Medicaid

Health Insurance

SOCIAL ISSUES IN THE UNITED STATES

REASONS FOR HEALTH INSURANCE

TYPES OF PLANS IN THE UNITED STATES

Medicaid

Medicaid programs provide medical coverage for some people with low incomes, especially children and pregnant women. Depending on individual state eligibility requirements, Medicaid may also provide coverage for adults with certain disabilities. State programs that meet federal guidelines qualify to receive federal funding that pays for most of the program’s cost. These guidelines use federal statistics that define the poverty level (minimum level of income below which households are considered poor) to help states determine which low-income families are eligible for Medicaid.

As originally conceived, any household that fell below the federal poverty level would qualify for Medicaid benefits. In practice, however, budget shortfalls have forced states to vary eligibility standards for Medicaid. In a particular budget cycle, for example, a given state might set its eligibility requirements at 80 percent of the federal poverty level. For that year, households earning 79 percent of the federal poverty level could receive government-paid health care, but those earning 81 percent could receive no Medicaid benefits.

Advocates for the poor have led calls for Medicaid reform that would reinstate health insurance for all Americans below the federal poverty level. Between 1989 and 1995 the state of Oregon made changes in health care policy that many other states considered a model for national Medicaid reform. Oregon passed several pieces of legislation—collectively known as the Oregon Health Plan—that shifted its Medicaid requirements away from a mechanism that divided the population falling below federal poverty-level standards. Instead of asking who among the poor should receive state assistance with medical costs, the state asked what services the poor should receive, since there were not enough resources to provide all services to all qualified citizens. The Oregon Health Plan became the first state plan to limit public funding for certain health care services, but in doing so it expanded basic services to virtually all of the state’s poor citizens.

DISABILITY INSURANCE
OBTAINING COVERAGE
FEATURES OF HEALTH INSURANCE POLICIES
LEVEL OF COVERAGE
SPECIFIC BENEFITS
HISTORY IN THE UNITED STATES
HEALTH INSURANCE IN CANADA
HEALTH INSURANCE IN OTHER COUNTRIES

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