
As Washington, D.C. changes hands following the 2024 election, every aspect of health policy is potentially poised for change. One program that has drawn attention in the early days of the new administration is Medicaid. Many middle- and upper-class Americans assume Medicaid has nothing to do with them, but the program’s scale and reach is vast. As patient advocates, it’s important to know at least the basics of our healthcare system. Here are 12 facts about Medicaid that every patient advocate should know:
- Medicaid is the largest public insurance program for low-income Americans. It covers one-fifth of all Americans (more than 79 million people), including nearly 40% (or 38 million) of children.
- Income is the primary factor in determining eligibility for Medicaid, but the income threshold varies by state. The national median income requirement is 138% of the federal poverty level (FPL), or about $21,500 in annual income for an individual. But in Texas, the cut off is 15% of FPL, or $3,873 per year for a family of three.
- Other eligibility criteria includes age, health condition or disability status, and caregiver status (e.g., a single adult may not qualify while a parent or caregiver with the same income may).
- Overall Medicaid spending was $880 billion in 2023. That equates to 8% of overall federal spending in 2024. By comparison, Social Security accounted for 21%.
- Most people on Medicaid are not subject to premiums or deductibles. However, eight states have programs in place to impose premiums on Medicaid enrollees. Federal rules prevent states from charging premiums for families who earn less than 150% of the federal poverty level, and limit consumer costs to 5% of a family’s income.
- Undocumented immigrants are not eligible for Medicaid.
- Most (61%) non-elderly adults on Medicaid have full- or part-time jobs.
- 12.5 million Americans qualify for both Medicaid and Medicare. Most are elderly, but 37% are under 65 and qualify based on a disability. This group is referred to as ‘dually eligible’ or ‘Dual Eligibles’ (and sometimes, just ‘Duals’).
- People over age 65 who qualify for Medicaid do so on the basis of income and asset limits, according to state-specific Medicaid requirements. Some seniors qualify for Medicaid only after spending down any income they have in excess of the income limit for Medicaid eligibility. Medicaid coverage supplements Medicare coverage, such as for nursing home services that Medicare does not cover.
- Medicaid is jointly funded by the federal government and the states. The federal government share was 69% (more than $600 billion) of Medicaid costs in 2023. The states covered 31%, or about $275 billion.
- The federal-state financing split varies by state. The lower the per capita income in a state, the more the federal government contributes. For example, 76% of Medicaid funding in Mississippi comes from the federal government. That share is only 50% in states such as Massachusetts, Connecticut, New York, and California.
- The Affordable Care Act (“Obamacare”) gave states incentives to expand Medicaid eligibility via a 90% federal match to cover the cost of expanded coverage. As of 2024, 10 states had chosen not to expand Medicaid, despite economic incentives. Ironically, those include some of the poorest states, such as Mississippi and Alabama.
Current U.S. health policy may be in flux, but the core building blocks of the healthcare system are likely to be in place in some form for the foreseeable future. Too many people rely on these programs for them to disappear overnight. As professional advocates, it’s important to know the basics, and then stay on top of major changes that could affect patients in the future.
Want to become a professional patient advocate? Learn more about the profession of patient advocacy and how you can help patients at the Alliance of Professional Health Advocates (APHA). Already in practice? Get listed in APHA’s sister property, the Umbra Health Advocacy Directory.