Medicaidisn’t a one-size-fits-all program; after meeting certain federalrequirements, each state has the flexibility to shape coverage andbenefits. As a result, the Medicaid program in Pennsylvania bearslittle resemblance to the one in Louisiana. For example, non-workingparents in Pennsylvania qualify for Medicaid if their incomes are belowtwice the federal poverty level ($44,100 for a family of four). But inLouisiana, non-working parents qualify only if their incomes are below11 percent of the poverty level ($2,426 for a family of four). Statesfrequently experiment with new concepts in benefit design, eligibilityand delivery systems.

2. If you’re poor enough, Medicaid will cover your health care needs.

False.Medicaid covers about 45 percent of poor Americans, defined as thosewith incomes below the federal poverty level (about $22,000 for afamily of four). To be eligible for coverage, individuals must fallbelow certain income thresholds, which vary by state, and belong tocertain categories, such as having dependent children, or beingpregnant or disabled. In 20 states, a parent in a family of four whogets paid the federal minimum wage makes too much to qualify. Only 18states cover adults without dependent children.

3. Medicaid provides bare-bones coverage compared to what’s available in the private sector.

False. "Atleast on paper, Medicaid has a longer list of benefits t han manyprivate plans," said John Holahan, director of the health policy centerat the Urban Institute, a Washington think tank. Medicaid benefitsinclude mental health services, transportation-to-health services, andcomprehensive screenings and treatment for children. In addition,Medicaid enrollees have much lower out-of-pocket costs than people withprivate coverage. There are typically no monthly premiums and no, orvery low, copayments.

4. Medicaid patients get better treatment than patients covered by private insurance.

Not necessarily.In many states, specialists and dentists don’t see Medicaid patients."It is far from a given to get referrals to specialists," said DanHawkins, policy director for the National Association of CommunityHealth Centers. Providers typically blame low reimbursement rates asthe main reason for not accepting Medicaid patients. In Kentucky,Medicaid pays doctors $210 for a colonoscopy; Medicare pays $333.Private insurers usually pay more. In Pennsylvania, Medicaid paysdoctors $300 for an appendectomy, while Medicare pays $575. "It’s a sadfact that Medicaid payments don’t come close to covering the cost ofcaring for the vulnerable patient population that relies on it forcoverage," said Dr. Joseph Heyman, chairman of the American MedicalAssociation Board of Trustees.

5. Most Medicaid enrollees are children and their parents.

True. About76 percent of all enrollees are children and their parents. And 65percent of people on Medicaid come from working families.

6. Most Medicaid spending pays for services for children and their parents.

False.About three qua rters of Medicaid spending is for the elderly anddisabled, even though the two groups make up only about one quarter ofthe program’s enrollees. Medicare provides little coverage forlong-term care, so many elderly, after depleting their savings, rely onMedicaid to pay their costly nursing home bills.

7. Medicaid is more efficient than private insurance.

True.Administrative costs of Medicaid are less than 7 percent, or half therate that’s typically seen in the private sector. Medicaid holds downcosts in part by paying providers lower fees and doing littlemarketing.