MEDICAID

Medicaid is the nation’s major public financing program for providing health and long-term care coverage to low-income people.

• Medicaid is funded by both the federal and state governments
• In Colorado, the federal match rate is 50%, Colorado gets one dollar for every state dollar spent
• Currently Medicaid comprises approximately 7% of total federal budget and 18% of state budget revenues, making it the second largest state expense after education. Medicaid accounts for over 13% of health expenditures in the state.

ELIGIBILITY:

• Individuals are not guaranteed Medicaid services just because they are low-income.  They must meet certain income requirements as defined by the state government, as well as fall into one of the following categories:  low-income pregnant women, low-income children, the elderly, Families are not guaranteed Medicaid benefits solely on the basis of their income level. The federal government sets minimum income standards and the state mandates that families must meet certain income requirements (see table), as well as fall into one of the following categories: low-income pregnant women, low-income children, the elderly, disabled and TANF eligible adults and families.
• Colorado eligibility for low-income families is at the minimum level required by the federal government. Colorado is also one of six states to impose asset tests to determine children’s eligibility, rendering children in families with assets of more than $2500, including a car worth up to $1500 in value, ineligible (pregnant women excluded).
• Eligibility does not guarantee that providers will accept Medicaid patients. In an attempt to cut Medicaid costs, many states have reduced reimbursement rates to providers. This reduction has caused some providers and insurance carriers to refuse or limit the number of Medicaid patients they will accept, leaving many recipients struggling to find care. States have an obligation to adequately fund programs so that providers are available to participants.
  

SERVICES COVERED:

• Federally mandated services include: inpatient and outpatient hospital, physician, midwife and certified nurse practitioner, lab and x-ray, nursing home and home health care, early and periodic screening, diagnosis and treatment for children under age 21,
• EPSDT, family planning and rural health clinics/federally qualified health cen

• ters. Medicaid is the primary payer for 60% of all nursing facility expenses. In addition to these services, the states have the option of providing additional care. Colorado has opted to cover services such as: prescription drugs, dental, eyeglasses, hearing aids and mental health.

RECENT TRENDS:

• Medicaid costs are expected to increase dramatically in the coming years due to a combination of factors, including rising prescription drug costs, growing enrollment of the aged and disabled and rising health care price inflation
• At the same time, Medicaid enrollment is on the rise due to the downturn in the economy, the subsequent increase in the unemployment rate and decrease in employer sponsored health insurance
• The Colorado Department of Health Care Policy and Financing, the department that oversees Medicaid, is growing faster than the TABOR 6% growth limit permit, creating serious budget constraints
• Cuts in Medicaid at the state level have a significant impact because the federal match is lost.

       Colorado Medicaid Eligibility Levels