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Title XIX of the Social Security Act, also known as Medicaid, became law in 1965. It is a jointly funded cooperative venture between the Federal and State governments to assist States in providing medical assistance to eligible needy persons. Medicaid is the largest source of funds for medical and health-related services to America's poorest people.
Each State designates a single agency that is responsible for Medicaid program operations. The Federal Government provides broad national guidelines to the States under which they: (1) establish their own eligibility standards; (2) determine the type, amount, duration, and scope of services; (3) set the rates of payment for services; and (4) administer their own programs. Thus, Medicaid programs vary considerably from State to State, as well as within each State over time.
MEDICAID ELIGIBILITY
Mandatory Eligibility Groups
To be eligible for Federal funds, States are required to provide Medicaid coverage for most individuals who receive Federally assisted income maintenance payments, as well as for related groups not receiving cash payments. The mandatory eligibility groups include:
* Families with children receiving Aid to Families with Dependent Children (AFDC) or linked in specific ways to assistance through the AFDC program.
* Pregnant and/or postpartum women and children under 6 years of age (including infants) whose family incomes do not exceed 133 percent of the FPL, or a higher level if that level was used before the implementation of the mandated 133-percent level. States are also required to extend Medicaid eligibility until 19 years of age to all children born after September 30, 1983, in families at or below the FPL This coverage is being phased in, so that by the year 2002, all poor children under 19 years of age will be covered.
* Recipients of adoption assistance and foster care under Title IV-E of the Social Security Act.
* Aged, blind, and disabled individuals receiving assistance under the Federal Supplemental Security Income (SSI) program or whose eligibility for Medicaid is determined under State standards that are more restrictive than the standards for SSI.
* Medicare-eligible individuals whose incomes do not exceed the FPL and whose resources are at or below twice the standard allowed under the SSI program, known as QMBs. Medicaid pays their Medicare premiums and cost-sharing expenses...