Making Sense of Medicaid

Centers for Medicare and Medicaid Services blue and yellow "CMS" logo.

Medicaid, a government program established in 1965 funding healthcare for qualified persons living below the poverty level and/or who have disabilities is a free or low-cost national public health insurance program supported by the federal government and the state. Medicaid is a critical component of the U.S. healthcare system, covering about 72.4 million Americans, including eligible low-income adults, pregnant women, children, older adults, and people with disabilities. Despite its role as a lifeline for vulnerable populations, Medicaid often faces controversies and social stigma, a negative label characterized by one or more personal traits that form a stereotype about the individual. These controversies most likely stem from concerns over funding, coverage, and political discourse of health care reform. 

History 

Medicaid was established in 1965 under Title XIX of the Social Security Act, enacted and signed into law by President Lyndon B. Johnson. Its purpose was to provide quality healthcare coverage to low-income populations. Policy changes made to the Social Security Act from 1967 to 1995 expanded Medicaid coverage to persons with disabilities and children and led to the creation of the Children’s Health Insurance Program (CHIP). CHIP addresses the sector of children in families with incomes too high for Medicaid but still too low for private health insurance. In 2010, the Affordable Care Act (ACA), colloquially known as Obamacare, was enacted and significantly reformed Medicaid and healthcare in the U.S. These reforms included expanding eligibility, enforcing consumer protections, such as allowing young adults to stay on their parent’s insurance until the age of 26, and requiring middle-market employers to offer more affordable health insurance. This expansion aimed to provide coverage to millions of uninsured individuals. Within its comprehensive coverage, states are obligated to cover mandatory benefits but vary by state with coverage beyond the mandatory benefits. These benefits include, but are not limited to, services like transportation to healthcare, pediatric care, and inpatient and outpatient hospital services. Some optional benefits that depend on the state include respiratory care for ventilator-dependent individuals, hospice, vision care, prosthetics, and physical and occupational therapy.  

Eligibility 

Eligibility is often based on income, money earned on a regular basis through work with limits relative to the Federal Poverty Line, a governmental standard of measurement indicating the income level of when an individual or family is designated as poor 

2024 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA 
Persons in the family/household  Poverty guideline 
1  $15,060 
2  $20,440 
3  $25,820 
4  $31,200 
5  $36,580 
6  $41,960 
7  $47,340 
8  $52,720 
For families/households with more than 8 persons, add $5,380 for each additional person. 

Eligibility varies by state but generally covers those who are considered low-income and fit into one of these three categories. 

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About Author

Alexa Pena
Alexa Pena is originally from Houston, Texas, but she is currently in Austin attending the University of Texas at Austin. She is majoring in Rhetoric & Writing and Human Dimensions in Organizations with a minor in Creative Writing. She plans on returning to school to earn her M.F.A in Creative Writing and eventually teaching higher education. Her favorite genres are creative nonfiction, short stories, essay and expository writing. A fun fact about her is that she is a classically trained vocalist!

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