History of Medicaid in Timeline

Medicaid is a U.S. government program offering health insurance to low-income adults and children. While states administer Medicaid and determine specific eligibility and benefits, the federal government provides substantial funding and sets minimum standards. State participation is voluntary, but all states currently participate. The program aims to provide healthcare access to vulnerable populations, but variations exist across states due to their administrative control.

1927: Section 1927 Added to Social Security Act

In 1990, the Omnibus Budget Reconciliation Act (OBRA-90) helped to add Section 1927 to the Social Security Act of 1935 to control discount price outpatient drugs.

1927: Omnibus Budget Reconciliation Act of 1993 amended Section 1927 of the Act

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

1935: Omnibus Budget Reconciliation Act adds Section 1927 to the Social Security Act of 1935

The Omnibus Budget Reconciliation Act of 1990 helped to add Section 1927 to the Social Security Act of 1935.

1965: Medicaid Established

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

1965: Social Security Amendments create Medicaid

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 eligible residents.

1965: Estate recovery policies for Medicaid recipients established

Since Medicaid's establishment in 1965, states could recover from estates of deceased recipients over 65 with no surviving spouse/child.

1973: Medicaid Fee for Service Program for Schools

Medicaid offers a Fee for Service Program to schools throughout the United States for the reimbursement of costs associated with services delivered to students with special education needs mandated by Section 504 of The Rehabilitation Act of 1973.

1982: All states participate in Medicaid

By 1982, all states in the United States had joined the Medicaid program. Participation in Medicaid is voluntary; however, since 1982, all states have participated.

1990: Omnibus Budget Reconciliation Act Creates Medicaid Drug Rebate Program

In 1990, the Omnibus Budget Reconciliation Act of 1990 (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 becomes effective

On January 1, 1991, the Medicaid Drug Rebate Program, created by the Omnibus Budget Reconciliation Act of 1990, became effective.

1993: Omnibus Budget Reconciliation Act and Medicaid Estate Recovery

In 1993, Congress enacted the Omnibus Budget Reconciliation Act, mandating states to recoup long-term care expenses for deceased Medicaid recipients 55 or older, while also setting exceptions for surviving family members and certain types of property.

1993: Omnibus Budget Reconciliation Act of 1993 amends Medicaid Drug Rebate Program

In 1993, the Omnibus Budget Reconciliation Act (OBRA-93) amended Section 1927 of the Act, introducing changes to the Medicaid Drug Rebate Program and mandating states to implement Medicaid estate recovery programs.

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

Legal permanent residents (LPRs) entering after August 22, 1996, are barred from Medicaid for five years, after which their coverage becomes a state option, with the option to cover LPRs who are children or who are pregnant during the first five years.

1999: Definition of "Public Charge" by Immigration Officials

In 1999, immigration officials issued a policy letter defining "public charge" and identifying benefits considered in public charge determinations, influencing current regulations and guidance on public charge grounds of inadmissibility and deportability.

2000: Increase in Medicaid paid hospital stays for children

From 2000 to 2012, there was a shift in how hospital stays for children were paid, with Medicaid's share increasing by 33% and private insurance's share decreasing by 21%.

2001: Medicare and Medicaid Dual Enrollment

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

2002: Medicaid enrollees statistics

In 2002, Medicaid enrollees numbered 39.9 million Americans, with children comprising the largest group at 18.4 million, representing 46% of the total 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, 43 million Americans were enrolled in Medicaid (19.7 million of them children) at a total cost of $295 billion.

2005: Deficit Reduction Act Requirements for Medicaid Applicants

The Deficit Reduction Act of 2005 (DRA) required Medicaid applicants to provide documentation proving U.S. citizenship or resident alien status, with exceptions for Emergency Medicaid for pregnant and disabled individuals.

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 and the federal government money but increasing the financial burden on millions of recipients.

2008: Health Insurance Premium Payment Program Status

As of 2008, relatively few states had premium assistance programs (HIPP) and enrollment was relatively low, though interest in the approach remained high.

2008: Medicaid Coverage Statistics

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

2008: Oregon Medicaid Lottery

In 2008, Oregon implemented a randomized lottery system to provide Medicaid insurance to 10,000 lower-income individuals, enabling more accurate measurement of health insurance impact by eliminating selection bias.

2008: Start of Recession and Impact on Medicaid

The economic recession that started in 2008 led to job losses and a lack of medical insurance, which resulted in higher Medicaid enrollment in 2009.

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 Surge Due to Recession

In 2009, the loss of income and medical insurance coverage during the 2008-2009 recession resulted in a substantial increase in Medicaid enrollment, straining state budgets. Nine U.S. states experienced an increase in enrollment of 15% or more.

2010: Affordable Care Act Expands Medicaid Program

In 2010, the Affordable Care Act (ACA) substantially expanded the Medicaid program, requiring states to expand coverage to individuals earning up to 138% of the federal poverty level beginning in 2014.

2010: Medicaid Expanded by Affordable Care Act

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

2011: Medicaid's Share of Hospital Stays and Costs

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 and CHIP funds could be used to pay employer health care premiums in some states

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: Shift in Payment of Hospital Stays for Children

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 individually decide on Medicaid expansion, leading to disproportionate adoption by northern states with predominantly Democratic legislators, who often extended existing eligibility.

2013: Medicaid Eligibility Requirements

As of 2013, Medicaid eligibility required membership in a defined category, such as low-income children, pregnant women, parents of Medicaid-eligible children, low-income disabled people, and low-income seniors. Category definitions varied by state.

2013: Drop in uninsured rate in Arkansas following Medicaid expansion

From 2013 to 2015, the uninsured rate dropped from 42% to 14% in Arkansas.

2013: Dual Enrollment in Medicare and Medicaid

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

2013: Federally-funded increase in Medicaid payments

In 2013, as part of the Affordable Care Act, there was a federally-funded increase in Medicaid payments to match 100% of equivalent Medicare payments. This was done to encourage more providers to participate in Medicaid programs.

2013: Demographics of Medicaid Recipients

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

2013: Variance in Medicaid reimbursements

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

2014: 26 states contract with managed care organizations for long-term care

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: Rate of Uninsured Children Reduced

As of 2014, the rate of uninsured children was reduced to 6% (5 million children remain uninsured).

2014: Kaiser Family Foundation Report Estimates Medicaid Service Costs

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

2014: Federally-funded increase in Medicaid payments

In 2014, as part of the Affordable Care Act, there was a federally-funded increase in Medicaid payments to match 100% of equivalent Medicare payments. This was done to encourage more providers to participate in Medicaid programs.

2014: ACA Requires States to Expand Coverage

Under the provisions of the ACA law passed in 2010, any state that participated in Medicaid would need to expand coverage to include anyone earning up to 138% of the Federal poverty level beginning in 2014.

October 2015: Kaiser Family Foundation estimates additional uninsured due to Medicaid expansion rejections

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: Varied Asset Tests for Medicaid Eligibility

As of 2015, asset tests for Medicaid eligibility varied by state. Eight states had no 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: Drop in uninsured rate in Kentucky following Medicaid expansion

From 2013 to 2015, the uninsured rate dropped from 40% to 9% in Kentucky.

2016: DHHS study finds lower premiums on exchange policies in expansion states

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

2016: Long-Term Health Effects of Medicaid Eligibility

A 2016 paper found that early childhood Medicaid eligibility has substantial positive long-term effects on the health of recipients, reducing mortality and disability and increasing labor supply for whites.

2016: Study of Medicaid expansion impacts

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

2016: Uninsured rates vary by Medicaid expansion status

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 Total Annual Cost

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

2017: Study on Medicaid and Political Participation

In 2017, a study indicated that Medicaid enrollment increases political participation, specifically voter registration and turnout.

2017: Survey on Academic Research on Medicaid

In 2017, a survey of academic research on Medicaid found that it improved recipients' health and financial security, with expansions linked to higher employment and student status among enrollees.

2018: Medicaid Impact on Mortality Rates

A 2018 study in the Journal of Political Economy found that Medicaid reduced infant and child mortality in the 1960s and 1970s, with a particularly steep decline in mortality rate for nonwhite children. Another 2018 study in the American Journal of Public Health found that infant mortality rate declined in states that had Medicaid expansions (as part of the Affordable Care Act) whereas the rate rose in states that declined Medicaid expansion. A 2018 study found that Medicaid expansions in New York, Arizona, and Maine in the early 2000s caused a 6% decline in the mortality rate.

2018: Higher uninsured rates in non-expansion states

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

March 27, 2019: Federal Judge Blocks Medicaid Work Requirements in Arkansas and Kentucky

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 indicates reduced mortality in Medicaid expansion states

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 Reports Lower Uninsured Rates in Expansion States

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: Impact of Medicaid Changes on COFA Migrants in Hawaii

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, 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 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: Positive Fiscal Effects of Medicaid Expansion in Michigan

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

2019: Medicaid's Share of Births Paid in the United States

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

2019: Medicaid Eligibility Under PPACA Expansion

As of 2019, in states that expanded Medicaid under the PPACA, eligibility is determined by an income test using Modified Adjusted Gross Income, without state-specific variations or asset/resource tests.

2019: Medicaid pays for half of all U.S. births

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

2019: Stanford and Wharton study on Medicaid expansion

In 2019, research by Stanford University and Wharton School economists found that Medicaid expansion significantly increased hospital revenue and profitability, especially for government hospitals, but did not detect significant improvements in patient health, despite increased hospital and emergency room use.

2020: Medicaid Expansion and Breast Cancer Detection

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. A 2020 study found no evidence that Medicaid expansion adversely affected the quality of health care given to Medicare recipients.

2020: States responsible for 10% of ACA Medicaid expansion costs

By 2020, states would need to pay for 10% of the costs of the newly covered population under the Affordable Care Act (ACA) Medicaid expansion, which was passed in 2010.

2020: Study on Medicaid Expansion Impact on Hospitals

In 2020, a study revealed that Medicaid expansion positively impacted rural hospitals' revenue and operating margins, had no effect on small urban hospitals, but negatively affected large urban hospitals.

2020: Medicaid covers 5.6 million Americans needing long-term services and support

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

2020: States could not afford the 10% contribution in 2020

Several states argued that they could not afford the 10% contribution to Medicaid expansion costs in 2020.

2021: Study on Medicaid Expansion and 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 in Louisiana

A 2021 study published in the American Journal of Public Health found that Medicaid expansion in Louisiana reduced medical debt.

2021: Study on Medicaid Dental Coverage Expansion

In 2021, a study showed that expanding adult Medicaid dental coverage led dentists to set up practices in poor, previously underserved areas.

2021: American Economic Review Study on Medicaid

In 2021, an American Economic Review study found that early childhood access to Medicaid significantly reduces mortality and disability, increases employment, and reduces reliance on disability transfer programs up to 50 years later, saving the government money and improving quality of life.

2021: Average Medicaid cost per enrollee at $7,600

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

2022: Medicaid Program Reach

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

2022: Medicaid provides insurance to 85 million people

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 and Criminality

In 2022, a study found that Medicaid eligibility during childhood reduced the likelihood of criminality during early adulthood, potentially due to increased economic security and access to treatment for substance abuse or behavioral disorders.

March 2023: 40 states accept ACA Medicaid extension

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: Medicaid annual cost totals $870 billion

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

2025: Republican leaders announce goals of cutting the US federal budget in 2025

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. The 2025 budget resolution, which was passed by the House of Representatives with only Republicans votes, proposed cutting $880 billion dollars from the Standing Committee for Energy and Commerce, which includes many areas, such as Medicaid and Medicare.