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Medicaid, the nation’s publicly funded health coverage program for low-income Americans, is a primary source of coverage, access, and health care financing, as well as a key component of the expansion of coverage in the Affordable Care Act. How much do you know about Medicaid, the role it plays in the lives of many Americans, how program dollars are spent and how Medicaid eligibility will change under health reform?

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1

Medicaid fills in gaps in the availability of health insurance by:

2

Approximately what percent of Americans receive health insurance coverage through Medicaid at some point during the year?

3

True or False: The Medicaid program is the same in all states.

4

Of the nearly 63 million people served by Medicaid each year, approximately how many are children?

5

Which group accounts for most Medicaid spending?

6

How does the recent growth in Medicaid spending per person compare to the growth in private health insurance premiums per person?

7

Which type of coverage is the primary payer for long-term care services and supports for elderly and disabled individuals?

8

What types of assistance does Medicaid provide for Medicare beneficiaries?

9

Are Medicaid beneficiaries more likely than people with private health insurance to go to the emergency room for non-emergency care?

10

Who will become eligible to gain Medicaid coverage starting in 2014 through the Affordable Care Act?

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Medicaid Quiz

You Answered out of 10 Questions Correctly.

Question

Correct Response

1

Medicaid fills in gaps in the availability of health insurance by:

Answer: Covering certain groups of low-income people

Medicaid is the nation’s health program for low-income people, but does not cover all of the poor. Historically, to qualify for Medicaid, a person must be both low-income and fall into one of the covered eligibility groups, which generally include children, their parents, pregnant women, individuals with disabilities, and the elderly. Eligibility for children in Medicaid is more generous than for adults. In most states, adults without dependent children are ineligible for Medicaid, regardless of how low their income is. Under the Affordable Care Act, Medicaid will be expanded in 2014 to nearly all individuals up to 138% of poverty ($15,415 for an individual, $26,344 for a family of three in 2012) and eligibility will be determined by income and not personal characteristics.

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2

Approximately what percent of Americans receive health insurance coverage through Medicaid at some point during the year?

Answer: About 20%

Medicaid plays an important role by providing health insurance to nearly one-in-five individuals and families across the country who do not have access to other affordable coverage options. During economic downturns, Medicaid enrollment increases as individuals lose jobs and income. Medicaid also provides coverage for medical and long-term care services for millions of low-income people of all ages with disabilities who cannot obtain private health insurance or for whom such coverage is inadequate. In addition, Medicaid helps pay Medicare premiums and fills in gaps in coverage for millions of low-income Medicare beneficiaries.

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3

True or False: The Medicaid program is the same in all states.

Answer: False, states have flexibility to design their own Medicaid programs within federal guidelines

Under federal Medicaid rules, states must cover certain services (such as physician and hospital services) and certain groups of individuals up to defined poverty levels (such as low-income children, parents, pregnant women, disabled individuals, and elderly adults) as a condition of receiving federal Medicaid funds. On average, the federal government pays 57 percent of Medicaid costs for services. However, states also have significant flexibility to determine coverage for optional benefits and groups and in how they deliver and pay for care. As a result, Medicaid programs vary from state to state both in the number and income level of people they cover and in the range of and payment for services covered for each group of individuals.

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4

Of the nearly 63 million people served by Medicaid each year, approximately how many are children?

Answer: One-half.

In fiscal year 2009, just under 50 percent of all Medicaid enrollees, or about 31 million, were children. Together, Medicaid and the Children’s Health Insurance Program (CHIP) cover over one-third of children in the United States, providing them access to needed health care services, including preventative and primary care. Eligibility levels for children in Medicaid and CHIP have expanded over time. Today, all but 4 states cover children at or above 200% of the federal poverty level ($46,100 per year for a family of four in 2012). Medicaid eligibility levels are much lower for parents in most states, and adults without dependent children are typically excluded from coverage.

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5

Which group accounts for most Medicaid spending?

Answer: Elderly and disabled adults.

Although elderly and disabled adults only make up one-quarter of Medicaid beneficiaries, they account for 68% of total costs. This is because these individuals are more likely to have complex healthcare needs that require costly acute and long-term care services. Medicaid provides coverage for individuals with a range of health conditions and disabilities, including children with intellectual or developmental disabilities, young adults with spinal cord or traumatic brain injuries, and older individuals with Alzheimer’s disease, Parkinson’s disease, or diabetes. Medicaid pays for the range of services needed by these individuals to both assist them in managing their conditions and in performing daily living activities.

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6

How does the recent growth in Medicaid spending per person compare to the growth in private health insurance premiums per person?

Answer: Medicaid spending grew slower than private health insurance premiums.

From 2007 to 2011, Medicaid spending per person grew more slowly than private health insurance premiums per person. While spending across the entire health care sector has been increasing, Medicaid spending per person has been increasing more gradually over recent years than it has for other payers. The recent increase in overall Medicaid spending is largely due to an increase in the number of people enrolling in the program. During times of economic downturn, like the recent recession, when unemployment rises and incomes fall, an increasing number of low-income people become eligible for Medicaid. After accounting for enrollment growth, analyses show that Medicaid has been able to keep cost increases below that of other sectors of the health care system.

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7

Which type of coverage is the primary payer for long-term care services and supports for elderly and disabled individuals?

Answer: Medicaid.

Medicaid is the primary payer for long-term care services and supports for low-income individuals across the age spectrum, paying for 40% of all long-term care services each year. Medicaid covers a continuum of long-term care services in a variety of settings, including home and community-based care and institutional care, like a nursing homes. To qualify for Medicaid long- term care services and supports, individuals must be low-income or must have incurred health expenses that have caused them to “spend down” their incomes to Medicaid eligibility levels. Medicare does not cover long-term care services and only pays for post-acute services in long-term care settings. Private long-term care insurance is typically not available or affordable for people who need long-term services and supports. Because paying for long-term services is expensive, many people who need long-term services and supports have exhausted lifetime savings.

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8

What types of assistance does Medicaid provide for Medicare beneficiaries?

Answer: Both are true.

Medicaid plays an important role for nearly 9 million low-income Medicare beneficiaries, known as “dual eligible” beneficiaries, by filling in the gaps in Medicare’s benefit package. Medicaid’s assistance ranges from paying for Medicare premiums and copays to coverage of benefits not offered under Medicare, such as long-term care services and supports in nursing homes and in the community, and, in some states, vision, dental, and case management services. Dual eligible beneficiaries represent 15% of enrollees, but nearly 40% of all Medicaid spending.

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9

Are Medicaid beneficiaries more likely than people with private health insurance to go to the emergency room for non-emergency care?

Answer: No.

According to a study by the National Center for Health Statistics, Medicaid beneficiaries were no more likely to use the emergency room for non-emergency situations than individuals with private insurance. More generally, people with Medicaid fare just as well on most measures of access to preventative and primary care, despite often cited concerns about provider participation; and people with Medicaid have much better access to care than those without insurance.

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10

Who will become eligible to gain Medicaid coverage starting in 2014 through the Affordable Care Act?

Answer: Many low-income adults.

Beginning in 2014, the Affordable Care Act’s Medicaid expansion will provide a new coverage pathway for millions of currently uninsured low income adults, including childless adults who have been historically excluded from Medicaid coverage. The Supreme Court ruling on the ACA maintains the Medicaid expansion, but limits the Secretary’s authority to enforce it, which may impact state decisions to implement the expansion. States that expand Medicaid coverage will receive substantially enhanced federal support to cover newly eligible low-income adults up to 138% of the federal poverty level ($15,415 for an individual, $26,344 for a family of three in 2012). Lawfully residing immigrants will be eligible for the Medicaid expansion (with some restrictions for those who have been residing in the United States for less than five years), while undocumented immigrants will remain ineligible for Medicaid under health reform.

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