The Q Series: Health Care Quality Answers – What is Medicaid?

March 25, 2016 · Shireesha Jevaji


The Q Series: Health Care Quality Answers

The Q Series: A series of informative blog posts that explain the building blocks of health care quality and emerging trends in health care delivery reform – this time, on Medicaid.  

The Q Series: What is Medicaid?

In our last Q Series post, we reviewed Medicare and its four parts. In this post, we’ll walk through what makes Medicaid an important player in our nation’s health care system.

Medicaid is a joint federal and state assistance program for low-income people of all ages. It helps pay health care costs for people and families with limited income and resources. The federal government sets guidelines, and states choose the scope of coverage. Each state creates its own Medicaid program, including federally mandated and optional, additional state benefits.

Mandatory benefits include care physician services and services received in a hospital, skilled nursing facility, rural health clinic or federally qualified health center. The most important benefit is long-term health care services and support. While Medicare provides limited coverage for long-term care, Medicaid can cover the cost of nursing homes, assisted living facilities and other long-term care alternatives, as long as they are medically necessary. According to, Medicaid’s mandatory benefits also include:

  • Early and Periodic Screening, and Diagnostic, and Treatment (EPSDT) services for children.
  • Nursing facility services.
  • Home health services.
  • Midwife services.
  • Certified pediatric and family nurse practitioner services.

In addition to these and other benefits, states can also choose to provide Medicaid coverage for prescription drugs, occupational or physical therapy services; speech and hearing services; or respiratory care services.

The cost of coverage depends on income and state rules, and may include limited premiums, deductibles, copays and coinsurance. Some groups are exempt from certain out-of-pocket costs.

For more information on state Medicare eligibility requirements and enrollment, visit this list of state Web sites.

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