Over ** million Americans were estimated to be enrolled in the Medicaid program as of 2023. That is a significant increase from around ** million ten years earlier. Medicaid is basically a joint federal and state health program that provides medical coverage to low-income individuals and families. Currently, Medicaid is responsible for ** percent of the nation’s health care bill, making it the third-largest payer behind private insurances and Medicare. From the beginning to ObamacareMedicaid was implemented in 1965 and since then has become the largest source of medical services for Americans with low income and limited resources. The program has become particularly prominent since the introduction of President Obama’s health reform – the Patient Protection and Affordable Care Act - in 2010. Medicaid was largely impacted by this reform, for states now had the opportunity to expand Medicaid eligibility to larger parts of the uninsured population. Thus, the percentage of uninsured in the United States decreased from over ** percent in 2010 to *** percent in 2022. Who is enrolled in Medicaid?Medicaid enrollment is divided mainly into four groups of beneficiaries: children, adults under 65 years of age, seniors aged 65 years or older, and disabled people. Children are the largest group, with a share of approximately ** percent of enrollees. However, their share of Medicaid expenditures is relatively small, with around ** percent. Compared to that, disabled people, accounting for **** percent of total enrollment, were responsible for **** percent of total expenditures. Around half of total Medicaid spending goes to managed care and health plans.

In 2023, some 47.6 percent of Medicaid and CHIP enrollees were aged between 18 and 64 years, while adults aged 65 years accounted for only eight percent of enrollees. Medicaid program is funded jointly by the federal and the state governments, it provided coverage to nearly 19.5 percent of the U.S. population in 2022. Medicaid vs CHIPMedicaid and the Children’s Health Insurance Program (CHIP) both provide health insurance coverage for children from low-income families. Children who are not eligible for Medicaid but who would otherwise be unable to obtain insurance through a family plan are covered by CHIP. More than five million children were enrolled in CHIP in the U.S. in 2023. Medicaid and CHIP funding rateThe Federal Medical Assistance Percentages (FMAPs) are used to calculate the amount of federal matching funds for State Medicare and CHIP programs. To encourage states to expand coverage for uninsured children the federal matching rates for CHIP are generally 15 points higher than the Medicaid rate. However, unlike permanent federal funding for Medicaid, CHIP federal funding is capped and due to expire in FY 2027.

The number of older individuals – those aged 65 and older – enrolled in the Medicaid health insurance program was projected to be *** million in 2020. Enrollment is expected to increase year-on-year and is forecast to reach ***** million by 2027.

Which enrollment group is the largest? The percentage of people covered by Medicaid has notably increased since 2000, and enrollment has accelerated in recent years due to the program’s expansion under the Affordable Care Act. The elderly represent the smallest enrollment group, and this looks set to continue in the coming years. The number of disabled enrollees is projected to grow to nearly ****** million, while children are expected to remain the largest enrollment group.

Combining Medicaid and Medicare Aged individuals can qualify for Medicaid based on their low-income or via another eligibility pathway, such as receiving Supplemental Security Income. Some seniors may also qualify for both Medicaid and Medicare, and these dual-eligible beneficiaries receive a comprehensive range of medical support. Medicare is a health insurance program primarily aimed at individuals aged 65 and older – this group accounted for around ** percent of all Medicare enrollees in 2019.

In 2023, the criminal cases opened by Medicaid Fraud Control Units (MFCUs) resulted in 814 convictions for fraud. PCS (personal care services) attendants and agencies accounted for 279 fraud convictions, which was significantly more than any other provider type. Overall fraud convictions in 2023 were lower than previous year.

Total criminal convictions increase MFCUs investigate and prosecute Medicaid provider fraud, but also patient abuse or neglect in nursing homes and care facilities. Convictions involving personal care service assistants accounted for nearly a quarter of all the convictions for abuse or neglect in 2020. Overall, the criminal cases opened by MFCUs resulted in 1,143 convictions in 2023, which was lower than the previous year.

Who is eligible for Medicaid? Medicaid is a health care program that helps eligible groups of people obtain health insurance. The plan primarily serves low-income groups, including children, parents, and pregnant women. Historically, low-income adults without children were excluded from the program. However, the Affordable Care Act – signed into law by President Obama in 2010 – created the opportunity for states to expand their Medicaid programs to cover nearly all low-income adults under the age of 65.

There has been a noticeable shift in the distribution of expenditures among Medicaid long-term care services over the past three decades. In 1990, home- and community-based care accounted for 13 percent of the program’s long-term care costs, but this has risen to a majority share of approximately 65 percent by 2022. Institutional care rates continue to fall Medicaid spent approximately 32 billion U.S. dollars on long-term care services in 1990, and close to 90 percent of that went towards institutional care, such as nursing homes and other residential facilities. The decrease over recent years in the proportion of spending devoted to institutional care can be partly attributed to a push towards home- and community-based care. This expansion of services is growing in popularity because individuals can receive treatment in familiar surroundings and benefit from increased levels of comfort. State variations in long-term care costs Medicaid expenditures for long-term care services vary significantly from state to state, which is primarily due to each state being able to administer its Medicaid program differently. On average, Medicaid spent 19 percent on long-term care in 2022.

As of August 1, 2024, approximately 2.5 million Medicaid enrollees have been disenrolled in Texas, the highest number of people disenrolled across all states in the United States. Overall, more than 24.5 million people in the United States have lost their Medicaid coverage, the majority of those terminations were for so-called procedural reasons, which means that the enrollees did not finish the renewal process for various reasons.

California has more Medicaid and CHIP enrollees than any other state in the United States. As of April 2023, approximately 13 million Americans were enrolled in the Medicaid health insurance programs in California, which accounted for approximately 15 percent of the total number of Medicaid enrollees nationwide (94.4 million).

Blow to Medicaid expansion plans California is one of many states that has expanded its Medicaid program under the Affordable Care Act (ACA) to encourage more low-income adults to sign up for health coverage. One of the original aims of the ACA was to limit some of the variations in state Medicaid programs, but the Supreme Court ruled that the expansion should be optional. Governors of the states that did not expand said they were concerned about long-term costs. California is the leading state for Medicaid expenditure, spending approximately 97.8 billion U.S. dollars in FY2020.

Health coverage for children The Children’s Health Insurance Program (CHIP) was created as a complement to Medicaid, expanding the reach of government-funded health coverage to more children in low-income families. As of May 2021, over five million children were enrolled in Medicaid/CHIP programs in California, more than any other state. As of January 2021, the median Medicaid/CHIP eligibility level for children was 255 percent of the federal poverty level.

In 2022, just under four in ten Medicaid/CHIP enrollees were White, non-Hispanic. In comparison, roughly three-quarters of Medicare beneficiaries were White. The Affordable Care Act (ACA) Medicaid expansion in 2014, has helped reduce racial disparities in access to healthcare in the United States.

Medicaid eligibility

Medicaid provides health coverage to certain low-income individuals, families, children, pregnant women, the elderly, and persons with disabilities. Each state has its own Medicaid eligibility criteria in accordance with federal guidelines. As a result, Medicaid eligibility and benefits differ widely from state to state. Medicaid expansion provision under the Affordable Care Act (ACA) allows states to provide coverage for low-income adults by expanding eligibility for Medicaid to 138 percent of the federal poverty line (FPL).

Medicaid coverage gap

Uninsured individuals who live in states that have chosen not to expand Medicaid under the Affordable Care Act (ACA) are referred to as being in the Medicaid coverage gap. As of January 2021, 12 states have not adopted the Medicaid expansion provision under the Affordable Care Act (ACA). More than two million uninsured adults fall into this coverage gap, and among them, more than 60 percent are people of color.

Children accounted for 36.5 percent of Medicaid enrollees in 2021, which was the largest share of all enrollment groups. The elderly and persons with disabilities had the smallest shares, but together they accounted for more than half of all Medicaid expenditure.

Medicaid expenditures per enrollee Medicaid is a joint federal and state health care program in the United States. The program provides medical coverage to millions of Americans and supports a variety of enrollment groups, particularly senior citizens and individuals with disabilities. Medicaid per enrollee spending is significantly higher for these two groups because they require more frequent and costly long-term care in the community and nursing homes. In 2022 of the total U.S. health expenditure on home health care, Medicaid paid one-third.

Millions of Americans are uninsured The United States has a multi-payer health care system, meaning that some Americans will be covered by private health insurance, and others will be covered by a government program such as Medicaid. However, approximately 27.6 million people in the U.S. had no health insurance in 2021, and should they require health care, they would have to pay the full price out of their own pocket. This becomes a real problem for many because the United States has the most expensive health care system in the world.

According to a survey done in March 2024, long wait times on the phone was the most common problem reported by 44 percent of Americans who tried to renew their Medicaid coverage last year before Medicaid unwinding. Another 26 percent mentioned that they did not know what documents were needed to complete re-enrollment. This statistic illustrates the types of problems Medicaid enrollees experienced when they tried to renew their coverage in 2023.

The criminal cases opened by Medicaid Fraud Control Units (MFCUs) resulted in 329 convictions for patient abuse or neglect in nursing homes and care facilities in 2023 – the cases are rising from the 2020 level. Of these, 108 convictions involved nurses or nurse's aides.

Most criminal convictions are for fraud MFCUs investigate and prosecute fraud and patient abuse or neglect by health care providers in the administration of the Medicaid program. Overall, there were 1,143 criminal convictions in 2023, which was lower than previous years. Fraud convictions also decreased in 2023, and 279 of those cases involved PCS (personal care services) attendants and agencies.

How do criminal cases work? The journey that leads to a criminal conviction starts with MFCUs being made aware of a possible case – a referral may come from an external source such as a state Medicaid agency or a member of the public. The case is reviewed for validity, and if the claims are substantiated, the MFCUs will gather further evidence and conduct an investigation. As prosecutors, the MFCUs may file a criminal complaint that could lead to a conviction. MFCUs have proven to be very successful and recovered more than 272 million U.S. dollars from criminal convictions in 2023.

In the fiscal year 2022, Medicaid expenditure in California amounted to a total of about 119 billion U.S. dollars, of which 81 billion U.S. dollars were federal-funded and approximately 38 billion U.S. dollars were state-funded. California had, as expected, the highest spending and also the largest number of people enrolled in Medicaid in the United States. The Federal Medical Assistance Percentage (FMAP) varies by state depending on the state's per capita income compared to the national average.

Medicaid continues to provide comprehensive long-term care in the United States. In 2022, the program was estimated to have paid for 34.2 percent of all home health care and nearly 30 percent of nursing home care. In addition, Medicaid covered over 58 percent of other health, residential, and personal care, which includes payments for intermediate care facilities and other home- and community-based services.

Health care spending in the U.S. Medicaid expenditure accounted for around 16 percent of all U.S. health expenditures in 2021. Overall, health spending in the United States totaled 4.1 trillion U.S. dollars in 2020 – hospital care continues to be the largest spending category. Around 1.3 trillion U.S. dollars was spent on hospital care in 2020, and expenditures are projected to continue on an upward trajectory.

The high price of hospital care Medicare and Medicaid spend significant amounts of money on national health services, and for both programs, hospital care is the largest expense category. Hospital care spending by both Medicare and Medicaid grew by around 20 percent between 2013 and 2019. During the same period, private health insurance spending in this service category accelerated, rising by approximately 90 billion U.S. dollars.

In fiscal year 2021, the Children’s Health Insurance Program (CHIP) spent a total of about 20.9 billion U.S. dollars, of which 15.8 billion U.S. dollars were federal-funded and 5.1 billion U.S. dollars were state-funded. California had, as expected the highest spending and also the largest number of children enrolled in CHIP/Medicaid. The federal government matches spending for both Medicaid and CHIP, but has a higher match rate for CHIP than traditional Medicaid. The Federal Medical Assistance Percentage (FMAP) varies by state depending on the state's per capita income compared to the national average. This statistic illustrates CHIP spending in the United States in FY 2021, by state and state & federal share.

In fiscal year 2021, Medicaid spent 8,651 U.S. dollars per full-year equivalent enrollee. However, spending per enrollee varied by eligibility group with disabled enrollees costing the most per enrollee at 23,935 U.S. dollars. States also show large variations in Medicaid spending per enrollee. This statistic illustrates Medicaid benefit spending per full-year equivalent (FYE) enrollee in the United States in FY 2021, by eligibility group.

2022 saw the largest expenditures on Medicaid in U.S. history. At that time about 824 billion U.S. dollars were expended on the Medicaid public health insurance program that aims to provide affordable health care options to low income residents and people with disabilities. Medicaid was signed into law in 1965. By 1975 around 13 billion U.S. dollars were spent on the program.

Groups covered by Medicaid

There are several components of the Medicaid health insurance program. The Children’s Health Insurance Program (CHIP) was started in 1997 to provide health coverage to families and children that could not afford care. As of 2021, children represented the largest distribution of Medicaid enrollees. Despite having the largest proportion of enrollees, those that were enrolled in Medicaid as children had the lowest spending per enrollee. As of 2021, disabled Medicaid enrollees had the highest spending per enrollee.

Medicaid expenditures

Currently, Medicaid accounts for 19 percent of all health care expenditure in the United States. Expenditures on Medicaid programs vary among the U.S. states and depend heavily on whether Medicaid expansion was accepted after the Affordable Care Act was enacted. California and New York are the top states with the highest Medicaid expenditures. It is projected that Medicaid expenditure will continue to increase at both the state and federal levels.

Medicare is an important public health insurance scheme for U.S. adults aged 65 years and over. As of 2023, an estimated 18.9 percent of the U.S. population was covered by Medicare, an increase from the previous year. As of 2021, California, Florida, and Texas had the largest number of adults aged 65 years and older. The Medicare program Medicare has two primary parts: Medicare Part A covers hospital care and Medicare Part B covers medical and preventative services. Both parts of Medicare are available to those aged 65 years and older under certain conditions. Medicare premiums are variable and depend on the enrollee’s income. Despite a majority of the Medicare enrollees being above the federal poverty line, there are still several programs in place to help cover the costs of healthcare for the elderly. Opinions on elderly care in the U.S. It is estimated that about 23 percent of Medicare enrollees are in fair/poor health. But there are lots of questions about who should pay for or help with elderly care long-term. In a recent survey of U.S. adults, about half of the respondents said that health insurance companies should pay for elderly care. However, a majority of adults also supported a long-term government sponsored health plan like Medicaid. The issue is still hotly debated and politicized in the United States.

In fiscal year 2021, Medicaid spent 8,651 U.S. dollars per full-year equivalent enrollee. However, spending per enrollee varied by state with North Dakota spending the most per enrollee at 12,434 U.S. dollars, while in South Carolina each Medicaid enrollee cost 5,191 U.S. dollars. This statistic illustrates Medicaid benefit spending per full-year equivalent (FYE) enrollee in the United States in FY 2021, by state.

In 2022, the Children’s Health Insurance Program spent a total of about 23.5 billion U.S. dollars on health care. This has risen from just over one billion U.S. dollars in health expenditure from the previous year. This statistic illustrates CHIP health expenditure from 2000 to 2022.