Story highlights
- Medicaid is the single largest source of health coverage in the United States
- It covers three out of five nursing home residents, two out of five Americans with disabilities
There is a wide range of benefits for enrollees: doctor services, emergency room visits, inpatient hospital services, family planning, pediatric and family nurse practitioner care, screening, diagnostic and treatment services, nursing facility services, home health care, lab and X-ray tests, rural health clinics, smoking cessation programs for pregnant women and transportation to medical care.
Federal law says these benefits must be provided to Medicaid enrollees. Yet individual states can choose to also cover services such as prescription drug fees, dental services, physical therapy, optometry services, chiropractic services, hospice and private nursing services.
When Medicaid was signed into law in 1965, fewer than 5 million Americans qualified for benefits under this program. But a growing population and a number of changes to the law — the Affordable Care Act alone added 16.3 million enrollees — amplified the total number of beneficiaries.
Medicaid and the Children’s Health Insurance Program cover nearly 36 million children. The Children’s Health Insurance Program uses federal funds to match state funds that are providing coverage to children in families with incomes too high to qualify for Medicaid but unable to afford private coverage.
As a result, Medicaid ranks as the single largest source of health coverage in the United States, according to the government website.
Medicaid’s wide-ranging effects, by the numbers
3 out of 5: How many nursing home residents across America are covered by Medicaid, according to the Kaiser Family Foundation, a nonprofit organization focused on national health issues. (The foundation is not associated with the managed care plan Kaiser Permanente.)
36%: How much of Medicaid’s funds are spent on senior citizens receiving its benefits, though they make up only 15% of Medicaid enrollees, according to Kaiser. Medicare, a federal health insurance program, mostly serves people 65 or older. To pay for this program, the Federal Insurance Contributions Act requires 1.45% of citizens’ earnings go to Medicare, with an additional employer contribution of the same amount.
Medicaid covers services, such as long-term care, that Medicare does not cover for the elderly.
7.9: The average rating, on a zero to 10 scale, that Medicaid enrollees gave their overall health care, according to a study published in July in JAMA Internal Medicine. Zero represented “the worst health care possible,” and 10 represented “the best health care possible.” Eighty-four percent of enrollees reported that they were able to get all the care they or their physician believed was necessary in the past six months; 3% of enrollees reported that they were not able to get care because of waiting times or because physicians did not accept their insurance.
53 cents on the dollar: How much Medicaid generally pays doctors and other health care providers, compared with what they would receive from a privately insured patient, according to an index created by Kaiser. The index calculates the current rate paid to providers for serving Medicaid patients as 66% of the fee allowed for a Medicare beneficiary, which is 80% of the price charged by private insurers. The number of doctors who refuse to see Medicaid patients due to lower fees is difficult to estimate and has been the subject of an ongoing debate.
3 in every 10: How many people with an opioid addiction were covered by Medicaid and the Children’s Health Insurance Program in 2014, according to Kaiser. Medicaid covered about 690,000 of the 2.3 million people addicted to heroin or prescription opioid medicines that year.
Half: How many births in New York and California are paid for by Medicaid. Other states range from 72% (New Mexico) to 27% (New Hampshire), according to Kaiser. Meanwhile, the average payment made by a private US insurer for maternal care plus vaginal childbirth was $12,520 in 2010, according to Truven Health Analytics, an IBM company.
84%: How many adults on Medicaid report getting their blood pressure checked. It’s higher than the percentage of people with private insurance — 79% — who report getting a blood pressure check. People with Medicaid are also more likely to get their cholesterol checked: 60%, versus 56%, Kaiser reports.
30%: How many non-elderly adult Medicaid beneficiaries say they’re in fair or poor health, according to Kaiser, and many have preventable or controllable conditions. Seven in 10 adult Medicaid enrollees are overweight or obese. One in 10 has a diagnosed mental illness. And nearly one in three smokes tobacco.
Medicaid affects millions of Americans, young and old – CNN