Whether to pay for home care services, doctor’s appointments, or essential surgical procedures, using Medicaid is necessary for many Americans. Despite the program’s magnitude and importance, many people who seek Medicaid cannot receive it. Understanding more about the system and how it works offers insight that may make navigating its nuance more doable.
- Medicaid is a government program that helps certain individuals pay for the medical services they need.
- While millions of Americans apply for Medicaid each year, only a small percentage receive coverage.
- Despite its selectivity, Medicaid continues to grow in scale each year.
- New York is among other top states for Medicaid enrollments and spending, making it easier for residents to access care than in other areas.
What Is Medicaid?
Medicaid is a federal and state government program designed to help cover medical costs for low-income families and individuals. While state and federal governments manage the program, it is administered at the state level. As a result, each state varies in terms of its eligibility criteria, Medicaid benefits, and how services can be delivered.
In 2010, Medicaid coverage expanded to more low-income families and adults under specific conditions with the introduction of the Affordable Care Act (ACA), colloquially called “Obamacare.” However, not all states chose to adopt it. Those that haven’t continue to have more restrictions on who can access Medicaid.
Still, there’s no shortage of health services Medicaid can cover, from hospitalization to prescription medications and long-term care. The exact services that Medicaid beneficiaries can receive vary from state to state, but basic healthcare services like doctor’s visits are generally covered.
Who Qualifies for Medicaid?
Not everyone seeking government support qualifies for Medicaid. Many factors, including family size, assets, and income, may influence eligibility in each state. Some populations, such as those with disabilities and older adults, are typically deemed eligible for Medicaid. Likewise, children can receive coverage through the Children’s Health Insurance Program (CHIP), a closely-related yet separate care program.
- In 2023, approximately 1,157,800 individuals were deemed eligible for Medicaid upon application.
- In New York, 827,152 individuals applied for Medicaid. However, only 82,466, or around 10%, of this group were deemed eligible for coverage. (2023)
Some groups, including pregnant people, children, and persons with disabilities are more likely to be deemed eligible for Medicaid.
- Around 10% of the population relying on Medicaid or CHIP coverage comprises persons with disabilities. (2023)
- Around 7% of those using Medicaid are considered “aged” or fall above 65 years of age. (2023)
Percentage of U.S. Enrolled in Medicaid
Annual reports reveal that a significant portion of the U.S. population relies on each state’s Medicaid program.
- As of February 2023, around 93,373,794 individuals were enrolled in Medicaid and CHIP based on enrollment data from state governments and Washington, D.C.
- Of this group, 86,174,094 individuals were enrolled specifically in Medicaid rather than CHIP. (2023)
Since the total U.S. population is about 330 million, around one-third of U.S. residents are enrolled in Medicaid or CHIP.
State and federal enrollment data reveals that the demand for Medicaid services has increased over time, especially after the COVID-19 pandemic.
However, enrollment is disproportionate across states, perhaps due largely to differences in how the ACA’s Medicaid expansion has been handled. Some groups continue to benefit from Medicaid more than others.
Federal Medicaid enrollment reports clearly show that younger and middle-aged populations receive coverage the most.
- As of 2023, the approximate percentage of Medicaid enrollment held by people aged 21 or younger reached 63%.
- The approximate percentage of recipients aged 21-26 was just 7%. (2023)
- The amount of enrolled individuals between 27-45 years old was 19%. (2023)
- The approximate percentage of recipients who were “middle-aged” (45-64) was lower, falling to around 14%. (2023)
- Seniors and older adults were the least served population, with an average of just 8% of total enrollments. (2023)
Some states generally produce higher numbers of Medicaid enrollment. These states usually have a higher population than others, just as states with little enrollment tend to be sparsely populated.
- California had the highest rate of Medicaid enrollment, with 12,880,735 individuals covered. (2023)
- Florida (4,859,249), New York (6,913,364), and Texas (5,442,911) were the next three states to have the highest enrollment numbers. (2023)
- South Dakota (126,826), Vermont (188,786), and Wyoming (78,482) were the states with the lowest enrollment numbers.
Overall, more females take advantage of Medicaid than males, though the sex-based split between Medicaid recipients is fairly even.
- Around 46% of the population receiving Medicaid and CHIP in 2023 were male.
- Around 54% of the population receiving Medicaid and CHIP were female.
Total Medicaid spending nationwide is in the billions between Medicaid services and administration.
- The median total spent per capita on medical assistance and administration reached $8,436 in 2023.
U.S. Medicaid Spending
- As of 2023, the estimated annual Medicaid expenditures by payer fell to $613.5 billion.
- Annual Medicaid and CHIP expenditures varied by service: common options included managed care ($310 billion), long-term care ($130 billion), and physician and lab services ($96 billion).
New York Medicaid Spending
Spending on Medicaid in New York is significant, especially given that the state is a top provider of Medicaid health coverage.
- As of 2023, Medicaid services in New York cost $58,094,211,692.
- The estimated total Medicaid spending in New York, including CHIP, reached $61,864,728,609 in 023.
Over the past decade, Medicaid applications and spending have increased by an average of 20-30%. But some states experience more noticeable growth than others.
As more providers accept Medicaid, the number of people who use and benefit from it can increase.
- Since February 2020, Medicaid enrollment has increased by about 22,369,004 individuals (35.1%).
- States with the fastest-growing enrollments include New Jersey, Missouri, and Nevada. (2023) NJ, MO, NV
- Other states with lower, yet steady, rates of growing enrollments include Oregon, Utah, Wyoming, Colorado, Texas, and many states in the southern U.S.
The number of people who need Medicaid grows with the U.S. population, and this trend will almost certainly continue. The COVID-19 pandemic seems to have spiked Medicaid enrollments, so a steady plateau may develop with time. But with more healthcare resources and providers available developing continuously, it’s safe to say that Medicaid is going nowhere and may even expand to support more populations.