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medicaid law: an overview

Medicaid is a medical assistance program jointly financed by state and federal governments for low income individuals and is embodied in 42 U.S.C. §1396 et seq. It was first enacted in 1965 as an amendment to the Social Security Act of 1935. Today, Medicaid is a major social welfare program and is administered by the Centers for Medicare and Medicaid Services, formerly known as the Health Care Financing Administration.

Among the services that Medicaid covers are: in-patient hospital services, out-patient hospital services, laboratory and x-ray services, skilled nursing home services, physicians' services, physical therapy, hospice care, and rehabilitative services. Patients are restricted when selecting who will take care of their needs by selecting from pre-approved physicians and other providers of medical care. Because physicians are not fully reimbursed for services provided to Medicaid patients, many of them limit the number of Medicaid patients they see.

Federal law dictates that states may not reduce other welfare benefits people receive when they become eligible for Medicaid. Also, states may not impose citizenship or residency requirements other than requiring that an applicant be a resident of the state. Neither the age of the applicant nor the fact that he or she works are restrictions to receiving Medicaid.

Since its inception, the program has been plagued by fraud from both health care providers and patients. To curb these, Congress passed a law in 1996 making persons criminally liable for committing fraud in order to become eligible for medical assistance. (See 42 U.S.C.§§ 1320a-7b)

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Category: Public Benefits