Medicaid is considered to be the largest health insurance program in the United States, covering more than 81 million people. The program was authorized by the Social Security Act which was signed into law in 1965. The Medicaid program was gradually introduced into all the 50 states, and today, its coverage has been expanded to cover a wide range of the population. It currently provides benefits to low-income families, pregnant women, children, individuals with disabilities, and those in need of long term care. The guidelines for the Medicaid program is established by the Center for Medicare and Medicaid Services (CMS), which is the federal agency found in the United States Department of Health and Human Services (HHS) ( Adams, Gebru & Kimmel, 2017 ). Through the federal guidelines, every state establishes its own Medicaid program, and as a result, there are 50 different Medicaid programs in the United States, each program for each state.
After having been established in 1965, Hawaii became the first state to adopt the Medicaid program in 1966. Many other states also adopted the program with Arizona becoming the last to adopt it. Currently, the Medicaid program is found in all the 50 states, with every state running its own program, but with the guidelines set by the federal agency. The Medicaid program is financed jointly by both the state and federal governments, with the federal contribution providing a matching rate of between 50-82% of the Medicaid expenditure of the state ( Adams, Gebru & Kimmel, 2017 ). The funding formula has been made in such a way that it provides more funds to states with lower per capita income and fewer funds for those with higher per capita income.
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The Medicaid program is a structured federal-state partnership. The federal agency is responsible for setting the objectives and guidelines but allows much flexibility for the states. The states are flexible and free to administer Medicaid programs by determining the covered population, care, delivery models, covered services, and the methods of payment. This means that each of every 50 states is flexible in determining how to administer their own programs or even obtain section 1115 waiver to implement approaches that are different from what is required by the federal statute ( Rudowitz, Garfield & Hinton, 2018 ). As a result, Medicaid can be considered to be 50 different programs because of the significant variation that exists across state Medicaid programs. The federal laws on Medicaid program have set broad standards for the population covered while letting most of the components optional and flexible for a decision by the individual states on how to administer their program.
Each of the 50 states is allowed to make its own policy decisions regarding eligibility, services, and delivery systems. The states can also plan and amend their own Medicaid programs, but it must be first approved by the CMS before receiving the funds. Even though the federal agency demands that the states provide coverage to people within a particular income group, they are also allowed to go beyond this federal requirement ( Adams, Gebru & Kimmel, 2017 ). Every state, therefore, has much flexibility to administer the program although within the federal guidelines. Based on this state autonomy, different states have different health care delivery models, services covered, the population covered, and the methods of payment. Based on the differences existing in the Medicaid program for every state, the Medicaid program can be said to be 50 different programs. Every state has its own different way to administer the program, and the variation exists in almost every state. These variations have been as a result of the flexibility and autonomy that the states have been given when administering the program.
References
Adams, C., Gebru, F., & Kimmel, L. (2017). MEDICAID 101: AN OVERVIEW . Institute for Medicaid Innovation.
Rudowitz, R., Garfield, R., & Hinton, E. (2018). 10 Things to Know about Medicaid: Setting the Facts Straight. Kaiser Family Foundation , 12 .
