Medicaid
What is Medicaid?
Medicaid is health insurance for some of the most vulnerable populations in our community:
- 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
- Individuals with disabilities
- 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.
- As part of the Affordable Care Act, many states chose to expand Medicaid to all adults who have very limited income.
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:
- Residential and employment support services, as well as services in schools for children with disabilities
- Access to Medicaid helps people find and maintain work.
- People with disabilities in states that expanded Medicaid are more likely to be able to work.
- Rehabilitative and nursing services
- Durable medical equipment and assistive technology
- Personal care services
- Transportation to medical appointments
- Residential and employment support services, as well as services in schools for children with disabilities
- 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.
- All states offer some home and community-based services (HCBS) through Medicaid.
- The vast majority of people with disabilities and older adults prefer HCBS over institutional services.
- HCBS allow people to live independently, fully participate in their communities, and avoid the health and safety risks associated with living in a congregate setting (especially during the COVID-19 pandemic).
- Medicaid has an “institutional bias,” meaning states are required to cover most institutional services but coverage of HCBS is optional. As a result, many states cap access to HCBS and have long waitlists for services.
- Access to HCBS and the specific services covered vary by state.
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.
- 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.
- 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)