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