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Eligibility

Medicaid and CHIP provide health coverage to nearly 60 million Americans, including children, pregnant women, parents, seniors and individuals with disabilities. In order to participate in Medicaid, Federal law requires States to cover certain population groups (mandatory eligibility groups) and gives them the flexibility to cover other population groups (optional eligibility groups). More information is available in the Eligibility section.

Benefits

States establish and administer their own Medicaid programs, and determine the type, amount, duration, and scope of services within broad federal guidelines. States are required to cover certain "mandatory benefits," and can choose to provide other "optional benefits" including prescription drugs. States receive federal matching funds to provide these benefits.  More information is available in the Benefits section.

Cost Sharing

States have the option to charge premiums and to establish out of pocket spending (cost sharing) requirements for Medicaid enrollees. Out of pocket costs may include copayments, coinsurance, deductibles, and other similar charges. More information is available in the Cost Sharing section.

Waivers

The Social Security Act authorizes multiple waiver and demonstration authorities to allow states flexibility in operating Medicaid programs. Each authority has a distinct purpose, and distinct requirements. To find out what kinds of waivers and demonstrations have been proposed and/or approved in each State, see the list below. This option will allow you to find a waiver operated under a specific authority. More information is available in the Waivers section.

Long-Term Services & Supports

The Medicaid program allows for the coverage of Long Term Care Services through several vehicles and over a continuum of settings. This includes Institutional Care and Home and Community Based Services (HCBS). Please click on this option for more information. More information is available in the Long-Term Services & Supports section.

Delivery Systems

States have choices in their approach to reimbursement and delivery system design under the Medicaid Program. More information is available in the Delivery Systems section.

Quality of Care

Medicaid and the Children's Health Insurance Program seek to provide safe, effective, efficient, patient-centered, high quality and equitable care to all enrollees. To achieve these goals, the Centers for Medicare & Medicaid Services (CMS) partners with States to share best practices and to provide technical assistance to improve the quality of care. More information is available in the Quality of Care section.

Data & Systems

Medicaid.gov is intended to become a major resource for information on Medicaid systems, coding information and data. The plan is to over time enhance the current capabilities of these Medicaid systems to share timely and meaningful Medicaid data. More information is available in the Data & Systems section.

Enrollment Strategies

The Center for Medicaid and CHIP Services (CMCS) works with States to identify and enroll people who are eligible for Medicaid or the Children's Health Insurance Program but who are not enrolled. More information is available in the Enrollment Strategies section.

Program Integrity

The Centers for Medicare & Medicaid Services (CMS) is committed to combating Medicaid provider fraud, waste, and abuse which diverts dollars that could otherwise be spent to safeguard the health and welfare of Medicaid enrollees. More information is available in the Program Integrity section.

Financing & Reimbursement

Medicaid is jointly funded by the Federal government and the States. The Federal government pays States for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP). More information is available in the Financing & Reimbursement section.

Indian Health and Medicaid

The population of American Indians and Alaska natives living in the United States totals 5.2 million according to the Census Bureau.  More than 1 million American Indians and Alaska Natives are enrolled in coverage through Medicaid and CHIP and many more are eligible for coverage as a result of the Affordable Care Act's Medicaid expansion. Medicaid and CHIP can serve as a critical source of care for this community. More information is available in the Indian Health & Medicaid section.

Outreach Tools

Throughout the nation, efforts to enroll eligible individuals in health insurance are moving forward. Millions are eligible for Medicaid and the Children’s Health Insurance Program (CHIP) – in many states, more people than ever before – and still need to be connected to the vital health benefits these programs provide. Medicaid and CHIP enrollment is year-round and is not subject to an open enrollment period. Eligible individuals can enroll at any time and get coverage right away. More information is available in the Outreach Tools section.

Medicaid State Plan Amendments

A Medicaid and CHIP state plan is an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are underway in the state. More information is available in the Medicaid State Plan Amendments section.