Understanding Medicaid: What it is and What's at Risk

posted on Monday, February 24, 2025

Since its establishment in 1965, Medicaid has served as a vital safety net for millions of Americans. Funded jointly by the federal and state governments and administered by the states within federal guidelines, Medicaid provides essential healthcare coverage for individuals who might otherwise be unable to afford it.

As of 2025, Medicaid provides health coverage to over 80 million Americans, about 1 in 5 people, including low-income families, pregnant women, the elderly, and individuals with disabilities.

Who does Medicaid Cover?
Based on information from medicaid.gov, Medicaid covers:

• Nearly 4 in 10 children
• Over 8 in 10 children in poverty
• 1 in 6 adults
• More than 1 in 3 adults with disabilities
• Almost half of adults in poverty
• 41% of all births in the United States
• Nearly half of children with special health care needs
• 5 in 8 nursing home residents
• 23% of non-elderly adults with any mental illness

What Does Medicaid Cover?
Medicaid provides a broad range of health services, including but not limited to:

• Doctor visits and hospital stays
• Long-term care services
• Prescription drugs
• Preventive care (immunizations and screenings)
• Mental health services
• Dental and vision care for children
• Physician services
• Lab and x-ray services
• Nurse midwife services
• Nursing facilities
• Home health care for those eligible for nursing facility services
• Home and Community-Based Services (HCBS)
• Family planning services
• Hospice

Many of us could unexpectedly find ourselves needing these critical services, whether due to an accident or health crisis. Medicaid ensures access to this care during life’s unpredictable moments.

Why Is Medicaid in Danger?
Despite its importance, Medicaid faces significant threats that could undermine its ability to serve millions of Americans:

• Funding Cuts: Proposals to reduce federal funding could lead states to cut services, narrow eligibility, or increase out-of-pocket costs for beneficiaries.
• Policy Changes: Changes to federal policies, like work requirements or block grants, could limit Medicaid access and reduce coverage for many.
• State-Level Decisions: States have the authority to manage Medicaid programs, and decisions at the state level can influence the reach and quality of services. Some states have opted out of expanding Medicaid under the Affordable Care Act (ACA), leaving many low-income adults without coverage.
• Economic Pressures: Economic downturns can strain state budgets, leading to cuts in Medicaid funding and services.

Impact on Providers Like EPI
Organizations like Exceptional Persons, Inc. (EPI), which offer Home and Community-Based Services (HCBS), rely on Medicaid funding to operate. Cuts to Medicaid could significantly affect these providers, leading to reduced services or even closures. This would harm not only the individuals who depend on these services but also the broader community that benefits from having accessible, high-quality care options.

Home and Community-Based Services (HCBS)
Approximately 15 million individuals with intellectual and developmental disabilities (I/DD) are covered by Medicaid. A large portion of these individuals receives HCBS, which help them live, work, and thrive in their communities. Funded through Medicaid, HCBS supports people with I/DD by providing vital services such as personal care, job coaching, and housing assistance. These services empower individuals to live as independently as possible while staying connected to their families and communities.

The Importance of Protecting Medicaid
Medicaid is more than just health insurance—it is a lifeline for millions of Americans. It reduces health disparities, supports vulnerable populations, and provides essential services that improve the quality of life. Protecting Medicaid is crucial to ensuring that everyone has access to the healthcare and services they need.

What Can You Do?
If you’re concerned about the future of Medicaid, there are several ways you can get involved:

• Contact Your Legislators – Tell Congress to protect Medicaid and oppose funding cuts to disability services. Take action now with this easy to use toolkit.
• Spread the Word – Share this message with your networks, educate and encourage others to advocate.
• Support Funding Gaps – Help bridge Medicaid funding gaps and ensure continued access to essential services. Support our mission.
• Stay Informed - Follow along on our website advocacy page, follow us on social media: LinkedIn  |  Facebook  |  Twitter  |  Instagram, and sign up for our electronic newsletter by clicking the button below.

Medicaid is a cornerstone of the American healthcare system, and its preservation is essential for the health and well-being of millions. By staying informed and advocating for its protection, we can help ensure that Medicaid continues to provide vital services to those who need them most.