Aug 15, 2013 9:00 PM

Medicaid vs Medicare


The names sound similar, but Medicaid and Medicare are two different programs. Medicaid is an assistance program for low-income people of all ages who meet certain requirements and whose medical bills are paid from federal and state taxes. Medicare is a federal insurance program that primarily serves people over the age of 65, or under 65 with a disability, who have contributed to Medicare funding through social security and income taxes during their working years.

Medicaid Population

Funded through state and federal taxes, Medicaid provides health care coverage to low-income groups, including children, pregnant women, women with breast or cervical cancer, disabled adults, and qualifying adults over the age of 65. Low-income adults who are not in the groups listed above are not eligible for traditional Medicaid. Currently, there are 398,000 Medicaid beneficiaries in Utah.

Medicaid Funding

Medicaid is jointly financed by state and federal governments. In Utah, the federal government generally pays 70% ofthe Medicaid costs, which equals about $2.33 in federal Medicaid funding for every $1 the state provides. Utah health care providers contribute funding in order to increase the federal matching dollars. Last year, Utah paid about $600M for Medicaid health care benefits.

Medicaid & Family Income

People qualify for Medicaid coverage based on their monthly income. Poverty levels vary based on the number of adults and children in a household. In addition to other requirements, those receiving Medicaid must be at or below the federal poverty level, which is set at earning $11,490 a year for an individual or $23,550 for a family of two adults and two children. In comparison, the median household income in Utah is $57,783.

Medicaid Expansion

Under the Affordable Care Act (ACA), states have the option to extend health care benefits to qualifying adults ages 19-65. Income guidelines for Medicaid increase to 138% of the poverty level, which is $15,856 annually for an individual and $32,499 for a family of 2 adults and 2 children. In Utah, a Medicaid expansion would provide coverage to an additional123,000 low-income uninsured individuals.

The cost of covering this new group will be funded by the federal government through 2016. At that time, state funding increases gradually from 0% to 10% of the cost. Depending upon the benefit level of the Medicaid plan, the state cost would average approximately $15 million per year for the next ten years. Projections show that these costs will be offset by additional state and county revenues generated and uncompensated care savings. States may choose to offer health care benefits to the new beneficiaries in a variety of ways, including through the traditional Medicaid program or through a health insurance exchange.

States have other "partial expansion" options under the ACA, which are being explored in Utah by state leaders and community workgroups.

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