FACT SHEET
Medicaid Primer: Ensuring Basic Health
Care for Millions of Women and Children
JANUARY 2013
Medicaid provides critical health care for millions of lower income women and children who
otherwise would be uninsured. At all ages, women and girls make up the majority of
enrollees in Medicaid.1
Background
Medicaid is the safety net for many of the
most vulnerable pregnant women, children,
older persons and people with disabilities who
are unable to afford private health coverage.
Medicaid is a federal-state partnership; the
federal government and the states share the
cost of the program, and states design and
administer their own programs within broad
federal rules. To qualify for Medicaid, a person
must meet financial criteria and belong to a
“categorically eligible” group: children,
parents with dependent children, pregnant
women, people with severe disabilities, or seniors.
Through the ACA, Medicaid coverage will be extended to
nearly all non-disabled adults living at or below 133% of
the FPL in January 2014, including 10 million women.2,3
Medicaid is also the largest source of financing for
nursing home and community-based long-term care.
In 2010, about half of Medicaid enrollees were children,
and the other half were predominantly older persons and
people with disabilities, including those dually eligible for
both the Medicare and Medicaid programs.4
On average, Medicaid spent $6,775 per enrollee in 2010 – but costs varied widely among the
different populations in the program. Medicaid spent an average of $2,717 per enrolled
child, and $15,495 per enrolled older adult.5 Even though children make up half of the
Medicaid population, two-thirds of program spending is for vulnerable older adults and
people with disabilities. 6 Spending for non-disabled, non-elderly adults – most of whom are
pregnant women7 – accounted for only about 14 percent of the program’s spending that
year.
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Primary and Preventive Care
Women and families need ready access to primary and preventive care to stay healthy.
Medicaid provides coverage for doctor and hospital visits, pediatric and family nurse
practitioner services, and access to federally qualified health center and rural health clinic
services.
Medicaid covers one in four children in the U.S., providing comprehensive health coverage
that includes pediatric check-ups and well-child care as well as acute health services.
Prenatal and Maternity Care
Good prenatal and maternity care are critically important for women to have healthy
pregnancies and healthy children. The program plays a significant role in improving
maternal health and reducing infant mortality, low birth weight babies, and avoidable birth
defects.8 Research shows that pregnant women covered by Medicaid obtain more timely and
adequate prenatal care than low-income women who are uninsured.9 10
Medicaid also provides for critically important well-woman care for women with dependent
children, including cancer screenings, access to prescription drugs, and other services that
help them to stay healthy and care for their families.
Nursing Home and Long Term Care Services
Women live longer, and experience higher rates of chronic illness and disability than men.
Women are more likely than men to need long-term care services and to lack the social
supports and resources that might allow them to live independently in the community.11
Medicaid pays for long-term care services for more than four million low-income, elderly
women that are “dually eligible” for both Medicare and Medicaid. These women tend to be
among the most vulnerable, as they often have extensive health needs and are very poor.
For these women, Medicaid provides coverage for long-term care services like nursing home
stays and home health, as well as assistance with Medicare cost-sharing and deductibles.
1 Kaiser Family Foundation. (2007, October). Medicaid’s Role for Women. Retrieved May 2, 2011 from http://www.kff.org/womenshealth/7213.cfm
2 Musumeci, MaryBeth. (2012, March). The Health Reform Law’s Medicaid Expansion: A guide to the Supreme Court Arguments. Kaiser Family Foundation. Retrieved April 9, 2012
from http://www.kff.org/healthreform/upload/8288.pdf
3 Kaiser Family Foundation. (2012, January). Medicaid’s Role for Women Across the Lifespan: Current Issues and the Impact of the Affordable Care Act. Retrieved March 6, 2012 at
http://www.kff.org/womenshealth/upload/7213-03.pdf
4 Office of the Actuary, Centers for Medicare & Medicaid Services, United States Department of Health & Human Services. (2012 March 16). 2011 Actuarial Report on the
Financial Outlook for Medicaid. Retrieved April 4, 2012 from http://www.cms.gov/actuarialstudies/downloads/MedicaidReport2011.pdf
5 See note 4. p.13.
6 See note 3.
7 See note 4.
8 Kaiser Family Foundation’s Kaiser Commission on Medicaid and the Uninsured. (2010, June). Medicaid: A Primer. p. 7. Retrieved May 2, 2011 from
http://www.kff.org/medicaid/upload/7334-04.pdf
9 Kaiser Family Foundation’s Kaiser Commission on Medicaid and the Uninsured. (2010, April). Medicaid Beneficiaries and Access to Care. Retrieved May 2, 2011 from
http://www.kff.org/medicaid/8000.cfm
10 See note 6. p. 12
11 Salganicoff A, et al. (2009). Health Coverage and Expenses: Impact on Older Women’s Economic Well-Being. Journal of Women, Politics, and Policy, 30. Retrieved May 2, 2011
from http://www.kff.org/womenshealth/whp081409oth.cfm
NATIONAL PARTNERSHIP FOR WOMEN & FAMILIES | FACT SHEET | MEDICAID: ENSURING HEALTH CARE FOR WOMEN AND CHILDREN
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