Medicaid Database Description Background

Medicaid was established by Title XIX of the Social Security Amendment of 1965 as an entitlement program providing medical assistance. It is cooperative venture jointly funded by the federal government and by individual state governments (including the District of Columbia and Territories), and is administered by the states with federal oversight.

While coverage varies by state, mandatory services generally include: inpatient hospital services, outpatient hospital services, prenatal care, vaccines for children, physician services, nursing facility services for those 21, family planning services and supplies, rural health clinic services, home health care, laboratory and x-ray services, pediatric and family nurse practitioner services, nurse-midwife services, federally qualified health-center services, and early and periodic screening, diagnostic, and treatment services for those 21. Although states are not required to cover outpatient prescription drugs, all states provide such coverage for at least some categories of enrollees.

In fee-for-service plans, Medicaid is billed by health care providers (physicians, hospitals, and pharmacies) for specific goods and services provided (physician visits, hospitalizations, and prescription drugs). In capitated plans, Medicaid pays an insurance company a certain dollar amount per person per time period (e.g., month) to cover all or specific aspects of that enrollee's health care. Importantly for researchers, the degree of completeness of encounter information for patients in capitated plans depends on the specific plan.

In 2002, 51 million persons, or 16% of the US population, received health care services through Medicaid.

Background & General Acquisition Medicaid 2010 » (pdf)

Background & General Acquisition Medicare 2010 » (pdf)

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