Medicaid

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What is Medicaid?

Medicaid is a critical source of healthcare services for people with disabilities  and other populations, including:

  • Low-income children, pregnant women, and parents
    • Medicaid is the largest insurer for children in the country and provides extra services and protections for children with special health care needs
  • Older adults (many people on Medicare also receive Medicaid)
  • People with serious medical needs

More than 10 million non-elderly people with disabilities receive Medicaid coverage.

The Medicaid program is a partnership between the federal government and each state:

  • The federal government sets the foundation and requirements for what each state must provide. 
  • State governments can add more services and eligible populations than what is federally required.
    • As part of the Affordable Care Act, many states chose to expand Medicaid to all adults who have very limited income.
      • The expansion population includes millions of people with disabilities who do not meet the strict federal definition or who previously could not access doctors who could document their disabilities to help them get Medicaid.
      • Some states are still considering this expansion. Check the status of your state here.
    • In some states, Medicaid has a different name (such as Medi-Cal in California and MassHealth in Massachusetts).
      • Because of these different names, and the different ways that states can offer Medicaid, many people do not even realize they have this type of insurance.
      • You can check the name of Medicaid in your state here.

Medicaid covers approximately 1 in 5 Americans, including almost half of adults and children with disabilities in the United States. 

Medicaid is a unique lifeline for people with disabilities to access the care and supports they need:

  • Medicaid includes a wide range of services that allow people with disabilities to live, work, and participate in the community, including:
    • Home and Community-Based Services
      • Medicaid provides opportunities for people to receive services in their home and community, rather than in institutions or isolated from their families
      • These services help people with functional limitations, such as those with intellectual or developmental disabilities, so they can perform basic daily activities
    • Residential and employment/education support services
    • Rehabilitative and nursing services
    • Durable medical equipment and assistive technology
    • Personal care services
    • Transportation to medical appointments
  • Medicaid is the largest insurer for long-term services and supports as well as mental health care and substance use disorder treatment, filling the gaps left by other insurance plans that fail to offer this level of care.
  • Other insurance plans are not required to cover many of these services, especially those provided in the home and community.

Medicaid improves access to care and health outcomes for everyone.

What’s at Stake?

When the federal government cuts spending for Medicaid, states cannot continue to provide all of the services for all of the people who need them.

If someone meets the requirements to be eligible for Medicaid, they are guaranteed coverage.

  • Spending cuts force states to limit the categories of people they can cover under Medicaid.
  • Eligibility requirements become stricter.
    • These requirements typically impose additional burdens on people with disabilities.
    • Caregivers for family members will also face more barriers to continue receiving Medicaid.
  • People who receive Medicaid have certain rights that ensure they are treated fairly and equally.
    • People who lose their Medicaid could lose these consumer protections, such as the right to appeal an unfair denial of care.

Medicaid has equal protection requirements so all people can access the care they need.

  • States will need to limit the services they can offer, or make the requirements for the services stricter, since states must meet basic access requirements for all of the services they provide.
    • Optional services can have waiting lists – the average wait time for people to access Home and Community Based Services is over two years already.
  • Services for people with disabilities that are not required by the federal government – such as home and community-based services – are more likely to get cut.
    • Home and Community Based Services are largely optional for states. Since a significant amount of Medicaid spending goes to these services, especially for people with disabilities, it is a likely target for states to try to reduce costs.
  • More expensive services – like long-term care and prescription medications – will also become harder to access, especially as health care keeps getting more expensive.

Additional Resources

Medicaid (NHeLP)

Medicaid Works for People with Disabilities (Center on Budget and Policy Priorities)

The Basics: Medicaid Eligibility and Benefits (National Health Policy Forum)

10 Things to Know about Medicaid (Kaiser Family Foundation)

Medicaid’s Role for Children with Special Health Needs (Kaiser Family Foundation)

How Medicaid Protects Children with Special Health Care Needs (Families USA)

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