Mandatory and Optional Enrollees and Services in Medicaid

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June 2017 | Spending

Chapter 1 responds to a request from the chairmen of the U.S. Senate Committee on Finance, the House Energy and Commerce Committee, and the Energy and Commerce subcommittees on Health and Oversight and Investigations for an in-depth look at Medicaid coverage of optional eligibility groups and benefits and the resources associated with them.

MACPAC’s analysis finds that in fiscal year 2013—the most recent year for which data are available—the largest share of benefit spending was on mandatory populations receiving mandatory services and the largest share of both mandatory and optional spending was for people eligible on the basis of disability. The distribution of mandatory and optional enrollment and spending varied considerably across states, reflecting state decisions about the health needs of residents, the cost of paying for care, and other policy goals.

The chapter notes that mandatory and optional designations reflect the decisions states have made within the parameters available to them but they are not synonymous with necessary or unnecessary, or important or less important. For example, Medicaid plays a singular role in covering vulnerable populations such as adults with physical and intellectual disabilities, people with severe mental illness and addictions, children with special health care needs, and frail elderly. These populations are covered through a mix of mandatory and optional eligibility pathways.

Publication Type: Reports to Congress

From: June 2017 Report to Congress on Medicaid and CHIP

Tags: benefits, eligibility, enrollment, federal/state partnership, mandatory services, optional services, spending