Congressional Republicans are paying attention $880 billion cut Medicaid jointly with federal government health programs for low-income people.

Republican proposals to reduce 90% federal contribution to the state’s expanded Medicaid program, depending on the state’s response, Up to 20 million Of Medicaid’s 72 million people, or $626 billion over the next decade, it could keep them on the roll. Over 5 million If the Fed imposes work requirements, they could lose compensation.

With this complex government programme increasingly gaining attention over the past few months, Stateline has put together a guide explaining what Medicaid is and how it works.

1. Medicaid is not Medicare.

Medicaid We serve people with low incomes and disabilities. Medicare It focuses primarily on seniors regardless of income.

Medicaid and Medicare were created in 1965 under President Lyndon B. Johnson. Medicare is a federal health insurance program for people over the age of 65, but younger people with special circumstances such as permanent renal failure or ALS may be eligible before.

Medicare is a supplementary insurance program The range is limited. You will not pay for long-term care, most dental treatments, or routine physical examinations. Approximately 68.4 million people It’s registered With Medicare.

Medicaid is a more comprehensive government insurance plan jointly funded by the federal and states. Medicaid covers most nursing home care and long-term care based on home and community. Medicaid people usually don’t have any self-pay. Only people and their families with income under certain thresholds are eligible for Medicaid. About 72 million peopleor one-fifth of those living in the US will receive Medicaid benefits.

2. Medicaid eligibility varies from state to state.

Among them OriginalMedicaid Generally Available only on Children and less than 100% of parents or caretakers of eligible children with household incomes Federal Poverty Line ($32,150 for a family of four in 2025). Over the years, the program has been extended to include pregnant women, older adults, blind people and people with disabilities.

If the Fed imposes work requirements, more than 5m could lose Medicaid compensation

States must follow broad federal guidelines to receive federal funding. But they have Great flexibility The way they design and manage programs has different eligibility rules and offers a variety of benefits.

In 2010, President Barack Obama signed the Affordable Care Act, also known as Obamacare. This allowed the state to expand the eligibility threshold to cover adults with incomes of up to 138% of the federal poverty line (about $21,000 for one person today) in exchange for federal matching funds. Columbia area It covers parents and caregivers who earn up to 221% of the federal poverty line.

Only 10 states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming chose not to expand coverage. In a non-expanded state, caregiver and parental eligibility range From 15% of the federal poverty line in Texas to 105% of Tennessee. In Alabama, people can Just get it Medicaid is $4,678 per year for three households if it wins below 18% of the federal poverty line.

3. Traditional Medicaid exists alongside a children’s health insurance program called Chip.

Low-income children are always eligible for Medicaid. However, in 1997, Congress created a chip Children’s Health Insurance Program. The law gave states the opportunity to lower their enhanced federal matching funds to expand Medicaid compensation to children in families who earn too much money to qualify for traditional Medicaid compensation but can’t make too much money to buy commercial health care.

Like Medicaid, tips are jointly funded by the federal government and state, but are not qualification programs. Chip is a block grant program. This means that states receive fixed federal amounts each year and are not obligated to cover everyone who meets eligibility requirements. State can determine within broad federal guidelines how their chipping programs will work and what income restrictions will be. It is found in some states Choose to keep them Chip and Medicaid Programs anotherothers have decided to combine them by using chip funds to expand Medicaid eligibility.

4. Medicaid and tipping are important parts of the state budget.

2024, the federal government I spent time There’s less Medicaid and tipping than Medicare, with Medicare spending accounting for 12%, or $847.5 billion, federal benefits budgets, while Medicaid and tipping accounting for 8%, or $584.5 billion.

But at the same time, Medicaid is the largest source of state federal funds, accounting for about a third of the state’s budget on average. 57% of all federal funds The state received it last year.

5. Federal funding varies by state.

Before the Affordable Care Act, federal Medicaid funding to states relied primarily on formulas known as FMAP, or federal medical assistance rates based on the average personal income of residents. States with lower average incomes receive more financial support. For example, the federal government will refund relatively poor Mississippi and reimburse net costs of $2 for nearly $8 for every $10 spent. However, New York will only get a refund of $5. By law, FMAP cannot be less than 50%.

The ACA has expanded eligibility and provided the state with the opportunity to receive even greater federal matching rates. In the expanded state, the federal government covers 90% of the cost of expanding adults. If Republicans in Congress reduce that percentage, states will have to use their money to compensate for lost federal dollars. You may need to reduce Medicaid coverage for some groups, eliminate optional perks, or reduce provider payment rates. Alternatively, they could raise or cut other large budget items, such as education.

Another possibility is that states that adopted the Medicaid expansion will reverse it. Nine states (Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah and Virginia) already have “trigger” laws. It will be automatically cancelled Expansion if federal match rates drop below 90%. Other states are considering similar laws.

One new analysis If the health research policy group KFF reduces federal matches of the growing population by Congress to the percentages the state earns; Traditional Medicaid population – 50% in the wealthiest states and 77% in the poorest states – Rolls can continue to expand that states cost $626 billion over the next decade, with everyone undergoing Medicaid expansion.

6. Medicaid is the biggest source of health insurance, especially for low-income people.

Medicaid is the country’s largest health payer and is especially important for people in poverty. Almost a fifth of people living in the US are covered through Medicaid. However, almost half of all adults with incomes below the federal poverty line are insured through the program. Medicaid covers four for 10 children overall, but eight for 10 children under the federal poverty line. Medicaid also provides compensation to those experiencing homelessness or leaving prison.

7. Medicaid covers important services such as childbirth.

In exchange for receiving federal funds, the state is Obligation To cover important healthcare services such as inpatient and outpatient hospital services, doctor visits, laboratory work, and home health services. The state can decide which optional services they wish to cover, such as prescription medications and physical therapy.

Medicaid is a key payer for critical services. For example, the program covers 41% of all births in the United States and 40% of all adults aged 19-65 years and healthcare services with HIV.

8. The majority of Medicaid spending will be sent to people with disabilities and will pay for long-term care.

ACA Extended Adults – Approximately 1 in 4 Registrants – accounted for 21% of total Medicaid spending in 2021. Children, who account for one in three enrollees, account for only 14% of their spending.

About one in four enrollees are those who have qualified for Medicaid due to a disability, or those over the age of 65. But they accounted for more than half of all Medicaid spending. This is because these populations typically experience higher rates of chronic disease and require more complex medical care. Elderly people are also more likely to use nursing homes and other long-term care facilities, which can be expensive.

Reductions could mean that older people who rely on Medicaid for home care and long-term nursing home services could be significantly more likely. Affected.

9. Some states’ Medicaid programs cover people who live in the country illegally.

That’s what people in the country illegally do. Inappropriate For traditional Medicaid or chips. but Some states I created an exception to extend coverage using state dollars.

As of January, 14 states and the District of Columbia are offering Medicaid compensation for children regardless of their immigration status. The 23 states and the District of Columbia use tips to cover pregnant enrollees regardless of their immigration status.

Seven states also offer Medicaid to some adults who are illegal here. new york Regardless of immigration status, choosing to cover those over the age of 65, California will provide compensation to adults aged 19-65 who are exposed to income thresholds, regardless of immigration status.

10. The majority of the public holds a positive view of Medicaid.

According to investigation From KFF, two-thirds of Americans say that those close to them have received health insurance from Medicaid at some point in their lives. Half of the nation also says that they or someone in their family is covered through Medicaid.

Generally, Republicans are less likely to share that view than Democrats and independents, but they say Medicaid is very important. At the same time, less than a third of people want to see a decline in spending on the Medicaid program. In fact, the majority of people living in states that have not expanded Medicaid under the ACA want to do so in their states.

You can access Stateline Reporter Shalina Chatlani [email protected].

Stateline It is a nonprofit news network that is part of the state newsroom and supports a coalition of grants and donors as a public charity of 501C(3). Stateline maintains editorial independence. For questions, please contact editor Scott S. Greenberger. [email protected].