Just the Facts: Medicaid

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Medicaid is a health insurance program that helps low-income Americans pay for medical care. It's a joint program between the federal government and the states.

WHAT IS THE TOTAL COST OF MEDICAID, AND WHAT PERCENTAGE OF THE BUDGET DOES IT COMPRISE?

In 2022, the total expenditure on Medicaid in the United States was approximately $824 billion. This accounted for about 19% of all healthcare expenditures in the country.

WHAT PERCENTAGE OF THE TOTAL NATIONAL HEALTHCARE COSTS IS MEDICAID?

Medicaid is a significant part of the federal budget, representing around 18% of the total national healthcare expenditure.

WHAT PERCENTAGE OF THE TOTAL US BUDGET IS MEDICAID?

Medicaid accounts for approximately 10% of the total US federal budget. This makes it one of the largest single expenditures in the federal budget, reflecting its critical role in providing healthcare to millions of Americans.

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WHO QUALIFIES FOR MEDICAID?

Medicaid eligibility varies by state, but generally, it covers several groups of people, including:

1. Low-income families: This includes parents and children who meet certain income criteria.

2. Pregnant women: Pregnant women with low income can qualify for Medicaid.

3. Children: Medicaid provides health coverage for children from low-income families.

4. Seniors: Individuals aged 65 and older who meet income and asset requirements.

5. People with disabilities: Individuals with disabilities who meet specific income and asset criteria.

6. Individuals receiving Supplemental Security Income (SSI): Automatically qualify for Medicaid in most states.

7. Adults under 65: In states that have expanded Medicaid under the Affordable Care Act, low-income adults under 65 may also qualify.

Each state has its specific eligibility criteria and income limits, so it's essential to check with your state's Medicaid office for precise information.

WHAT PERCENTAGE OF ALL MEDICAID COSTS ARE PAID TO NON-CITIZENS?

Non-citizens account for a very small portion of Medicaid spending. Less than 1% of total Medicaid spending goes to emergency care for non-citizen immigrants. This includes emergency services for undocumented immigrants and lawfully present immigrants subject to a waiting period for Medicaid eligibility.

WHAT PERCENTAGE OF TOTAL MEDICAID COSTS ARE PAID TO SENIORS?

Seniors and people with disabilities account for a significant portion of Medicaid spending. In 2021, approximately 51% of Medicaid's funds were spent on seniors and people with disabilities. This reflects the higher healthcare costs associated with these groups due to more complex healthcare needs and higher rates of chronic conditions.

DO YOU HAVE TO BE A DOCUMENTED LEGAL IMMIGRANT TO RECEIVE MEDICAID?

Yes, to qualify for Medicaid, you generally need to be a documented legal immigrant. Undocumented immigrants are not eligible for Medicaid, except for emergency services.

However, certain lawfully present immigrants, such as lawful permanent residents (green card holders), refugees, asylees, and others, may qualify for Medicaid if they meet specific eligibility criteria.

WHY DO PEOPLE OVER 65 RECEIVE MEDICAID WHEN THEY CAN RECEIVE MEDICARE INSTEAD?

Medicare and Medicaid provide health coverage but serve different purposes and populations.

Medicare is primarily for people aged 65 and older, as well as some younger individuals with disabilities. It covers services like hospital stays (Part A), outpatient care (Part B), and prescription drugs (Part D). However, Medicare has gaps in coverage, such as long-term care and some out-of-pocket costs.

Medicaid steps in to help fill those gaps for eligible seniors. Medicaid provides more comprehensive coverage, including long-term care services (like nursing home care) and additional support for medical expenses not fully covered by Medicare. This can be a significant benefit for seniors with limited incomes and resources.

So, while seniors can receive Medicare, those who qualify for Medicaid can benefit from its more extensive coverage, ensuring they get the care and support prescribed without facing financial hardships.

ARE THERE ANY STATISTIC ON HOW MANY UNDOCUMENTED IMMIGRANTS MIGHT ILLEGALLY BE RECEIVING MEDICAID?

Undocumented immigrants are generally ineligible for federal healthcare programs like Medicaid and Medicare. Due to the Personal Responsibility and Work Opportunity Act of 1996 (PRWORA), undocumented immigrants are barred from accessing most federal benefits, including Medicaid and the Children’s Health Insurance Program (CHIP). They can only access emergency services, such as emergency Medicaid, if they meet all other Medicaid eligibility requirements2.

However, there are no specific statistics on how many undocumented immigrants might be illegally receiving Medicaid. The data available shows that undocumented immigrants consume only a small fraction of total health expenditures and contribute more through federal, state, and local taxes. Most undocumented immigrants do not have any health coverage apart from emergency care.

WHAT PERCENT OF TOTAL US HEALTH COSTS ARE EMERGENCY CARE VISITS NOT PAID FOR BY INSURANCE?

Emergency care visits not covered by insurance contribute significantly to healthcare costs in the United States. According to a report by the U.S. News & World Report, a substantial portion of emergency department visits are considered "avoidable" and could have been addressed by primary care providers. These avoidable visits add approximately $32 billion annually to national healthcare costs.

While specific percentages of total U.S. health costs attributed to uninsured emergency care visits are not readily available, it's clear that these visits represent a significant financial burden on the healthcare system.

All data and information were obtained from Copilot, an AI-powered chatbot owned and operated by Microsoft Corporation.

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David Nevins is co-publisher of The Fulcrum and co-founder and board chairman of the Bridge Alliance Education Fund.