Medicaid: The More You Know
It’s important to understand the impact Medicaid has on the health care landscape
- Kate McEvoy
As we move through the process of eligibility redeterminations for the millions of Americans who use Medicaid as their health insurance, it’s important to understand the program impact on the health care landscape.
Who does Medicaid serve?
Medicaid is currently a mainstay of health insurance coverage for almost 90 million people. Even after Medicaid “unwinds” the pandemic-related continuous eligibility requirement, the overwhelming majority of current members will remain eligible and enrolled.
Today, Medicaid covers:
- 4 in 10 births
- 27 million children
- Two-thirds of older adults and people living with disabilities
After declines in enrollment from 2017 through 2019, enrollment in Medicaid grew 11.2% in 2021 and 8.4% in FY 2022. It is expected to contract again in 2023, related to “unwinding”, but will continue to serve at least 70 million people.
Does Medicaid coverage contribute to community health?
Medicaid coverage has been shown to positively influence health, well-being, economic security and life expectancy for children and pregnant women.
- Medicaid coverage of children and pregnant women is linked to fewer chronic conditions, better overall health, improved oral health, and fewer hospitalizations and emergency room visits in adulthood. Most importantly, Medicaid is associated with lower mortality and longer lives.
- Children who were eligible for Medicaid were less likely to report having disabilities and to apply for disability benefits as adults.
- Medicaid coverage of children, and of their mothers during pregnancy, was associated with increased rates of high school graduation, on-time high school graduation, college enrollment, and four-year college graduation.
- Medicaid coverage of children and pregnant women produces considerable financial benefits for both individuals and society at large. It raises both children’s earnings in adulthood and improves intergenerational mobility, which, in turn, increase tax payments that help offset the earlier investment in health coverage.
Is Medicaid an economic contributor?
Medicaid is also an essential source of reimbursement for health care providers including physicians, behavioral health providers, health centers, hospitals and nursing homes.
- Medicaid reflects nearly 1 in 6 dollars spent on health care nationwide, and 1 in 2 dollars spent on long-term services and supports.
- Medicaid is the United States’ single largest payer for behavioral health services, including mental health and substance use care.
- Recent studies have demonstrated that hospitals experienced higher reimbursements and decreased uncompensated care costs, and that health centers experienced increased revenue, in states that have adopted Medicaid expansion.
Is Medicaid helping with additional health-related issues?
State Medicaid programs are continuing to innovate and expand.
- Medicaid programs and their managed care plan partners are addressing social drivers of health by covering screening for services, community health workers, supportive housing services, and integration with SNAP and other sources of assistance.
- Medicaid programs are mobilized around a range of strategies to reduce health disparities, including:
- Improvement in collection and analysis of Race, Ethnicity and Language (REL) data;
- Means of enhancing access to care, including telehealth, community health workers, consumer self-direction for older adults and people with disabilities, and integrated supports for justice-served people; and
- Financial incentives for providers that are tied to reduction of disparities.
- During the pandemic, Medicaid programs have enhanced their programs through:
- Significant benefit coverage expansions around behavioral health, post-partum eligibility, and adult dental benefits;
- Rapidly expanding access to telehealth services; and
- Targeted rate increases for behavioral health providers, nursing homes and home care.
Does the public find value in the Medicaid program?
The American public is strongly supportive of the Medicaid program.
A targeted study found that over 60% of Americans have a connection to the program and are more likely to view the program as important than people with no connection. The Kaiser Family Foundation Health Tracking Poll found:
- A 2019 report, that 75% of the public has a favorable view of Medicaid.
- In its 2022 report, that 92% of Democrats, 80% of Independents and 62% of Republicans support expanding government health insurance coverage for lower-income people in states that have not expanded their Medicaid programs.
- Emerging national and state efforts to solicit, broadcast and act on reports of member experience reinforce that the program has significant value to its members as well.
Is Medicaid a partnership between the state and federal governments?
Since its inception in 1965, Medicaid has been structured as a successful equity partnership between the federal and state governments under which state spending for each and every Medicaid eligible person is matched by federal funds. This model is crucial to states’ capacity to implement program aims.
In 2021, total Medicaid spend exceeded $728 billion in FY 2021, with 31% of costs covered by states and the remaining 69% provided by the federal government. Federal match enables states to:
- Maintain program investments in covered services and provider rates through fluctuations in need for the program related to economic downturns, increased unemployment, public health emergencies and natural disasters; and
- Avoid financial cliffs or caps, beyond which people would have to be waitlisted for the program.
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