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.

Author: John Richards, M.A., 2008