S.I Session 5

Medicare is a federal program that provides health coverage if you are 65 and older or have a severe disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income.

Medicare: 65 and older Medicaid: Low Income

1.) provide health and financial security for people ages 65 and older and younger people with permanent disabilities. 2.) People with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) are eligible for Medicare

Medicaid is the nation's public health insurance program for people with low income

Medicaid covers a broad array of health services and limits enrollee out-of-pocket costs. The program is also the principal source of long-term care coverage for Americans. Medicaid finances nearly a fifth of all personal health care spending in the U.S., providing significant financing for hospitals, community health centers, physicians, nursing homes, and jobs in the health care sector.

Structured as a federal state partnership program. Subject to federal standards, states administer Medicaid programs and have flexibility to determine covered populations, covered services, health care delivery models, and methods for paying physicians and hospitals.

-Under the original 1965 Medicaid law, Medicaid eligibility was tied to cash assistance (either Aid to Families with Dependent Children (AFDC) or federal Supplemental Security Income (SSI) starting in 1972) for parents, children and the poor aged, blind and people with disabilities. -Congress also required Medicaid to help pay for premiums and cost-sharing for low-income Medicare beneficiaries and allowed states to offer an option to "buy-in" to Medicaid for working individuals with disabilities

Medicaid covers nearly half of all births in a typical state, 76% of poor children, 48% of children with special health care needs, 45% of non-elderly adults with disabilities and more than 6 in 20 nursing home residents.

-Managed care plans are responsible for ensuring access to Medicaid services through their networks of providers and are at financial risk for their costs. -Community health centers are a key source of primary care, and safety-net hospitals, including public hospitals and academic medical centers, provide a lot of emergency and inpatient hospital care for Medicaid enrollees.

-Moreover, rates of access to care and satisfaction with care among Medicaid enrollees are comparable to rates for people with private insurance. -Medicaid coverage of low-income pregnant women and children has contributed to dramatic declines in infant and child mortality in the U.S. -A growing body of research indicates that Medicaid eligibility during childhood is associated with reduced teen mortality, improved long-run educational attainment, reduced disability, and lower rates of hospitalization and emergency department visits in later life

-Medicaid is low-cost compared to private insurance, largely due to lower Medicaid payment rates for providers. -Medicaid spending per enrollee has also been growing more slowly than private insurance premiums and other health spending benchmarks.

Financed jointly by the federal government and states. The federal government matches state Medicaid spending; the federal match rate varies by state based on a federal formula and ranges from a minimum of 50% to nearly 75% in the poorest state.

Medicaid has very strong support among those who are disproportionately served by Medicaid including children with special health care needs, seniors, and people with disabilities.