Medicaid Information by Topic
Eligibility
Medicaid and CHIP provide health coverage to nearly 60 million Americans, including children, pregnant women, parents, seniors and individuals with disabilities. In order to participate in Medicaid, Federal law requires States to cover certain population groups (mandatory eligibility groups) and gives them the flexibility to cover other population groups (optional eligibility groups). More information is available in the Eligibility section.
Benefits
States establish and administer their own Medicaid programs, and determine the type, amount, duration, and scope of services within broad federal guidelines. States are required to cover certain “mandatory benefits,” and can choose to provide other “optional benefits” including prescription drugs. States receive federal matching funds to provide these benefits. More information is available in the Benefits section.
Cost Sharing
States have the option to charge premiums and to establish out of pocket spending (cost sharing) requirements for Medicaid enrollees. Out of pocket costs may include copayments, coinsurance, deductibles, and other similar charges. More information is available in the Cost Sharing section.
Waivers
The Social Security Act authorizes multiple waiver and demonstration authorities to allow states flexibility in operating Medicaid programs. Each authority has a distinct purpose, and distinct requirements. To find out what kinds of waivers and demonstrations have been proposed and/or approved in each State, see the list below. This option will allow you to find a waiver operated under a specific authority. More information is available in the Waivers section.
Long-Term Services & Supports
The Medicaid program allows for the coverage of Long Term Care Services through several vehicles and over a continuum of settings. This includes Institutional Care and Home and Community Based Services (HCBS). Please click on this option for more information. More information is available in the Long-Term Services & Supports section.
Delivery Systems
States have choices in their approach to reimbursement and delivery system design under the Medicaid Program. More information is available in the Delivery Systems section.
Quality of Care
Medicaid and the Children’s Health Insurance Program seek to provide safe, effective, efficient, patient-centered, high quality and equitable care to all enrollees. To achieve these goals, the Centers for Medicare & Medicaid Services (CMS) partners with States to share best practices and to provide technical assistance to improve the quality of care. More information is available in the Quality of Care section.
Financing & Reimbursement
Medicaid is jointly funded by the Federal government and the States. The Federal government pays States for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP). More information is available in the Financing & Reimbursement section.
Data & Systems
Medicaid.gov is intended to become a major resource for information on Medicaid systems, coding information and data. The plan is to over time enhance the current capabilities of these Medicaid systems to share timely and meaningful Medicaid data. More information is available in the Data & Systems section.
Outreach & Enrollment
The Center for Medicaid and CHIP Services (CMCS) works with States to identify and enroll people who are eligible for Medicaid or the Children’s Health Insurance Program but who are not enrolled. More information is available in the Outreach & Enrollment section.
Program Integrity
The Centers for Medicare & Medicaid Services (CMS) is committed to combating Medicaid provider fraud, waste, and abuse which diverts dollars that could otherwise be spent to safeguard the health and welfare of Medicaid enrollees. More information is available in the Program Integrity section.
Children’s Health Insurance Program (CHIP)
The Children’s Health Insurance Program (CHIP) provides health coverage to nearly 8 million children in families with incomes too high to qualify for Medicaid, but can’t afford private coverage. Signed into law in 1997, CHIP provides Federal Matching Funds to States to provide this coverage. More information is available in the Children’s Health Insurance Program (CHIP) section.
