Specialist in Health Care Financing
Medicaid is a means-tested, state-operated program providing health and long-term services and supports (LTSS) to certain people who are unable to afford private insurance or pay out-of-pocket for services. Under federal law, Medicaid has approximately 50 distinct eligibility groups; some are mandatory, meaning that states participating in Medicaid must cover them, while others are optional. People aged 65 and over and certain persons with disabilities are among the population groups who may qualify. Eligibility groups are differentiated, in part, by their income and asset thresholds. These financial thresholds are set by states within federal guidelines. The groups and thresholds that states cover determine who has access to Medicaid in that state and who does not.
At the request of states, Congress is currently debating whether and how to allow states to cut back on certain optional eligible populations. Congress demonstrated a similar interest in containing Medicaid eligibility, and therefore spending, around the time of passage of the Deficit Reduction Act of 2005 (DRA, P.L. 109-173). DRA amended federal law to create more limitations on coverage for people who might have transferred assets to meet Medicaid’s means testing requirements. Although this interest in containing Medicaid eligibility is not new, Congress recently made changes to federal law to allow states additional options to expand coverage. Under the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148), for example, states were provided new flexibility to extend coverage to certain people aged 65 and over and younger persons with disabilities with LTSS needs, among other populations.
Despite this activity, recent information to help Congress and other stakeholders evaluate how legislation would affect Medicaid eligibility for aged and disabled individuals is limited. Among the information that would be potentially helpful are profiles of states’ eligibility rules. In 2009, CRS partnered with AARP’s policy research group to conduct a survey of the 50 states and the District of Columbia’s Medicaid eligibility rules for the major aged and disabled groups, including eligibility rules for accessing certain LTSS. This report presents the results of the survey by describing the major eligibility groups and other rules states used to allow people aged 65 and older and younger persons with disabilities to qualify for Medicaid in 2009. It also includes profiles of each state’s eligibility rules.
The report begins with background on the general rules for determining eligibility in Medicaid for aged and disabled individuals. It then provides an explanation of the major eligibility groups about which states were surveyed and the income and resources thresholds associated with each of these groups. Next, the report provides a general explanation of the types of Medicaid services that individuals might be eligible to obtain, by eligibility group. Finally, profiles of each state and the District of Columbia are provided, including a description of the major groups covered and their associated financial thresholds. These state profiles include information on the types of Medicaid benefits that are available to beneficiaries by eligibility group.
Date of Report: June 28, 2011
Number of Pages: 80
Order Number: R41899
Price: $29.95
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