Editing Medicaid (section)

== Budget and financing ==
[[File:U.S. healthcare GDP.gif|none|Medicaid spending as part of total [[Health care in the United States|U.S. healthcare]] spending (public and private). Percent of [[gross domestic product]] (GDP). [[Congressional Budget Office]] chart.<ref>[http://www.cbo.gov/ftpdocs/87xx/doc8758/MainText.3.1.shtml#1077141 The Long-Term Outlook for Health Care Spending] {{Webarchive|url=https://web.archive.org/web/20120126173451/http://www.cbo.gov/ftpdocs/87xx/doc8758/MainText.3.1.shtml#1077141 |date=January 26, 2012 }}. Figure 2. [[Congressional Budget Office]].</ref>|thumb|603x603px]]
Unlike Medicare, which is solely a federal program, Medicaid is a joint federal-state program. Each state administers its own Medicaid system that must conform to federal guidelines for the state to receive Federal [[matching funds]]. Financing of Medicaid in the [[American Samoa]], [[Puerto Rico]], [[Guam]], and the [[United States Virgin Islands|U.S. Virgin Islands]] is instead implemented through a [[Block grant (United States)|block grant]].<ref>{{Cite web | url=https://www.dcreport.org/2019/06/11/puerto-ricos-post-maria-medicaid-crisis/ |title = Puerto Rico's Post-Maria Medicaid Crisis|date = June 11, 2019}}</ref> The Federal government matches state funding according to the [[Federal Medical Assistance Percentages]].<ref>[http://www.ssa.gov/OP_Home/ssact/title11/1101.htm SSA.gov], Social Security Act. Title IX, Sec. 1101(a)(8)(B)</ref> The wealthiest states only receive a federal match of 50% while poorer states receive a larger match.<ref>{{cite book|last1=Mitchell|first1=Alison|title=Medicaid's Federal Medical Assistance Percentage (FMAP)|date=April 25, 2018|publisher=Congressional Research Service|location=Washington, DC|url=https://fas.org/sgp/crs/misc/R43847.pdf|access-date=5 May 2018}}</ref>

Medicaid funding has become a major budgetary issue for many states over the last few years, with states, on average, spending 16.8% of state general funds on the program. If the federal match expenditure is also counted, the program, on average, takes up 22% of each state's budget.<ref>{{cite web|url=http://www.nasbo.org/Publications/PDFs/Fiscal%20Survey%20of%20the%20States%20June%202007.pdf|title=Microsoft Word – Final Text.doc<!-- Bot generated title -->|website=nasbo.org|access-date=November 27, 2007|archive-url=https://web.archive.org/web/20071127095746/http://www.nasbo.org/Publications/PDFs/Fiscal%20Survey%20of%20the%20States%20June%202007.pdf|archive-date=November 27, 2007|url-status=dead}}</ref><ref>[http://ccf.georgetown.edu/index/medicaid-and-state-budgets-looking-at-the-facts "Medicaid and State Budgets: Looking at the Facts"], Georgetown University Center for Children and Families, May 2008.</ref> Some 43 million Americans were enrolled in 2004 (19.7 million of them children) at a total cost of $295 billion.<ref>{{cite web|url= http://www.cbpp.org/cms/index.cfm?fa=view&id=2223 |title=Policy Basics: Introduction to Medicaid|date=January 6, 2009}}</ref> In 2008, Medicaid provided health coverage and services to approximately 49 million low-income children, pregnant women, elderly people, and disabled people.{{Citation needed|date=January 2012}} Federal Medicaid outlays were estimated to be $204 billion in 2008.<ref>[https://web.archive.org/web/20070820164040/http://www.whitehouse.gov/omb/budget/fy2008/hhs.html "Budget of the United States Government, FY 2008"], Department of Health and Human Services, 2008.</ref> In 2011, there were 7.6 million hospital stays billed to Medicaid, representing 15.6% (approximately $60.2 billion) of total aggregate inpatient hospital costs in the United States.<ref>Torio CM, Andrews RM. National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011. HCUP Statistical Brief #160. Agency for Healthcare Research and Quality, Rockville, MD. August 2013. [http://hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp] {{Webarchive|url=https://web.archive.org/web/20170314171958/https://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp|date=March 14, 2017}}</ref> At $8,000, the mean cost per stay billed to Medicaid was $2,000 less than the average cost for all stays.<ref>{{cite journal |vauthors=Pfuntner A, Wier LM, Steiner C |title=Costs for Hospital Stays in the United States, 2011. |journal=HCUP Statistical Brief |issue=168 |publisher=Agency for Healthcare Research and Quality |location=Rockville, MD |date=December 2013 |pmid=24455786 |url=http://hcup-us.ahrq.gov/reports/statbriefs/sb168-Hospital-Costs-United-States-2011.jsp |access-date=January 24, 2014 |archive-date=July 29, 2020 |archive-url=https://web.archive.org/web/20200729154431/https://www.hcup-us.ahrq.gov/reports/statbriefs/sb168-Hospital-Costs-United-States-2011.jsp |url-status=dead }}</ref>

Medicaid does not pay benefits to individuals directly; Medicaid sends benefit payments to health care providers. In some states Medicaid beneficiaries are required to pay a small fee (co-payment) for medical services.<ref name=":4" /> Medicaid is limited by federal law to the coverage of "medically necessary services."<ref name="Adler">{{cite journal | vauthors = Adler PW | title = Is it lawful to use Medicaid to pay for circumcision? | journal = Journal of Law and Medicine | volume = 19 | issue = 2 | pages = 335–53 | date = December 2011 | pmid = 22320007 | url = http://www.doctorsopposingcircumcision.org/pdf/2011-12_Adler.pdf | access-date = April 30, 2012 | archive-url = https://web.archive.org/web/20141129090312/http://www.doctorsopposingcircumcision.org/pdf/2011-12_Adler.pdf | archive-date = November 29, 2014 | url-status = dead }}</ref>

On November 25, 2008, a new federal rule was passed that allows states to charge premiums and higher co-payments to Medicaid participants.<ref>[http://www.gpoaccess.gov/fr/ search: 42 CFR Parts 447 and 457] {{webarchive|url=https://web.archive.org/web/20120310235019/http://www.gpoaccess.gov/fr/ |date=March 10, 2012 }}</ref> This rule enabled states to take in greater revenues, limiting financial losses associated with the program. Estimates figure that states will save $1.1 billion while the federal government will save nearly $1.4 billion. However, this meant that the burden of financial responsibility would be placed on 13 million Medicaid recipients who faced a $1.3 billion increase in co-payments over 5 years.<ref>{{cite news|url=https://www.nytimes.com/2008/11/27/us/27medicaid.html |work=The New York Times |first=Robert |last=Pear |title=New Medicaid Rules Allow States to Set Premiums and Higher Co-Payments |date=November 27, 2008}}</ref> The major concern is that this rule will create a disincentive for low-income people to seek healthcare. It is possible that this will force only the sickest participants to pay the increased premiums and it is unclear what long-term effect this will have on the program.

A 2019 study found that Medicaid expansion in [[Michigan]] had net positive fiscal effects for the state.<ref>{{Cite journal|last1=Levy|first1=Helen|last2=Ayanian|first2=John Z.|last3=Buchmueller|first3=Thomas C.|last4=Grimes|first4=Donald R.|last5=Ehrlich|first5=Gabriel|title=Macroeconomic Feedback Effects of Medicaid Expansion: Evidence from Michigan|journal=Journal of Health Politics, Policy and Law|volume=45|pages=5–48|language=en|doi=10.1215/03616878-7893555|pmid=31675091|year=2020|issue=1|doi-access=free}}</ref>

===Medicaid estate recovery===
{{main|Medicaid estate recovery}}
Since the Medicaid program was established in 1965, "states have been permitted to recover from the estates of deceased Medicaid recipients who were over age 65 when they received benefits and who had no surviving spouse, minor child, or adult disabled child."<ref name="Kiely">Eugene Kiely, [http://www.factcheck.org/2014/01/medicaid-estate-recovery-program/ Medicaid Estate Recovery Program], [[FactCheck.org]], [[Annenberg Public Policy Center]], University of Pennsylvania (January 10, 2014).</ref> In 1993, Congress enacted the [[Omnibus Budget Reconciliation Act of 1993]], which required states to attempt to recoup "the expense of long-term care and related costs for deceased Medicaid recipients 55 or older."<ref name="Kiely"/> The Act allowed states to recover other Medicaid expenses for deceased Medicaid recipients 55 or older, at each state's choice.<ref name="Kiely"/> However, states were prohibited from estate recovery when "there is a surviving spouse, a child under the age of 21 or a child of any age who is blind or disabled." The Act also carved out other exceptions for adult children who have served as caretakers in the homes of the deceased, property owned jointly by siblings, and income-producing property, such as farms."<ref name="Kiely"/> Each state now maintains a Medicaid estate recovery program, although the sum of money collected significantly varies from state to state, "depending on how the state structures its program and how vigorously it pursues collections."<ref name="Kiely"/>