Medicaid: The Coverage Lifeline

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 thean 75 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.

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 comunities 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.

Medicaid Resources