Government Health Insurance Programs
State flexibility vs. national uniformity
Debate between allowing states significant flexibility in managing their Medicaid programs and ensuring uniformity across the country
Medicare
Federal health insurance program for people aged 65 and older, certain younger people with disabilities, and those with end-stage renal disease
Medicaid
Joint federal-state public health insurance program for the indigent, offering significant state flexibility in program operation
Patient Protection and Affordable Care Act (ACA)
Legislation making wide-ranging changes to Medicaid, CHIP, and Medicare, including significant Medicaid eligibility expansion, altered eligibility for children in Medicaid and CHIP, and added new benefits to Medicare
Medically Needy
Medicaid category covering individuals with extremely high medical expenses who earn too much money to be otherwise eligible for Medicaid
Entitlement programs
Programs where everyone eligible is legally entitled to receive benefits, with no cap on spending, e.g., Medicaid and Medicare
Block grant programs
Programs with a defined sum of money allocated for a particular program over a certain amount of time, with no additional funds available if program costs exceed the allocation, e.g., CHIP
Children's Health Insurance Program (CHIP)
Public health insurance program for children not qualifying for Medicaid, funded by federal and state governments
Categorical eligibility
Requirement for individuals to fit within a category (e.g., pregnant women) covered by the Medicaid program
Immigrant restrictions
Rules restricting immigrant eligibility for Medicaid, including a 5-year bar for most immigrants who come to the United States after August 22, 1996
Mandatory benefits
Services that all Medicaid programs must cover, such as inpatient and outpatient hospital services, physician services, and laboratory and x-ray services
Optional benefits
Services that states have the flexibility to cover in their Medicaid programs, such as prescription drugs, physical therapy, and dental services
ACA Medicaid expansion
Significant expansion of Medicaid eligibility to include all non-Medicare-eligible individuals younger than 65 years, with incomes up to 133% FPL