50 Facts about Medicaid
As we celebrate the 50th anniversary of Medicaid, the Partnership for Medicaid has identified 50 key facts about Medicaid that are useful – and sometimes surprising – for policymakers and health care leaders across the U.S.
Medicaid is Part of Americans’ Lives
- Medicaid serves nearly 70 million Americans across the United States.a
- More than two thirds of Americans have a friend or family member who has benefited from Medicaid or have received Medicaid benefits themselves.b
- Medicaid accounts for $1 of every $6 of personal health spending in the U.S.a
- One in five people with Medicare also rely on Medicaid to cover their healthcare needs – most notably, long-term care services, dental care, vision care and hearing services.a
- Medicaid benefits include both acute care services and a broad array of long-term care services that Medicare and most private insurance plans do not cover or tightly limit.c
- Medicaid participation is high. Almost two-thirds of low-income adults with children who are eligible for Medicaid are enrolled, and 87 percent of eligible children participate in Medicaid or CHIP.d, e
- More than 33 million children have their health coverage through Medicaid.c
- Half of all births in the United States are paid for by Medicaid.c
- Children aging out of foster care are covered by Medicaid until they turn 26.c
Medicaid Makes a Real Difference in People’s Health
- Numerous studies show that Medicaid has helped make millions of Americans healthier by improving access to preventive and primary care and by protecting against and providing care for serious diseases.f
- Compared with uninsured children, children with Medicaid are far more likely to have a usual source of care, visit physicians and dentists, and get recommended preventive care, and they are less likely to have unmet needs for medical, dental, and specialty care and prescription drugs.g
- Medicaid provides beneficiaries with access to health care services that is comparable to – but less costly than – what they could receive through employer-sponsored insurance.h
- Medicaid enrollees are just as likely as those with private insurance, and significantly more likely than uninsured adults, to report having a regular source of care.g
- Adults with Medicaid receive recommended preventative care at similar rates of those with private insurance.g
- Continuously insured adults with Medicaid are more likely to have timely care than those who are uninsured.g
- People with Medicaid are significantly less likely to skip services because of the cost of care compared with adults who are uninsured.g
People with Medicaid Value Their Benefits
- More than two-thirds (69%) of Americans earning less than $40,000 a year view Medicaid as an important program for their family.i
- Those with Medicaid report better experiences with their healthcare providers than those who had lacked coverage during the year, and equal experiences to privately insured patients.g
- The vast majority of adults who have ever received Medicaid benefits say that their overall experiences have been positive.a
- People with Medicaid report that their doctor always or often knows their medical history at higher rates than those who are uninsured.g
Medicaid Provides States with Flexibility
- Medicaid gives states significant flexibility to design their own programs, including who they cover, what benefits they provide, and how they deliver health care services.f
- The federal government matches state spending on Medicaid on an open-ended basis to help states respond to the health care needs of their residents.j
- The federal government funds a significant percentage of Medicaid care, ranging from a low of 50% to a high of 73.6% in Mississippi, the poorest state today.c
- States can seek federal waivers to test new approaches to operating their Medicaid programs outside of regular federal rules, with federal Medicaid matching funds. Since Medicaid was enacted, every state has been granted at least one waiver and most have been granted several waivers.i, k
- States have taken advantage of Medicaid’s flexibility to improve beneficiary health outcomes while lowering costs. In Vermont, for example, Medicaid reduced unnecessary ER visits by 10 percent by improving care coordination and case management.l
- States have flexibility to charge limited premiums and cost-sharing in Medicaid.c
- Medicaid rules give states the ability to use out of pocket charges to promote the most cost-effective use of prescription drugs.c
Medicaid Is an Innovator
- More than half of people with Medicaid get their coverage from a private managed care company.c
- Under CMS-approved waivers, about 20 states are now working with private health insurers to provide long-term services.a
- Medicaid’s Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) benefits have been a model for care to keep children healthy and treat conditions that could otherwise harm their development.a
- Medicaid is an active purchaser, using its market leverage to drive improvements in the quality of care provided to patients and to foster more accountable systems of care.a
- The availability of home and community-based services in Medicaid prevents unnecessary and unwanted institutionalization of people with physical impairments, severe mental illnesses, developmental and intellectual disabilities, and other disabling conditions.a
- Medicaid has been the principal engine of expanded access to home and community-based services that make independent living and community integration possible for people with disabilities, as well as elderly Americans.a
- Roughly 80% of nonelderly Medicaid beneficiaries with disabilities who use long-term care services and supports now receive services in the community rather than in institutions.a
- On a per-person basis, Medicaid spending has been growing more slowly than private insurance premiums and national health spending per capita. Medicaid’s per-person costs grew 2.5 percent between 2007 and 2010, significantly slower than the rate of growth in private insurance and a full point lower than overall medical trends.a, m
Medicaid Helps Working Families
- The majority of adult Medicaid recipients work full- or part-time.n, o
- Many people with Medicaid work in low-wage jobs for small firms or service industries that typically don’t offer health insurance.f
- Medicaid is a job creator, especially in rural communities, where it supports vital health care jobs at safety-net hospital, health centers and specialized providers.f, p
Medicaid Provides a Lifeline for Americans
- Since Medicaid lowers financial barriers to care and limits out-of-pocket costs, Medicaid beneficiaries are much less likely than the uninsured to report unmet health care needs.c
- Medicaid provides health and long-term coverage to more than 1 in 10 women. For women in particular, the program has served as a critical safety net by providing coverage for a wide spectrum of services that other government programs and private insurance did not, from contraceptives and pregnancy-related care to long-term care services and supports.q
- Medicaid finances 25% of all behavioral health care spending nationally.a
- Medicaid is a major source of support for specialized providers, including rehabilitation services and assistive technology.a
- Obtaining access to health care through Medicaid offers long-term benefits. For example, children eligible for Medicaid for more of their childhood earn more as adults and are more likely to attend and complete college.r
- Adults with Medicaid coverage are significantly less likely than either privately insured or uninsured individuals to report having difficulty paying medical bills.g
- More than 16 million people with Medicaid are living with disabilities or are over age 65.a
- Nearly two-thirds of Medicaid spending is attributable to people with disabilities (42%) and elderly beneficiaries (21%), many of whom are cared for in nursing homes.a
- By filling gaps in coverage among people of color, Medicaid plays a key role in advancing health equity.a
- Medicaid is the largest payer for HIV/AIDS care in the United States.s
- Certain groups, such as pregnant women, mandatory eligible children, and individuals receiving hospice are, are exempt from cost-sharing. In addition, services such as emergency services and family planning services are exempt as well.c
- Medicaid virtually eliminates catastrophic out-of-pocket spending (costs exceeding 30 percent of a person’s income).t
- Paradise J, Lyons B, Rowland D. Medicaid at 50. Kaiser Family Foundation, May 2015.
- Norton M, DiKulio B, Brodie M. Medicare and Medicaid at 50. Kaiser Family Foundation, July 2015.
- Paradise J. Medicaid Moving Forward. Kaiser Family Foundation, March 2015.
- Kenney GM et al. Medicaid/CHIP Participation Among Children and Parents. Urban Institute, December 2012.
- Kenney GM, Anderson N, Lynch V. Medicaid/CHIP Participation Rates Among Children: An Update. Robert Wood Johnson Foundation and Urban Institute, September 2013.
- Park E et al. Frequently Asked Questions About Medicaid. Center for Budget and Policy Priorities, June 2015.
- Blumenthal D, et al. Does Medicaid Make a Difference? Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2014. The Commonwealth Fund, June 2015.
- Coughlin T et al. What Difference Does Medicaid Make? Assessing Cost Effectiveness, Access, and Financial Protection under Medicaid for Low-Income Adults. Kaiser Family Foundation, May 2013
- Medicaid: A Primer – Key Information on the Nation’s Health Coverage Program for Low-Income People. Kaiser Family Foundation, March 2014.
- About Medicaid. Georgetown University Health Policy Institute Center for Children and Families.
- Ollove M. Medicaid Waiver’s Role in Innovation, Coverage, Expansion. The Pew Charitable Trusts, January 2014.
- Targeting Medicaid Super-Utilizers to Decrease Costs and Improve Quality. Center for Medicaid & CHIP Services Informational Bulletin, July 24 2013.
- Garfield R, Young K. Enrollment-Driven Expenditure Growth: Medicaid Spending During the Economic Downturn, FY 2007-2011. Kaiser Family Foundation, April 2013.
- Jacobs K, Perry I, MacGillvary J. The High Public Cost of Low Wages. UC Berkley Labor Center, April 2015.
- Are Uninsured Adults Who Could Gain Medicaid Coverage Working? Kaiser Family Foundation, February 2015.
- Commonwealth of Kentucky Medicaid Expansion Report 2014. Deloitte, February 2015.
- Salganicoff A, Ranji U, Sobel L. Medicaid at 50: Marking a Milestone for Women’s Health Issues. Women’s Health Issues 25(3): 198-201. March 2015.
- Cohodes S et al. The Effect of Child Health Insurance Access on Schooling: Evidence from Public Insurance Expansions. National Bureau of Economic Research, May 2014.
- The Affordable Care Act and HIV/AIDS. AIDS.gov, March 2015.
- Paradise J, Garfield R. What is Medicaid’s Impact on Access to Care, Health Outcomes and Quality of Care? Setting the Record Straight on the Evidence. Kaiser Family Foundation, August 2013.