One in Five Individuals in U.S. Relies on Medicaid

Medicaid is the country’s most inclusive health care program, providing high quality, affordable coverage to more than 90 million low-income individuals. Medicaid is the largest source of federally supported health care coverage. In exchange for federal funding, states must meet a number of requirements governing who is eligible, what health care must be provided, and protections for enrollees.

The National Health Law Program defends Medicaid by protecting the rights of Medicaid beneficiaries and enforcing Medicaid law in the courts, and advocates for Medicaid policies and laws in Congress and statehouses from coast to coast that meet the needs of low-income individuals, families, underserved communities, and people historically discriminated against by private health care insurance companies, such as people of color, women, people living with disabilities, and LGBTQ individuals.

Medicaid Unwinding

The federal COVID-19 Public Health Emergency (PHE) implemented flexibilities that help people across the country get on, and stay on, Medicaid. As a result, Medicaid enrollment numbers swelled during the pandemic.

Originally, the flexibilities and protections put in place during the pandemic were going to end with the end of the federal COVID-19 public health emergency (PHE). However, Congress passed the Consolidated Appropriate Act of 2023, which set the end date for the pandemic related Medicaid continuous coverage requirement as March 31, 2023. This means that state Medicaid agencies will begin the process of redetermining Medicaid eligibility for those beneficiaries who have not had their coverage renewed during the PHE as early as February 1, 2023. Medicaid terminations will begin as early as April 1, 2023 and end 14 months after the process starts, but some states will work to do it more quickly. It is anticipated that millions of individuals and families could lose coverage through this unwinding process.

Public education, outreach and advocacy will be critical to ensuring that individuals and families do not erroneously lose coverage. NHeLP, our partners, and other organizations will be supporting advocates on the ground to ensure a smooth unwinding process that preserves Medicaid coverage for all people who remain eligible.

NHeLP’s litigation team is monitoring the continuous coverage unwinding and focusing on this litigation. If you are interested in discussing litigation, please contact NHeLP’s Litigation Director, Jane Perkins at [email protected].

What Medicaid Covers

Medicaid covers a broad range of health care treatment and services for low-income individuals, families and underserved communities. Federal law requires every state Medicaid program cover a set of “mandatory” services, and states also cover additional “optional” services. The National Health Law Program advocates for low-income individuals, families and underserved communities for quality and comprehensive health care coverage.

Medicaid Managed Care

More than 81 percent of people enrolled in Medicaid receive health care services through managed care. The National Health Law Program advocates for robust consumer protections in managed care, holding Managed Care Organizations (MCOs) and state agencies accountable for their obligations to Medicaid enrollees.

Medicaid Section 1115 and Home-and-Community-Based Services Waivers

Medicaid Section 1115 waivers allow states to examine innovative ways to deliver care by waiving certain requirements of the Medicaid Act. The National Health Law Program works everyday to ensure that states use Medicaid Sec. 1115 waivers to conduct true innovations that are consistent with the requirements of the section (e.g., that they are indeed experiments) and are designed to improve health care coverage. Home-and-community based waivers, usually through Section 1915 of the Social Security Act, permit states to provide targeted services to help people with disabilities and older individuals stay in their communities, and out of institutions.

Medicaid Expansion

The Affordable Care Act created a new Medicaid eligibility group for low-income adults earning up to 138 percent of the Federal Poverty Level, providing coverage to millions of newly eligible low-income workers, students, parents, single adults and people with disabilities and chronic health conditions. The National Health Law Program works with state partners to convince states of the benefits of Medicaid expansion and to defend against threats that would reduce access to care in states that have already expanded.

Doula Medicaid Project

The National Health Law Program’s Doula Medicaid Project seeks to improve health outcomes for pregnant Medicaid enrollees by ensuring that all pregnant individuals enrolled in Medicaid who want access to a doula, will have one.

Medicaid Resources