Medicaid and the Children's Health Insurance Program (CHIP) are government-funded programs that provide free or low-cost health coverage to millions of Americans, including those with low incomes. The Center for Medicaid and CHIP Services (CMCS) is the focal point for all national program policies and operations related to Medicaid, CHIP, and the Basic Health Program (BHP). These programs serve families, children, pregnant women, adults without children, and older people and people living with disabilities. Authorized by Title XIX of the Social Security Act in 1965, Medicaid is managed differently by each state, resulting in variations in coverage across the country.
CHIP was enacted in 1997 and provides matching federal funding to states to provide health coverage to children from families with incomes too high to qualify for Medicaid but who cannot afford private coverage. Every state has expanded coverage for children significantly through their CHIP programs, and nearly every state provides coverage for children up to at least 200 percent of the Federal Poverty Level (FPL). The Basic Health Program was established by the Affordable Care Act and gives states the option of establishing health benefit coverage programs for low-income residents who would otherwise be able to purchase coverage through the health insurance marketplace. This provides affordable coverage and better continuity of care for people whose incomes fluctuate above and below Medicaid and CHIP levels.
Medicaid is a social assistance program while Medicare is a social security program. Medicaid funds account for one-fifth of health care spending and are an important source of support for hospitals, doctors, nursing homes, and jobs in the health sector. Community health centers are a key source of primary care, while hospitals with safety nets provide a large amount of emergency and inpatient hospital care to Medicaid members. State policies have a substantial impact on the amount the federal government spends on Medicaid due to their discretionary powers to determine eligibility, services covered, and payment amounts.
People without private health insurance can seek help from a federally qualified health center (FQHC). Most states are undertaking reforms in delivery systems and payments to control costs and improve quality. Medicaid has strong support among people who disproportionately receive services from it, including children with special medical needs, older people, and people with disabilities. Research shows that Medicaid beneficiaries have much better access to care than uninsured people and are less likely to postpone or be left without needed care because of cost.
Congress and states could consider broader health reform that could expand the role of public programs in health care, including Medicare for All or Medicaid enrollment programs. More than half of all Medicaid spending on long-term care now goes to services provided in the home or community that allow older people and people with disabilities to live independently. Federal regulations require state Medicaid programs to cover certain “mandatory” services such as hospital and medical care, laboratory and X-ray services, home health services, and adult nursing facility services. In addition to broad support, Medicaid acts as a high-risk group for the private insurance market. A large amount of research shows that Medicaid beneficiaries have much better access to care than uninsured people and are less likely to postpone or be left without needed care because of cost.