Medicaid Eligibility and benefits

Medicaid Eligibility and benefits

As of 2013, Medicaid is a program intended for those with low income, but a low income is not the only requirement to enroll in the program. Eligibility is categorical—that is, to enroll one must be a member of a category defined by statute; some of these categories include low-income children below a certain wage, pregnant women, parents of Medicaid-eligible children who meet certain income requirements, and low-income seniors. The details of how each category is defined vary from state to state.

People with disabilities who do not have a work history and who receive Supplemental Security Income, or SSI, are enrolled in Medicaid as a mechanism to provide them with health insurance. Persons with a disability, including blindness or physical disability, deafness, or mental illness can apply for SSI. However, in order to be enrolled, applicants must prove that they are disabled to the point of being unable to work. In recent years, a substantial liberalization occurred in the field of individual disability income insurance, which provides benefits when an insured person is unable to work because of illness or injury (HIAA, pg.13).

Some states operate a program known as the Health Insurance Premium Payment Program (HIPP). This program allows a Medicaid recipient to have private health insurance paid for by Medicaid. As of 2008 relatively few states had premium assistance programs and enrollment was relatively low. Interest in this approach remained high, however.[6]

Included in the Social Security program under Medicaid are dental services. These dental services are optional for adults above the age of 21; however, this service is a requirement for those eligible for Medicaid and below the age of 21.[7][clarification needed] Minimum services include pain relief, restoration of teeth, and maintenance for dental health. Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is a mandatory Medicaid program for children that aims to focus on prevention, early diagnosis and treatment of medical conditions.[7] Oral screenings are not required for EPSDT recipients, and they do not suffice as a direct dental referral. If a condition requiring treatment is discovered during an oral screening, the state is responsible for taking care of this service, regardless of whether or not it is covered on that particular Medicaid plan.

Medicaid expansion under the Affordable Care Act (ObamaCare)

2015 Medicaid expansion by state.

  Expanding Medicaid
  Not expanding Medicaid
  Still debating Medicaid expansion

The Patient Protection and Affordable Care Act, passed in 2010, would have revised and expanded Medicaid eligibility starting in 2014. Under the law as written, states that wished to participate in the Medicaid program would be required to allow people with income up to 133% of the poverty line to qualify for coverage, including adults without dependent children. The federal government would pay 100% of the cost of Medicaid eligibility expansion in 2014, 2015, and 2016; 95% in 2017, 94% in 2018, 93% in 2019, and 90% in 2020 and all subsequent years.[13]

However, the Supreme Court ruled in NFIB v. Sebelius that this provision of the ACA was coercive, and that the federal government must allow states to continue at pre-ACA levels of funding and eligibility if they chose. Several states have opted to reject the expanded Medicaid coverage provided for by the act; over half of the nation’s uninsured live in those states. They include Texas, Florida, Kansas, Georgia, Louisiana, Alabama, and Mississippi.[14] As of May 24, 2013 a number of states had not made final decisions, and lists of states which have opted out or were considering opting out varied,[15][16] but Alaska,[16] Idaho,[17] South Dakota,[17] Nebraska,[15]Wisconsin,[17] Maine,[17] North Carolina,[17] South Carolina,[17] and Oklahoma[17] seemed to have decided to reject expanded coverage.[17]

Several factors are associated with states’ decisions to accept or reject Medicaid expansion in accordance with the Patient Protection and Affordable Care Act. Partisan composition of state governments is the most significant factor, with states led primarily by Democrats tending to expand Medicaid and states led primarily by Republicans tending to reject expansion.[18]Other important factors include the generosity of the Medicaid program in a given state prior to 2010, spending on elections by health care providers, and the attitudes people in a given state tend to have about the role of government and the perceived beneficiaries of expansion.[19][20]

The federal government will pay 100 percent of defined costs for certain newly eligible adult Medicaid beneficiaries in “Medicaid Expansion” states.[21][22] The NFIB v. Sebelius ruling, effective January 1, 2014, allows Non-Expansion states to retain the program as it was before January 2014.

As of January 2014, confirmed opting out states include Alabama, Alaska, Florida, Georgia, Idaho, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Virginia & Wisconsin. States opting in after 2014 are Indiana & Pennsylvania.[23] On July 17, 2015, Governor Bill Walker sent a letter to the Alaskan state legislature, providing the required 45-day notice of his intention to accept the expansion of Medicaid in Alaska.[24]

States may bundle together the administration of Medicaid with other programs such as the Children’s Health Insurance Program (CHIP), so the same organization that handles Medicaid in a state may also manage the additional programs. Separate programs may also exist in some localities that are funded by the states or their political subdivisions to provide health coverage for indigents and minors.

State participation in Medicaid is voluntary; however, all states have participated since 1982 when Arizona formed its Arizona Health Care Cost Containment System (AHCCCS) program. In some states Medicaid is subcontracted to private health insurance companies, while other states pay providers (i.e., doctors, clinics and hospitals) directly. There are many services that can fall under Medicaid and some states support more services than other states. The most provided services are intermediate care for mentally handicapped, prescription drugs and nursing facility care for under 21-year-olds. The least provided services include institutional religious (non-medical) health care, respiratory care for ventilator dependent and PACE (inclusive elderly care).[30]

Most states administer Medicaid through their own programs. A few of those programs are listed below:

As of January 2012, Medicaid and/or CHIP funds could be obtained to help pay employer health care premiums in Alabama, Alaska, Arizona, Colorado, Florida, and Georgia.

Comparisons with Medicare

Unlike Medicaid, Medicare is a social insurance program funded at the federal level[39] and focuses primarily on the older population. As stated in the CMS website,[40]Medicare is a health insurance program for people age 65 or older, people under age 65 with certain disabilities, and (through the End Stage Renal Disease Program) people of all ages with end-stage renal disease. The Medicare Program provides a Medicare part A which covers hospital bills, Medicare Part B which covers medical insurance coverage, and Medicare Part D which covers prescription drugs.

Medicaid is a program that is not solely funded at the federal level. States provide up to half of the funding for the Medicaid program. In some states, counties also contribute funds. Unlike the Medicare program, Medicaid is a means-tested, needs-based social welfare or social protection program rather than a social insurance program. Eligibility is determined largely by income. The main criterion for Medicaid eligibility is limited income and financial resources, a criterion which plays no role in determining Medicare coverage. Medicaid covers a wider range of health care services than Medicare.

Some people are eligible for both Medicaid and Medicare and are known as Medicare dual eligibles.[41] In 2001, about 6.5 million Americans were enrolled in both Medicare and Medicaid. In 2013, approximately 9 million people qualified for Medicare and Medicaid

Single-payer health care Australia spends 9% of GDP vs 17% in USA

spend hc.JPG

Australia. … Medicare is the publicly funded universal health care venture inAustralia. It was instituted in 1984 and coexists with a private health system. Medicare is funded partly by a 2% income tax levy (with exceptions for low-income earners), but mostly out of general revenue.

Evening News: The Washington Post

House GOP narrowly passes bill to overhaul health-care system
The GOP-backed American Health Care Act, which advanced with a vote of 217 to 213, still must be debated in the closely divided Senate, where formal debate isn’t expected to begin until June. The vote marks an achievement for President Trump, who has pledged to repeal and replace Obamacare, but has struggled to secure legislative wins early in his presidency.
By Ed O’Keefe, Paige Winfield Cunningham and Amy Goldstein  •  Read more »
Health-care bill faces a steeper climb in the Senate
At a minimum, the House bill is expected to undergo major changes in the Senate, where it will be subject to unlimited amendments and it could even be introduced in a different form than it has taken in the lower chamber.
By Sean Sullivan, Paige Winfield Cunningham and Kelsey Snell  •  Read more »
GOP follows the playbook it attacked in Obamacare debate
After seven years of insisting the Affordable Care Act was jammed through without scrutiny, House Republicans brushed off questions about whether they read the new bill or why they needed to vote before a cost estimate was ready.
By David Weigel  •  Read more »
How the House voted to pass the American Health Care Act
Here’s a graphic break down of how the most conservative and most moderate Republicans swung, and how each representative voted.
By Kim Soffen, Darla Cameron and Kevin Uhrmacher  •  Read more »
Fact Checker | Analysis
What you need to know about preexisting conditions in the GOP health plan
The GOP says people with preexisting conditions are protected, but the reality is nuanced and complicated.
By Glenn Kessler  •  Read more »
Senate approves measure to fund the government through September
President Trump is expected to sign the measure, which includes more than $15 billion in new defense spending and $1.5 billion in money for U.S. border security, ahead of the Friday deadline to keep the government from shutting down.
By Kelsey Snell  •  Read more »
Texas governor poised to sign nation’s harshest anti-sanctuary bill
The legislation would outlaw sanctuary jurisdictions and fine or jail police who don’t work with federal immigration agents.
By Maria Sacchetti  •  Read more »
Trump plans first presidential overseas trip, to Israel, Vatican and Saudi Arabia
White House officials said the trip would be an effort to unite three of the world’s leading religious faiths in the common cause of fighting terrorism, reining in Iran, and “unifying the world against intolerance.”
By Karen DeYoung  •  Read more »
Family booted from Delta flight and threatened with jail after refusing to give up toddler’s seat
“You’re saying you’re going to give that away to someone else when I paid for that seat. That’s not right,” Brian Schear said before getting kicked off the flight from Maui to Los Angeles.
By Lindsey Bever  •  Read more »
Trump signs order aimed at allowing churches to engage in more political activity
The sweep of the measure was significantly narrower than a February draft that several religious groups are pushing.
By John Wagner and Sarah Pulliam Bailey  •  Read more »
North Korean state media lashes out at China and suggests Trump is ignorant
A commentary published by state media offered a rare, direct criticism of China, warning that “a string of absurd and reckless remarks are now heard from China every day only to render the present bad situation tenser.”
By Adam Taylor  •  Read more »
Prince Philip will step back from royal duties, Buckingham Palace announces
Queen Elizabeth II’s 95-year-old husband is retiring from his public role starting in the fall. The prince has long been expected to curtail his role as his health has gradually declined.
By Griff Witte and Karla Adam  •  Read more »
The Fix | Analysis
Breitbart’s frustration with President Trump just boiled over
A reporter from the Trump-friendly news site got into a tense exchange with White House press secretary Sean Spicer over the proposed border wall. We have annotated the transcript.
By Callum Borchers  •  Read more »
Stephen Colbert is not here to apologize to you
After the “Late Show” host made an oral-sex joke about President Trump and Russian President Vladimir Putin, calls for his firing were swift. But Colbert has a history of responding to controversy with non-apologies and more jokes.
By Emily Yahr  •  Read more »
‘Other: Mixed Race in America’
What being ‘American’ means to a woman who was put in an internment camp at age 10
In Episode 4 of this week-long podcast, hear from Virginia Matsuoka. Her mother was white and her father Japanese, and in April 1942, their family was torn apart.
By Alex Laughlin  •  Read more »

Bill House Republicans passed today is same cruel bill they tried to pass weeks ago

Elizabeth Warren for Massachusetts


The Republican Trumpcare bill isn’t a health care bill. A bill that strips health care away from millions of people in order to fund an enormous tax break for the rich is not a health care bill.

Make no mistake: The bill that the House Republicans passed today is the same cruel bill they tried to pass weeks ago. The only difference is that the new plan is even more brutal – opening the door to discriminating against people with pre-existing conditions.

The American people – Republicans and Democrats, independents and Trump voters – despise this bill. They rejected it before. We’ll reject it again.

The ACA repeal bill will now head to the Senate – and I promise you: I will fight my heart out to stop this monstrosity.

But we need you – yes, you Connie – to speak out and fight. Call, write, email, post, tweet, and share your story. Talk about what’s at stake for the people you love if they lose their health care.

It’s time to fight like your life is on the line – because for millions of people, it is.

Thanks for being a part of this,


Our Revolution


The House of Representatives just voted to pass the GOP’s disastrous bill to gut the Affordable Care Act and strip millions of their health coverage. Republicans have been pushing their so-called American Health Care Act through Congress without a score from the Congressional Budget Office because they know the numbers won’t add up.

The GOP would have you believe that they are the party of fiscal conservatism, but passing a bill of this magnitude without a full assessment of the cost is anything but.

Our Revolution will always give the American people the facts on health care, and the truth now is that more people will die if the health care repeal bill is signed into law. Chip in to help us fight back against the GOP attack on our health care so that we can win Medicare for All.

We may not have a score from the CBO, but it’s not hard to tell how Republicans expect us to pay for this: by burdening the middle class and working Americans with even higher costs than they incur under the Affordable Care Act today. The CBO study of the last Trumpcare bill found that 24 million people would lose their health insurance entirely, with millions more forced to pay more to receive less coverage. It’s no wonder the GOP forced through a vote before the CBO could do its job.

Some Republicans thought the last bill didn’t go far enough, and it appears that they got their wish. But the truth is that even rank and file Republicans don’t want their health insurance taken away and large percentages support Medicare for All.

Health care is the one topic on which we should all agree. Nobody should be at a greater risk of disease, disability, or death because of how much money they make. Donate to Our Revolution and help us fight to win Medicare for All.

We will fix this. With the health care of so many at greater risk today than it was yesterday, your contribution towards Medicare for All is more important now than ever before.

In solidarity,

Jeff Weaver
Our Revolution

We’re in SHOCK. Today, House Republicans voted to REPEAL Obamacare.

So Connie, where do we go from here?

We dig our heels into the ground, and we fight like we NEVER fought before.

The Senate is our last hope to stop the repeal before it reaches Trump’s desk. This is it, There are no second chances.

If you are with us, we need to hear from you TODAY. Donate right now to save Obamacare before it’s too late:


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Republicans exempt their own insurance from their latest health care proposal

“Republicans exempt their own insurance from their latest health care proposal” -Vox

SIGN YOUR NAME: Condemn Republicans for attacking our health care — while protecting their own.

The Republicans disgust us.

Their proposed new health care bill will…

  • Allow insurance companies to charge sick people and seniors more
  • Roll back maternity care and other coverage
  • Exempt members of Congress and their staff from any new changes

You heard that right.

They’re not just putting up a bad bill — they’re shielding themselves from its effects.

We’ve had enough.

The Republicans need to end their vicious assault on our health care and keep Obamacare intact!

ADD YOUR NAME: Reject the Republicans’ awful plan to destroy our health care.