In recent years, however, Congress and many states have expanded Medicaid coverage to poor children and pregnant women who do not qualify for cash assistance. Some states have also expanded coverage to nondisabled adults without children who are poor and have high medical expenses. The new program scarcely changes the current rules for Medicaid eligibility. Within federal guidelines, states have considerable flexibility in setting their own financial eligibility criteria, benefit packages, and payment policies. In 1994, for example, state coverage of low-income populations ranged from under 40 percent to 60 percent.
Children come first.
They comprised about half of the 34 million people who received Medicaid in 1994. For nondisabled children, for example, most funds go to acute care, with hospital in-patient care and HMO payments together accounting for over half of the total. For nondisabled adults, virtually all direct Medicaid spending goes to acute care services. For people with disabilities and the elderly, however, only 57 percent of spending went for acute care in 1994, while 43 percent went to long-term care. Low-income children and adults in families with children rely on Medicaid as their major public source of health care coverage.