Medicaid Basics
How much do we really know about the program and its beneficiaries?
As Republicans in Congress scramble to put the final touches on President Trump’s “big beautiful” tax and spending bill, one of the major open items is the extent of cuts to federal spending on Medicaid. which may or may not prove to be as severe as some fear and others desire. No doubt many B&B readers have strong views on this subject, but how much do we really know about Medicaid?
I have spent much of the past week grading student papers and have not had time to do my usual deep dive into the subject of Medicaid. But I do think this is an important and timely topic of public finance, and I suspect that many of us do not know as much about this large government program as we should, even about some very basic facts relating to Medicaid coverage and beneficiaries. And so in lieu of my usual long post, I will simply share with you this very short quiz from The Washington Post, which will allow you all to test your own Medicaid knowledge and fill in the gaps.
I myself took the quiz and did very poorly, a humbling but enlightening experience, and I encourage all of you to do the same. You might also wish to send the quiz along to your Congressional representatives before they vote on the final bill, on the off chance that they may know even less about Medicaid than you do.
For those of you who find yourselves behind the WaPo paywall, I have included the quiz questions and answers below. But please do take the quiz yourself if you can access it. [Note: I have tweaked some of the WaPo answers to provide a bit more clarity, especially around some of the confusing numbers in the published quiz. I have generally highlighted these edits in brackets.]
Number of Medicaid enrollees: 83 million. Medicaid covered 83 million people in 2024, including infants and children, parents and pregnant women, seniors, and people who are blind or disabled. The Affordable Care Act of 2010 made it possible for states to expand Medicaid to cover low-income people under age 65, which only 10 states have declined to do. [These states are: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.]
Federal government’s share of Medicaid spending: 69%. The federal government paid 69 percent of the $890 billion of total Medicaid spending in fiscal year 2023, so a bit over $600 billion. Spending varies from state to state, but those with the most residents, such as California, Ohio, Pennsylvania and Texas, receive the biggest share of federal Medicaid dollars.
Percent of Medicaid-covered adults who work: 64%. The total number of adults enrolled in Medicaid was around 40 million in 2023. Of these, approximately 15 million were added to the Medicaid rolls via the Affordable Care Act. Of the 25 million or so traditional Medicaid-eligible adults, 16.6 million under the age of 65 had jobs in 2023. Of those, ca 70% had full-time employment and 30% were working part time. Non-employed adult beneficiaries, comprising 36% of the 25 million total, claimed barriers to work due to an illness or disability, or because they were caregivers. [Most of the numbers in this answer were edited, to provide clarity]
Annual income limit for a Medicaid-eligible adult in states which have expanded Medicaid coverage: $21,597. When the Affordable Care Act allowed states to expand Medicaid to cover low-income people under age 65, it also made it possible for adults earning up to 138% of the poverty level to enroll. In 2023, the 138% cap equalled $21,597.
Number of children enrolled in Medicaid: 33 million. This number includes children in low- and moderate-income families, as well as children with special health-care needs and those in foster care. While some of these children have parents with commercial insurance, Medicaid is the sole source of health coverage for most children enrolled in the program. Medicaid [and CHIPS] covers roughly 80 percent of children living below the poverty level in the United States. [The remaining 20% are not covered for various reasons, including immigration status, state eligibility limits, parental choice and administrative reasons.]
Percentage of patients at children's hospitals covered by Medicaid: 50%. On average, half of patients at children’s hospitals are enrolled in Medicaid, making it a key revenue source for many institutions. Additionally, about one-third of pediatricians’ caseloads are Medicaid recipients, the highest rate of any medical specialty.
Number of blind and disabled people enrolled in Medicaid: 9 million. Individuals who are blind and disabled or who claim developmental disabilities or serious behavioral health concerns can also qualify for Medicaid. Although they make up just 13 percent of total enrollment in the program, their care accounts for nearly one-third of Medicaid spending.
Which states cover undocumented immigrants in their Medicaid programs: None. Undocumented immigrants are not eligible for Medicaid anywhere in the United States. However the program does reimburse hospitals for emergency department care for people who would otherwise quality for Medicaid except for their immigration status. Some states, such as California, Minnesota and Oregon, as well as D.C., have made the choice to cover undocumented immigrants with state or local dollars, a practice Congress has said could jeopardize their federal Medicaid funding.
Number of “seniors” enrolled in Medicaid: 7 million. People over age 65 account for just 10 percent of Medicaid enrollment but 20 percent of costs because they are more likely than other beneficiaries to have chronic conditions and to use long-term care.
True or false: Medicaid is the primary payer for long-term care services: True. Most people over age 65 have Medicare as their primary source of health insurance, but Medicaid pays for other critical services and costs, including Medicare premiums [and co-pays] as well as long-term care, nursing-home care and some in-home services.