Informational Brief

Who Is Eligible

Medicaid is America’s joint federal-state national health insurance program that covers low-income citizens of all ages. Any families or pregnant women with incomes below 138% of the federal poverty line are considered low-income and are eligible for the Medicaid entitlement program. Other eligible beneficiaries include senior and disabled people who receive Supplemental Security Income (SSI). In addition to these mandatory eligibility rules, states can also request federal funds for optional populations such as pregnant women and people with high health-related expenses that have incomes above the mandatory coverage limits.

Where the Money Comes From

The federal government matches state Medicaid spending by a one-to-one ratio or greater. States and the federal government combined spent about $476 billion on Medicaid in 2014. In 2015, Medicaid-related expenses accounted for 57% of state’s federal funds.

Where the Money Goes

Medicaid pays for the services to eligible parties indirectly by paying participating healthcare facilities rather than individual patients. Beyond the minimum federal requirements, each state has the freedom to elect additional services or providers and set their own premiums, provider rates, etc.

Medicaid Effectiveness

Medicaid costs substantially less than private insurance to cover comparable health issues and is found to be cost-effective. Under the Obama Administration’s expansion initiative, Medicaid helped reduce the number of uninsured Americans from 45 million to 29 million as of 2016. Traditionally, Republicans believe the program is too costly and try to cut back on Medicaid spending and eligibility (which is happening right now) while Democrats think it is vital to the overall well-being of American citizens and seek to expand coverage.

Engagement Resources

This brief was compiled by Ann Furbush. If you have comments or want to add the name of your organization to this brief please contact



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