Medicaid is an “entitlement” program. That means anyone who meets eligibility criteria related to poverty has a right to enroll and receive Medicaid coverage. It also means states have guaranteed financial support from Washington for part of the cost of their Medicaid programs if the states cover certain “mandatory” populations:
Children through age 18 in families with income below 138 percent of the federal poverty level. To most people, poverty means extremely poor. In the United States, poverty means thousands of surveyors, statisticians, analysts, and bureaucrats write thousands of pages explaining poverty. The complexity of the details is mind-numbing. The Census Bureau updates the figures every year. The poverty level of a state is used to determine the eligibility of many government entitlement programs, not just Medicaid. For 2017, the poverty level was set at $28,290 for a family of four. The Medicaid eligibility is $39,040. In 2015, 43.1 million people (13.5%) lived in poverty.
Pregnant women with income below 138 percent of the poverty line. For a single person, the poverty level is $12,060.
Numerous exceptions exist including seniors and persons with disabilities with income below the poverty line, and medically needy people with higher income but with high medical expenses, such as for nursing home care, that reduces their disposable income. Obamacare includes an additional category defined as “near-poor non-disabled adults without children”.
States have broad flexibility to determine who is covered and at what income levels, Thirty-one states and the District of Columbia expanded Medicaid under health reform to parents and childless adults up to 138 percent of the poverty line, but in the remaining states, eligibility is low. Not all low-income Americans are eligible for Medicaid. Childless adults over 21 who are not disabled, pregnant, or elderly are generally ineligible for Medicaid in the 19 non-expansion states, no matter how poor they are. Legal immigrants are not eligible for Medicaid during their first five years in this country, even if they meet all eligibility requirements.
In Health Attitude, I discussed whether healthcare is a right or a privilege. That is what the debate is about. Based on many lectures with Q&A and feedback from many emails, I conclude our population and Congress are split roughly 50/50 on the question. Unfortunately, the debate is partly economic, but mostly political. The political issue is the current legislative proposal would cause 20 million people to lose healthcare insurance. If that figure is correct, the cost to provide healthcare would be between 100 and 200 billion dollars per year. The waste, fraud, inefficiency, defensive medicine, lack of tort reform, legalized corruption of Congress and the pharmaceutical industry combined cost between $500 billion and $1.5 trillion per year. The problem is the cost of delivering healthcare, not who receives it. Poverty The special interests have firm control to keep it that way. Read more about Medicaid and Medicare policy choices in Health Attitude: Unraveling and Solving the Complexities of Healthcare.
