Medicaid

Medicaid is publicly funded medical assistance. It can be understood as a form of health insurance for special groups and low-income individuals. Medicaid is not a single, national program. Each state, territory, and the District of Columbia has its own, individual Medicaid program.

Medicaid is a federal-state partnership with the states and the federal government each paying to support the program. Medicaid is received through and administered by an individual’s state of residence. The Centers for Medicare and Medicaid Services (CMS) oversee this administration and establishes general program guidelines. Federal law and regulations provide a framework for Medicaid and stipulate the basic requirements that all state programs must have. States must include certain categories of individuals and specific services in their Medicaid coverage and can choose whether to include other groups and services at their discretion.

Medicaid can be seen in two parts - the recipient and the services provided.

Recipients are divided into groups known as eligibility groups. There are three broad Medicaid eligibility groups: categorically needy (mandatory or optional), medically needy, and special groups. Title IV-E adoption assistance is a mandatory group and state-funded is an optional group. States must provide Medicaid to mandatory groups and can choose which, if any, optional groups to cover.

Services are divided into two groups- mandatory and optional. All states, territories, and the District of Columbia must provide mandatory services. These services will be identical across jurisdictions. Optional services are not required and will vary widely across jurisdictions.

Note: All mandatory and elected optional services must be provided to all eligible individuals
so that they are “sufficient in amount, duration, and scope to reasonably achieve (their) purpose”
and must be provided throughout the state.

This section provides information on:

Updated: July 2010