09/03/2026
Why does the Federal Government provide greater Medicaid funding for able-bodied individuals under age 65 than it does for the Aged, Blind and Disabled on Medicare?
I came across this interesting article by Paragon Health Institute and it reinforces what I have learned about the challenge to Medicare eligible individuals (Aged, Blind, Disabled) to receive help.
The Affordable Care Act (ACA) had provision for Medicaid expansion. This expansion, if approved by voters in a State, would allow the State to provide Medicaid benefits which includes Health Insurance to those not eligible for Medicare.
What I found most interesting is the the Federal Government pays the State $9 for every $1 of state spending for expansion individuals. For the Aged, Blind and Disabled, the Federal government pays $1.33 on average for every $1 of state spending.
In other words, states receive roughly seven times more federal funding for each state dollar devoted to expansion adults than for the program’s most vulnerable populations.
These dramatically different matching rates encourage states to prioritize spending that maximizes federal reimbursements, including incorrectly categorizing traditional enrollees as expansion enrollees, rather than spending that delivers the greatest value or best serves the most vulnerable.
I'm not saying that vulnerable individuals, not eligible for Medicare, don't deserve some degree of help when they are at or below the Federal Poverty guidelines. But, I think the Federal money and State money budgeted for Medicaid program assistance needs to be more equitable.
