History of Medicaid in Timeline

Medicaid is a joint federal and state government program providing healthcare coverage to millions of low-income Americans. While the federal government establishes broad guidelines and provides substantial funding, states administer their own Medicaid programs, determining specific eligibility criteria and benefits packages. Although optional, all states participate. The program aims to ensure access to healthcare for vulnerable populations who might otherwise be unable to afford it.

1927: Section 1927 to the Social Security Act of 1935

In 1927, Section 1927 to the Social Security Act.

1927: Section 1927 of the Act amended

In 1927, the Omnibus Budget Reconciliation Act (OBRA-93) amended Section 1927 of the Act.

1935: Section 1927 to the Social Security Act of 1935

In 1935, Section 1927 to the Social Security Act.

1965: Medicaid Established

In 1965, Medicaid was established as part of President Lyndon B. Johnson's Great Society programs, aiming to provide healthcare to those with limited income and resources.

1965: Social Security Amendments of 1965

In 1965, the Social Security Amendments created Medicaid by adding Title XIX to the Social Security Act, providing matching funds to states for medical assistance to residents meeting eligibility requirements.

1965: Establishment of Medicaid

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

1973: The Rehabilitation Act of 1973

In 1973, The Rehabilitation Act

1982: All states participating in Medicaid

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

1990: Omnibus Budget Reconciliation Act of 1990

In 1990, the Omnibus Budget Reconciliation Act (OBRA-90) created the Medicaid Drug Rebate Program and the Health Insurance Premium Payment Program (HIPP) by adding Section 1927 to the Social Security Act of 1935.

January 1, 1991: Medicaid Drug Rebate Program Effective

On January 1, 1991, the Medicaid Drug Rebate Program, created by the Omnibus Budget Reconciliation Act of 1990 (OBRA-90), became effective, aiming to address the costs of outpatient drugs under Medicaid programs.

1993: Omnibus Budget Reconciliation Act of 1993

In 1993, Congress enacted the Omnibus Budget Reconciliation Act of 1993, requiring states to attempt to recoup the expense of long-term care and related costs for deceased Medicaid recipients aged 55 or older, while also outlining exceptions for estate recovery when there is a surviving spouse or certain types of children.

August 22, 1996: Medicaid eligibility for Legal Permanent Residents

Legal permanent residents (LPRs) entering after August 22, 1996, face a five-year bar from Medicaid, after which coverage becomes a state option. States can choose to cover LPRs who are children or pregnant during the first five years. Noncitizen SSI recipients are eligible for Medicaid, and refugees and asylees are eligible for seven years after arrival.

1999: Definition of "Public Charge"

In 1999, immigration officials issued a policy letter defining "public charge" and identifying the benefits considered in public charge determinations. This letter informs current regulations and guidance on inadmissibility and deportability based on public charge grounds, suggesting that an alien's receipt of public benefits alone is unlikely to result in removal.

2000: Increase in Hospital stays for children paid by Medicaid

From 2000 to 2012, there was a 33% increase in the proportion of hospital stays for children paid for by Medicaid.

2001: Medicare dual eligible

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

2002: Medicaid enrollment numbers

In 2002, Medicaid enrollees numbered 39.9 million Americans, with children comprising the largest group at 18.4 million, or 46%.

2003: Increase in hospital stays billed to Medicaid

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

2004: Medicaid Enrollment and cost

In 2004, approximately 43 million Americans, including 19.7 million children, were enrolled in Medicaid at a total cost of $295 billion, highlighting its financial significance.

2005: Deficit Reduction Act of 2005

The Deficit Reduction Act of 2005 (DRA) requires individuals seeking Medicaid to produce documentation proving United States citizenship or residency, with exceptions for Emergency Medicaid for pregnant and disabled individuals, regardless of immigration status. Special rules apply for those in nursing homes and disabled children at home.

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. This rule was projected to save states $1.1 billion and the federal government nearly $1.4 billion, but was also expected to increase co-payments for 13 million Medicaid recipients by $1.3 billion over five years, potentially disincentivizing low-income people from seeking healthcare.

2008: Health Insurance Premium Payment Program (HIPP)

As of 2008, a program known as the Health Insurance Premium Payment Program (HIPP) allowed a Medicaid recipient to have private health insurance paid for by Medicaid. Relatively few states had premium assistance programs and enrollment was relatively low, though interest remained high.

2008: Medicaid coverage

In 2008, Medicaid provided health coverage and services to approximately 49 million low-income children, pregnant women, elderly people, and disabled people.

2008: Oregon holds randomized lottery for Medicaid insurance

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. The lottery enabled studies to accurately measure the impact of health insurance on an individual's health and eliminate potential selection bias in the population enrolling in Medicaid.

2009: Medicaid Enrollment Figures

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

2009: Medicaid enrollment increase due to recession

In 2009, the Great Recession led to loss of income and medical insurance coverage, resulting in a substantial increase in Medicaid enrollment. Nine U.S. states experienced an increase in enrollment of 15% or more, straining state budgets.

2010: Affordable Care Act expansion

In 2010, the Affordable Care Act (ACA) significantly expanded Medicaid, allowing members of a household with income up to 138% of the federal poverty line to qualify for coverage in most states.

2011: Hospital stays billed to Medicaid

In 2011, approximately 7.6 million hospital stays were billed to Medicaid, representing 15.6% (about $60.2 billion) of total inpatient hospital costs in the United States. The mean cost per stay billed to Medicaid was $8,000, $2,000 less than the average cost for all stays.

January 2012: Medicaid/CHIP funds for employer health care premiums

As of January 2012, certain states, including Alabama, Alaska, Arizona, Colorado, Florida, and Georgia, began using Medicaid and/or CHIP funds to assist in paying employer health care premiums.

2012: Decrease in Hospital stays for children paid by private insurance

From 2000 to 2012, there was a 21% decrease in the proportion of hospital stays for children paid for by private insurance.

2012: Increase in hospital stays billed to Medicaid

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

2012: Supreme Court allows states to decide whether to expand Medicaid

In 2012, the Supreme Court allowed states to decide whether to expand Medicaid or not. Northern states, in which Democratic legislators predominated, disproportionately did so, often also extending existing eligibility.

2012: Supreme Court Decision on Medicaid Expansion

In 2012, the Supreme Court held in National Federation of Independent Business v. Sebelius that the federal government could not withdraw all Medicaid funding from states that refused to expand eligibility, allowing states to maintain pre-existing levels of funding and eligibility.

2012: Supreme Court decision on ACA

In 2012, the Supreme Court ruled that states could continue using pre-ACA Medicaid eligibility standards with previously established federal funding levels, leading some states to not expand coverage.

2013: Medicaid eligibility requirements

As of 2013, Medicaid eligibility is categorical and not solely based on low income. To enroll, individuals must belong to a category defined by statute, such as low-income children, pregnant women, or disabled people, with specific details varying by state.

2013: Uninsured Rate in Arkansas and Kentucky

From 2013 to 2015, the uninsured rate dropped significantly in Arkansas and Kentucky (both expanded Medicaid) compared to Texas (did not expand Medicaid).

2013: Variance in Medicaid reimbursements

In 2013, a significant variance existed in the reimbursements Medicaid offered to care providers across different states. For instance, the average difference in reimbursement for 10 common orthopedic procedures between New Jersey and Delaware was $3,047.

2013: Increase in Medicare and Medicaid enrollees

In 2013, approximately 9 million people qualified for both Medicare and Medicaid.

2013: Affordable Care Act Medicaid Payment Increase

In 2013, the Affordable Care Act included a federally funded increase in Medicaid payments to bring them up to 100% of equivalent Medicare payments, aimed at boosting provider participation.

2013: Demographics of Medicaid recipients

The Kaiser Family Foundation reported that in 2013, Medicaid recipients were 40% white, 21% black, 25% Hispanic, and 14% other races.

2014: Kaiser Family Foundation Report

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: Managed care expansion

As of 2014, 26 states had contracts with managed care organizations (MCOs) to deliver long-term care for the elderly and individuals with disabilities, paying a monthly capitated rate per member.

2014: Reduction of uninsured children

As of 2014, the rate of uninsured children was reduced to 6%, with 5 million children remaining uninsured, following access to preventive and primary services through Medicaid or SCHIP.

2014: Medicaid Expansion Under ACA

Beginning in 2014, the Affordable Care Act (ACA) required states participating in Medicaid to expand coverage to include individuals earning up to 138% of the Federal poverty level.

2014: Affordable Care Act Medicaid Payment Increase continued

In 2014, the federally funded increase in Medicaid payments, initiated by the Affordable Care Act in 2013 to match 100% of equivalent Medicare payments, continued, but most states did not subsequently continue this provision.

October 2015: Kaiser Family Foundation Estimate

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 of asset tests

As of 2015, asset tests for Medicaid eligibility varied across states. For instance, eight states did not have an asset test for a buy-in available to working people with disabilities, and one state had no asset test for the aged/blind/disabled pathway up to 100% of the Federal Poverty Level.

2015: Uninsured Rate in Arkansas and Kentucky

From 2013 to 2015, the uninsured rate dropped significantly in Arkansas and Kentucky (both expanded Medicaid) compared to Texas (did not expand Medicaid).

2016: DHHS Study on Medicaid Expansion

A 2016 DHHS study found that states that expanded Medicaid had lower premiums on exchange policies due to having fewer low-income enrollees.

2016: Medicaid has positive long-term health effects

In 2016, a paper found that Medicaid has substantial positive long-term effects on the health of recipients. Early childhood Medicaid eligibility reduces mortality and disability, increases labor supply, and reduces receipt of disability transfer programs up to 50 years later. The government recoups its investment in Medicaid through savings on benefit payments later in life and greater payment of taxes because recipients of Medicaid are healthier.

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 enrollment increases political participation

A 2017 study found that Medicaid enrollment increases political participation (measured in terms of voter registration and turnout).

2017: Total annual cost of Medicaid

As of 2017, the total annual cost of Medicaid was just over $600 billion, with the federal government contributing $375 billion and states adding $230 billion.

2017: Medicaid improved recipients' health and financial security

In 2017, a survey of the academic research on Medicaid found it improved recipients' health and financial security. A 2017 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." Studies have also found that Medicaid expansion reduced rates of poverty and severe food insecurity in certain states.

2018: Medicaid reduces infant and child mortality

A 2018 study in the Journal of Political Economy found that the introduction of Medicaid in the 1960s and 1970s led to a reduction in infant and child mortality, with a particularly steep decline in the mortality rate for nonwhite children. Also in 2018, a study in the American Journal of Public Health found that the infant mortality rate declined in states that had Medicaid expansions, but rose in states that declined Medicaid expansion.

2018: Uninsured Rates in Expansion vs Non-Expansion States

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

March 27, 2019: Medicaid Work Requirements Blocked

On March 27, 2019, a federal judge blocked Medicaid work requirements in Arkansas and Kentucky, ruling that the mandates undermined Medicaid's core purpose of providing health care to the needy.

July 2019: NBER Study on 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 September 2019, the Census Bureau reported that states that expanded Medicaid under the ACA had considerably lower uninsured rates than states that did not.

2019: Review of studies on Medicaid Expansion

A 2019 review by the 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

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

2019: Medicaid-funded births

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

2019: Medicaid eligibility under PPACA

As of 2019, when Medicaid was expanded under the PPACA, eligibility is determined by an income test using Modified Adjusted Gross Income, with no state-specific variations and no asset or resource tests.

2019: Changes in Hawaii's Medicaid program affect COFA migrants

In 2019, a 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, Medicaid-funded hospitalizations declined by 69% and emergency room visits declined by 42% for this population. However, uninsured ER visits increased and Medicaid-funded ER visits by infants substantially increased.

2019: Medicaid expansion increased hospital revenue and profitability

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. On the benefits side, we do not detect significant improvements in patient health, although the expansion led to substantially greater hospital and emergency room use, and a reallocation of care from public to private and better-quality hospitals."

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

A 2020 JAMA study found that Medicaid expansion under the ACA was associated with a reduced incidence of advanced-stage breast cancer, indicating that Medicaid accessibility led to early detection and higher survival rates. Another 2020 study found that Medicaid expansion had no adverse effects on the quality of health care given to Medicare recipients.

2020: Medicaid expansion boosted the revenue and operating margins of rural hospitals

A 2020 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: 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: Medicaid Coverage for Long-Term Services and Supports

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

2020: Affordability Concerns over Medicaid Expansion

Several states argued that they could not afford the 10% contribution to Medicaid expansion costs in 2020, raising concerns about the financial sustainability of the expansion.

2021: Medicaid dental coverage expansions led dentists to locate to poor areas

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

2021: Medicaid expansion in Louisiana led to reductions in medical debt

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

2021: Medicaid expansion leads to mortality reduction

In 2021, a study indicated that the Medicaid expansion, as part of the Affordable Care Act, led to a significant reduction in mortality, mainly due to fewer deaths from diseases.

2021: Early childhood access to Medicaid reduces mortality and disability

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. Medicaid has saved the government more than its original cost and saved more than 10 million quality adjusted life years."

2021: Average Cost Per Enrollee

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

2022: Medicaid serves over 92 million people

According to CMS, the Medicaid program provided health care services to more than 92 million people in 2022.

2022: Medicaid Coverage Statistics

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

2022: Medicaid eligibility during childhood reduced criminality during early adulthood

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 had accepted the Affordable Care Act Medicaid extension, while 10 states had not.

2023: Medicaid Annual Cost

In 2023, the total annual cost of Medicaid in the United States, including both federal and state contributions, was $870 billion.

2024: Medicaid's Role in Psychiatric Care Financing in 2024

In 2024, data analyzed for KFF Health News indicated that Medicaid covered approximately 41% of psychiatric inpatients at a sample of 680 hospitals, demonstrating its significant role in financing mental health care.

July 4, 2025: One Big Beautiful Bill Act Signed

On July 4, 2025, President Donald Trump signed the One Big Beautiful Bill Act, which implemented cuts to Medicaid by mandating work requirements, increasing fees, adding verification requirements, and placing restrictions on funding and healthcare providers.

2025: Republican Budget Cut Goals

In 2025, Republican Congressional leaders announced goals of cutting the US federal budget, with potential impacts on Medicaid and Medicare funding.

2025: One Big Beautiful Bill Act Established

The 2025 One Big Beautiful Bill Act established requirements that will begin in 2027 for most able-bodied adult Medicaid enrollees to work or volunteer for 80 hours per month in order to maintain coverage.

2027: Work Requirements for Medicaid

In 2027, requirements will begin for most able-bodied adult Medicaid enrollees to work or volunteer for 80 hours per month in order to maintain coverage, as mandated by the 2025 One Big Beautiful Bill Act.