Medicaid is a joint state and federal program providing healthcare coverage to low-income Americans. Around 85 million people were enrolled as of December 2024. While states manage the program, the federal government oversees it. It differs from the Children's Health Insurance Program (CHIP).
Eligibility criteria include low income and fall into categories such as children, pregnant women, the elderly, and disabled individuals. The Affordable Care Act expanded eligibility in 2014. Forty states and the District of Columbia adopted this expansion. CHIP eligibility varies by state.
Coverage varies by state and eligibility category. Basic services are mandated, but states can offer additional services. Funding comes from taxes, with states setting reimbursement rates. The federal government reimburses states a portion of their spending. In 2023, the total cost was $896 billion, with the federal government contributing $616 billion.
House Republicans aim to reduce federal spending, including Medicaid, by $1.5 trillion over 10 years. While Republicans claim to focus on eliminating fraud, Democrats argue insufficient fraud exists to justify the proposed cuts. The Government Accountability Office estimates significant annual losses to Medicaid fraud, though proven fraud is a small percentage of this estimate.
Suggestions for reducing spending include using AI to improve efficiency, lowering provider taxes (which disproportionately benefits the federal government), or imposing per-capita caps on federal reimbursement to states. However, some experts warn that such measures could negatively impact state healthcare access.