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U.S. states want flexibility in applying the Medicaid program which covers 53 million Americans earning lower levels of income. This amount was $11,616 a year for working parents in 2009, according to the Kaiser Fondation. Some states have a higher income level, as high as $48,400. The problem for states are serious budget deficits, with Medicaid comparing with education as a major cost. The recession and job losses has added 8 million Americans to Medicaid rolls. The Federal government supports 57% of the Meddicaid budget on average. A provision in the 2010 health care law says states cannot limit Medicaid eligibility, or they would lose funding by the federal government.
The Obama adminstration's position is that eligibility or provider cuts will not bring in large savings, and will allow larger cost-sharing by Medicaid users, with only minor cuts in eligibility. Its position is also that the law does not give the federal government waiver authority.
Some of the issues raised relate to the structure of Medicaid cost and its rapid escalation. Health and Human Services says 1% of benificiaries, especially the long term care, use up 25% of the Medicaid expenditures. One astonishing fact is that two thirds of all U.S. nursing home residents are on Medicaid. The total cost is rising, from $187 billion for Medicaid in 2000, to $346 billion in 2009, according to the Centers for Medicare and Medicaid Services. In July 2011, $26 billion in additional federal Medicaid funding expires, which will be added to state expenses as they struggle with large deficits. In states like Maine, with generous benefits, about one fourth of all residents are in the Medicaid program.
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