100% of the costs of the newly eligible enrollees for the first three years (2014-2016) and will gradually phase down thereafter.

For more, see: The Kaiser Commission on Medicaid and the Uninsured

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