History of Medicaid in Timeline

Medicaid is a joint federal and state government program in the U.S. providing health insurance to low-income individuals and families. While the federal government establishes minimum standards and provides funding, states administer their own programs, determining eligibility and benefits. This leads to variations in coverage across states. Medicaid is a significant source of healthcare coverage for millions of Americans, particularly children, pregnant women, seniors, and people with disabilities.

1927: Section 1927 Amended

In 1993, Section 1927 of the Act was amended by the Omnibus Budget Reconciliation Act (OBRA-93), leading to changes in the Medicaid Drug Rebate Program.

1927: Section 1927 Added to the Social Security Act

Section 1927 was added to the Social Security Act due to OBRA-90 in 1991. This section impacted Medicaid drug rebate programs.

1935: Social Security Act of 1935

In 1935, the Social Security Act was passed. Section 1927 was added to this act in 1991 due to OBRA-90.

1965: Medicaid Created by Social Security Amendments

In 1965, Medicaid was created by adding Title XIX to the Social Security Act, with the federal government providing matching funds to states to provide Medical Assistance to residents who met certain eligibility requirements.

1965: Medicaid Established as Part of the Great Society Programs

In 1965, Medicaid was established as part of President Lyndon B. Johnson's Great Society programs.

1965: Medicaid Program Established

Since the Medicaid program was established in 1965, states have been permitted to recover from the estates of deceased Medicaid recipients over age 65 who received benefits and had no surviving spouse, minor child, or adult disabled child.

1973: Rehabilitation Act of 1973

In 1973, the Rehabilitation Act was established, entitling children with disabilities to receive a "free appropriate public education", impacting Medicaid reimbursement for related services in schools.

1982: All States Participating in Medicaid

By 1982, all states were participating in Medicaid, with Arizona being the last state to join.

1990: Omnibus Budget Reconciliation Act (OBRA-90) Created Medicaid Drug Rebate Program

In 1990, the Omnibus Budget Reconciliation Act (OBRA-90) created the Medicaid Drug Rebate Program and the Health Insurance Premium Payment Program (HIPP).

January 1, 1991: Medicaid Drug Rebate Program Takes Effect

On January 1, 1991, The Medicaid Drug Rebate program, created by the Omnibus Budget Reconciliation Act of 1990 (OBRA-90), became effective, adding Section 1927 to the Social Security Act of 1935.

1993: Omnibus Budget Reconciliation Act of 1993

In 1993, Congress enacted the Omnibus Budget Reconciliation Act, requiring states to recoup long-term care expenses for deceased Medicaid recipients 55 or older, while also setting limits on estate recovery when there are surviving family members.

1993: Omnibus Budget Reconciliation Act (OBRA-93) Amended Medicaid Drug Rebate Program

In 1993, The Omnibus Budget Reconciliation Act (OBRA-93) amended Section 1927 of the Act, bringing changes to the Medicaid Drug Rebate Program. It also requires states to implement a Medicaid estate recovery program and gives states the option of recovering all non-long-term-care costs.

August 22, 1996: Restrictions on Medicaid Eligibility for Legal Permanent Residents

Legal Permanent Residents (LPRs) entering the U.S. after August 22, 1996, are barred from Medicaid for five years, after which coverage becomes a state option, with states having the option to cover LPRs who are children or pregnant during the first five years.

1999: Immigration Officials Define 'Public Charge'

In 1999, a policy letter from immigration officials defined 'public charge' and identified benefits considered in public charge determinations, influencing regulations and guidance on inadmissibility and deportability, suggesting that benefit receipt alone is unlikely to result in removal.

2000: Increase in hospital stays paid by Medicaid

From 2000 to 2012, the proportion of hospital stays for children paid by Medicaid increased by 33%, while the proportion paid by private insurance decreased by 21%.

2001: Medicare and Medicaid Dual Eligibles in 2001

In 2001, approximately 6.5 million individuals were enrolled in both Medicare and Medicaid, known as Medicare dual eligibles or medi-medis.

2002: Medicaid Enrollees in 2002

In 2002, Medicaid enrollment reached 39.9 million Americans, with children forming the largest group at 18.4 million, representing 46% of enrollees.

2003: Increase in Hospital Stays Billed to Medicaid

During 2003–2012, the share of hospital stays billed to Medicaid increased by 2.5%, or 0.8 million stays.

2004: Medicaid Enrollment and Costs in 2004

In 2004, approximately 43 million Americans, including 19.7 million children, were enrolled in Medicaid, with a total expenditure of $295 billion.

2005: Deficit Reduction Act of 2005

The Deficit Reduction Act of 2005 (DRA) requires Medicaid applicants to provide documentation proving U.S. citizenship or legal residency, with exceptions for Emergency Medicaid for pregnant and disabled individuals regardless of immigration status.

November 25, 2008: New Federal Rule on Medicaid Premiums and Co-payments

On November 25, 2008, a new federal rule was passed allowing states to charge premiums and higher co-payments to Medicaid participants, potentially saving states $1.1 billion and the federal government nearly $1.4 billion, but placing a $1.3 billion burden on 13 million Medicaid recipients over 5 years, raising concerns about access to healthcare.

2008: Health Insurance Premium Payment Program Status in 2008

As of 2008, relatively few states had Health Insurance Premium Payment Programs (HIPP), and enrollment was low, although interest in this approach remained high.

2008: Medicaid Coverage in 2008

In 2008, Medicaid offered health coverage and services to roughly 49 million low-income individuals, encompassing children, pregnant women, the elderly, and people with disabilities.

2008: Oregon Medicaid lottery

In 2008, Oregon decided to hold a randomized lottery for the provision of Medicaid insurance in which 10,000 lower-income people eligible for Medicaid were chosen by a randomized system, enabling studies to accurately measure the impact of health insurance.

2008: Start of Recession

The 2008 recession led to job losses and loss of medical insurance, contributing to increases in Medicaid enrollment.

2009: Increase in Medicaid Enrollment due to Recession

In 2009, Medicaid enrollment substantially increased due to the 2008-2009 recession, with nine U.S. states experiencing a rise of 15% or more, straining state budgets.

2009: Medicaid Enrollment in 2009

In 2009, around 62.9 million Americans were enrolled in Medicaid for at least one month, with an average monthly enrollment of 50.1 million individuals.

2010: Affordable Care Act Expanded Medicaid

In 2010, The Affordable Care Act (ACA) was passed, significantly expanding Medicaid by allowing any member of a household with income up to 138% of the federal poverty line qualifies for Medicaid coverage.

2010: Affordable Care Act (ACA) Expanded Medicaid Program

In 2010, The Affordable Care Act (ACA) was passed, substantially expanding the Medicaid program by including able-bodied adults and setting income eligibility at 138% of the Federal poverty level.

2011: Hospital Stays Billed to Medicaid in 2011

In 2011, there were 7.6 million hospital stays billed to Medicaid, representing 15.6% (approximately $60.2 billion) of total aggregate inpatient hospital costs in the United States.

January 2012: Medicaid/CHIP Funds for Employer Health Care Premiums

As of January 2012, Medicaid and/or CHIP funds could be obtained to help pay employer health care premiums in Alabama, Alaska, Arizona, Colorado, Florida, and Georgia.

2012: Increase in Hospital Stays Billed to Medicaid

During 2003–2012, the share of hospital stays billed to Medicaid increased by 2.5%, or 0.8 million stays.

2012: Changes in hospital stays paid by Medicaid

From 2000 to 2012, the proportion of hospital stays for children paid by Medicaid increased by 33%, while the proportion paid by private insurance decreased by 21%.

2012: Supreme Court decision on Medicaid expansion

In 2012, the Supreme Court allowed states to decide whether to expand Medicaid or not, leading to disproportionate expansion in northern states with Democratic legislators.

2013: Medicaid Eligibility Requirements in 2013

As of 2013, Medicaid eligibility was not solely based on low income but required membership in a specific category defined by statute, such as low-income children, pregnant women, or disabled individuals, with category definitions varying by state.

2013: Medicare and Medicaid Dual Eligibles in 2013

In 2013, around 9 million individuals qualified for both Medicare and Medicaid.

2013: Affordable Care Act Medicaid payment increase

In 2013, as part of the Affordable Care Act, the federal government funded an increase in Medicaid payments to match 100% of equivalent Medicare payments, aiming to boost provider participation.

2013: Uninsured Rate in Arkansas 2013

In 2013, before expansion, the uninsured rate in Arkansas was 42%.

2013: Kaiser Family Foundation Report on Medicaid Recipients

In 2013, the Kaiser Family Foundation reported that Medicaid recipients comprised 40% white, 21% Black, 25% Hispanic, and 14% other races.

2013: Variance in Medicaid Reimbursements

In 2013, the average difference in Medicaid reimbursement for 10 common orthopedic procedures in the states of New Jersey and Delaware was $3,047, illustrating the large variance in reimbursements Medicaid offers to care providers across states.

2014: Kaiser Family Foundation Report on Medicaid Costs

A 2014 Kaiser Family Foundation report estimated the national average per capita annual cost of Medicaid services for children to be $2,577, adults to be $3,278, persons with disabilities to be $16,859, aged persons (65+) to be $13,063, and all Medicaid enrollees to be $5,736.

2014: 26 States Contract with Managed Care Organizations

As of 2014, 26 states had contracts with Managed Care Organizations (MCOs) to deliver long-term care for the elderly and individuals with disabilities.

2014: Uninsured Children Rate Reduced

As of 2014, the rate of uninsured children was reduced to 6%, with 5 million children remaining uninsured.

2014: Affordable Care Act Medicaid payment increase

In 2014, as part of the Affordable Care Act, the federal government continued the increase in Medicaid payments to match 100% of equivalent Medicare payments, in an effort to boost provider participation.

2014: Medicaid Expansion Under ACA Begins

In 2014, under the provisions of the Affordable Care Act (ACA), states that participated in Medicaid were required to expand coverage to include anyone earning up to 138% of the Federal poverty level.

October 2015: Kaiser Family Foundation Estimates on Medicaid Expansion

In October 2015, the Kaiser Family Foundation estimated that 3.1 million additional people were not covered in states that rejected the Medicaid expansion.

2015: Variation in Asset Tests for Medicaid in 2015

As of 2015, asset tests for Medicaid eligibility varied by state; for example, eight states did not have an asset test for a buy-in available to working people with disabilities.

2015: Uninsured Rate Drops in Arkansas and Kentucky

From 2013 to 2015, the uninsured rate dropped from 42% to 14% in Arkansas and from 40% to 9% in Kentucky, compared with 39% to 32% in Texas.

2016: DHHS Study on Medicaid Expansion and Exchange Policy Premiums

A 2016 DHHS study found that states that expanded Medicaid had lower premiums on exchange policies because they had fewer low-income enrollees, whose health, on average, is worse than that of people with higher income.

2016: Medicaid has substantial positive long-term effects on the health of recipients

A 2016 paper found that Medicaid has substantial positive long-term effects on the health of recipients: "Early childhood Medicaid eligibility reduces mortality and disability and, for whites, increases extensive margin labor supply, and reduces receipt of disability transfer programs and public health insurance up to 50 years later. Total income does not change because earnings replace disability benefits."

2016: Study on Impact of Medicaid Expansion

A 2016 study found that residents of Kentucky and Arkansas, which both expanded Medicaid, were more likely to receive health care services and less likely to incur emergency room costs or have trouble paying their medical bills. In contrast, residents of Texas, which did not accept the Medicaid expansion, did not see a similar improvement during the same period.

2016: Uninsured Rates in Expansion vs. Non-Expansion States

In the first quarter of 2016, states that expanded Medicaid had an uninsured rate of 7.3% among adults aged 18 to 64, while non-expansion states had a 14.1% uninsured rate.

2017: Medicaid Costs in 2017

As of 2017, the annual expenditure for Medicaid exceeded $600 billion, with the federal government contributing $375 billion and states adding $230 billion.

2017: Study on Medicaid enrollment and political participation

In 2017, a study found that Medicaid enrollment increases political participation, measured in terms of voter registration and turnout.

2017: Survey of academic research on Medicaid

In 2017, a survey of the academic research on Medicaid found it improved recipients' health and financial security. Also in 2017, a paper found that Medicaid expansion under the Affordable Care Act reduced unpaid medical bills sent to collection by $3.4 billion in its first two years, prevented new delinquencies, and improved credit scores.

2018: Medicaid reduced infant and child mortality

A 2018 study in the Journal of Political Economy found that upon its introduction, Medicaid reduced infant and child mortality in the 1960s and 1970s. The decline in the mortality rate for nonwhite children was particularly steep.

2018: Uninsured Rates in Expansion vs. Non-Expansion States

In 2018, for adults between 100% and 399% of poverty level, the uninsured rate in expansion states was 12.7%, while in non-expansion states it was 21.2%.

July 2019: NBER Study on Medicaid Expansion and Mortality Rates

A July 2019 study by the National Bureau of Economic Research (NBER) indicated that states enacting Medicaid expansion exhibited statistically significant reductions in mortality rates.

September 2019: Census Bureau Report on Uninsured Rates in Expansion vs. Non-Expansion States

In September 2019, the Census Bureau reported that states that expanded Medicaid under ACA had considerably lower uninsured rates than states that did not. For example, for adults between 100% and 399% of poverty level, the uninsured rate in 2018 was 12.7% in expansion states and 21.2% in non-expansion states.

2019: Hawaii stopped allowing Compact of Free Association migrants to be covered by the state's Medicaid program

A 2019 National Bureau of Economic Research paper found that when Hawaii stopped allowing Compact of Free Association (COFA) migrants to be covered by the state's Medicaid program that Medicaid-funded hospitalizations declined by 69% and emergency room visits declined by 42% for this population, but that uninsured ER visits increased and that Medicaid-funded ER visits by infants substantially increased.

2019: Kaiser Family Foundation Review on Medicaid Expansion

A 2019 review by Kaiser Family Foundation of 324 studies on Medicaid expansion concluded that expansion is linked to gains in coverage, improvements in access, financial security, and some measures of health status/outcomes; and economic benefits for states and providers.

2019: Medicaid Expansion in Michigan had net positive fiscal effects

A 2019 study found that Medicaid expansion in Michigan had net positive fiscal effects for the state.

2019: Medicaid Pays for Half of all Births

As of 2019, Medicaid paid for half of all births in the United States.

2019: Medicaid Eligibility Under PPACA in 2019

As of 2019, when Medicaid was expanded under the PPACA (Patient Protection and Affordable Care Act), eligibility was determined by income using Modified Adjusted Gross Income, without state-specific variations or asset tests.

2019: Stanford University and Wharton School economists paper on Medicaid expansion

In 2019, a paper by Stanford University and Wharton School economists found that Medicaid expansion produced a substantial increase in hospital revenue and profitability, with larger gains for government hospitals, but did not detect significant improvements in patient health, although the expansion led to substantially greater hospital and emergency room use.

2020: Medicaid expansion reduced incidence of advanced-stage breast cancer

A 2020 JAMA study found that Medicaid expansion under the ACA was associated with reduced incidence of advanced-stage breast cancer, indicating that Medicaid accessibility led to early detection of breast cancer and higher survival rates.

2020: State Contribution to Medicaid Expansion Costs

By 2020, states participating in the Affordable Care Act (ACA) Medicaid expansion were required to pay for 10% of the costs of the newly covered population.

2020: Study on Medicaid expansion and hospital revenue

In 2020, a study found that Medicaid expansion boosted the revenue and operating margins of rural hospitals, had no impact on small urban hospitals, and led to declines in revenue for large urban hospitals.

2020: Medicaid Coverage for Long-Term Services

In 2020, approximately 5.6 million of the 7.7 million Americans who used long-term services and supports were covered by Medicaid.

2020: Concerns Over State Contributions to Medicaid Expansion in 2020

Several states argued that they could not afford the 10% contribution to Medicaid expansion costs in 2020, as required by the Affordable Care Act (ACA).

2021: Medicaid expansion led to mortality reduction

A 2021 study found that Medicaid expansion as part of the Affordable Care Act led to a substantial reduction in mortality, primarily driven by reductions in disease-related deaths.

2021: Study on Medicaid expansion and dental coverage

In 2021, a study found that expansions of adult Medicaid dental coverage increasingly led dentists to locate to poor, previously underserved areas.

2021: Study on Medicaid expansion in Louisiana

In 2021, a study in the American Journal of Public Health found that Medicaid expansion in Louisiana led to reductions in medical debt.

2021: American Economic Review study on early childhood access to Medicaid

In 2021, an American Economic Review study found that early childhood access to Medicaid reduces mortality and disability, increases employment, and reduces receipt of disability transfer programs up to 50 years later, saving the government more than its original cost.

2021: Average Cost Per Enrollee

In 2021, the average cost per Medicaid enrollee was $7,600.

2022: Medicaid Coverage in 2022

According to the Centers for Medicare & Medicaid Services (CMS), in 2022, the Medicaid program provided healthcare services to over 92 million people.

2022: Medicaid Provides Health Insurance to 85 Million

As of 2022, Medicaid provided free health insurance to 85 million low-income and disabled people in the United States.

2022: Study on Medicaid eligibility during childhood and criminality

In 2022, a study found that Medicaid eligibility during childhood reduced the likelihood of criminality during early adulthood.

March 2023: Medicaid Expansion Acceptance

As of March 2023, 40 states and the District of Columbia have accepted the Affordable Care Act Medicaid extension, while 10 states have not.

2023: Total Annual Cost of Medicaid

In 2023, the total annual cost of Medicaid was $870 billion, encompassing both federal and state contributions.

2025: Republican Goals of Cutting US Federal Budget

During 2025, Republican Congressional leaders John Thune and Mike Johnson announced goals of cutting 1.5 to 2 trillion dollars of the US federal budget. Various cuts to Medicaid and Medicare were proposed.