Medicaid or Medicare…what’s the difference and why should I care?

Many people do not know the difference between Medicaid and Medicare and simply consider them “entitlement programs”. There are a great number of people who CIP serve that utilize the Medicaid program to pay for their services. Medicaid is more than a health care program. It is a life-giving program. It’s not about just health care, it’s about supports to live in community. It is important to understand the difference as the legislature looks at making changes to the Medicaid system in the future through the American Health Care Act (AHCA).
Medicare and Medicaid are two different government-run programs that were created in 1965 in response to the inability of older and low-income Americans to buy private health insurance. They were part of President Lyndon Johnson’s “Great Society” vision of a general social commitment to meeting individual health care needs. Medicare and Medicaid are social insurance programs that allow the financial burdens of illness to be shared among healthy and sick individuals, and affluent and low-income families.

Medicaid is not the same as Medicare.

  • Medicare is a federal program that provides health coverage if you are 65 or older or have a severe disability, no matter your income.
  • Medicaid is a state and federal program that provides health coverage if you have a very low income. You must meet some specific requirements to receive Medicaid.
  • Qualifications for a Medicaid program will depend on:
    • your income (money you take in, for example, from Social Security payments or wages that you earn);
    • your assets (resources such as checking accounts, stocks and some property); and
    • if you need long-term care, whether you meet your state’s functional eligibility or level-of-care criteria standards for assessing your need for help with activities of daily living (for example, toileting, bathing, dressing) and your need for nursing care. Each state sets its own standards.
    • if you are eligible for both Medicare and Medicaid (dual eligible), people can use both.

Why is it important to understand the difference? Decisions are being made currently at the federal legislature that will impact Medicaid. There is a push to cut funding up to 1 trillion dollars over the next 10 years. There is also a push to allow states more flexibility, which in some cases is good but it also means states will need to make major decisions that may limit who can receive Medicaid services in the future.

You may hear your representatives say we are not touching entitlement programs such as Social Security or Medicare…which may be true. But the Medicaid program is a program that supports people with disabilities, children, and those aging who need long-term care assistance in their communities. The services provided through Medicaid are at risk. Consider reading 10 Things to Know about Medicaid from the Kaiser Foundation to learn more and advocate where you feel it is appropriate. http://kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight .

Rita Wiersma
Chief Executive Officer
Community Involvement Programs

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