Comparing Title V and Medicaid:
At a Glance
Highlights
of the Title V and Medicaid programs are presented
in the following chart to aid in obtaining a clearer
view of each program's mandates, requirements, foci,
and strengths.
| Title V and Medicaid: Compared |
| |
Title V |
Medicaid |
| Authorized by |
Sections 501-510, SSA, in 1935 |
Sections 1901-1936, SSA, in 1965 |
| Administered by |
Department of Health and Human Services (HHS),
Health Resources Services Administration (HRSA),
Maternal and Child Health Bureau (MCHB). |
Department of Health and Human Services (HHS),
Centers for Medicare and Medicaid Services (CMS),
Center for Medicaid and State Operations (CMSO). |
| Overarching Goal |
To improve the health of all women, children, youth,
and families.
|
To pay for medical assistance to
both “categorically” and “medically” eligible
children and families with low incomes. |
| Funding Mechanism |
Discretionary Federal “block” grant.
|
Joint Federal/State entitlement program. |
| Funding and/or Beneficiary Requirements |
Funding Requirements:
- Every
$4 of Federal funds must be matched by
at least $3 of State/ local funds.
- At
least 30% of funds must support CSHCN.
- At
least 30% of funds must support preventive
and primary
care services for children.
- No
more than 10% of funds can be used for administration.
|
FMAP Requirements:
- Federal
funds (the “Federal Medicaid matching
rate”) are provided for services/administration
dependant on State per capita income (from 50-83%
with average of 57%).
Eligibility
groups include:
- “Mandatory” categorically needy persons
(pregnant women and infants at or below 133% FPL).
- “Optional” categorically
needy persons (pregnant women and infants with
incomes between
133%-185% FPL).
- Medically
needy persons (who qualify for coverage because
of high medical
expenses).
|
| People Served and/or Covered |
Title V provides
services to:
Over
33 million women and children total, consisting
of:
- 2.5
million pregnant woman
- 3.9
million infants less than 1 year
- 22.5
million children 1 to 22 years
- 1.4
million CSCHN
Of
the 33 million individuals:
- 1.1
million are Medicaid-eligible pregnant women
- 1.4
million are Medicaid-eligible infants under
1 year old
- 6.9
million are Medicaid-eligible children 1-22
years old.
- 0.5
million are Medicaid-eligible CSHCN.
|
Medicaid covers:
52
million people total (2004 data), consisting
of:
- 26%
of all children
- 50%
of low-income children
- 37%
of pregnant women
- 20%
of persons with disabilities
|
| Legislative Reform/Program Services |
Omnibus
Budget Reconciliation Act (OBRA-1981):
- Incorporated
five other smaller, related programs into Title
V.
- Granted
States increased spending flexibility.
- Required
each State Title V agency to participate “in
the arrangement and carrying out of the
coordination agreements …related to coordination of care
and services under this title and Title XIX” (§505(2)(F)(ii)).
OBRA-1989:
provided stricter application, spending, and
reporting requirements.
1998:
Title V Information System developed to collect
and report data. |
- Personal
Responsibility and Work Opportunity Reconciliation
Act (1996): restricted eligibility for SSI coverage
for certain populations.
- Balanced
Budget Act (BBA) (1997): reinstated eligibility
for those children
and those included under SCHIP.
- Ticket
to Work and Work Incentives Improvement Act (1999):
provided
a sliding scale payment income-based
premium.
- Medicare,
Medicaid, and SCHIP Benefits Improvement and
Protection Act (BIPA) (2000):
allowed
for additional payments to hospitals serving large Medicaid populations.
- Deficit
Reduction Act (DRA) (2005): scheduled to create
$39 billion in Medicaid reductions
from 2006-2010 by shifting costs to beneficiaries and limiting certain
services for low-income recipients.
|
