Medicaid, the federal-state program that provides health care for poor Americans, is unraveling. A sluggish economy combined with rising numbers of poor citizens is placing unprecedented strains on the program. Congress and state legislatures are faced with complex economic, political and moral challenges in addressing this troubled, yet vital, program.
Enacted by Congress in 1965, Medicaid generated less debate and controversy than Medicare, which preceded it. Medicaid guaranteed basic outpatient and inpatient medical care but left the specifics to individual states. A state can establish requirements for eligibility and the range of services that are covered.
Eligibility for adults ranges from a low of 17 percent of the federal poverty level (Arkansas) to 150 percent (New York). Children from poor families are covered by a separate State Children’s Health Insurance Program (SCHIPS). Tennessee sets Medicaid eligibility for working adults at 129 percent of federal poverty level and SCHIPS eligibility at 250 percent. The federal poverty level for 2010 for a family of four was $20,050.
Some states offer comprehensive Medicaid services. Others offer minimal care.
In 2008, Medicaid spending reached almost $340 billion as it provided varying levels of health care to more than 60 million Americans. Medicaid paid for a third of all births, half of all treatment for HIV-AIDS, and almost 70 percent of patients in long-term care facilities.