Healthcare Data GlossaryPayer
Medicaid: Definition and Healthcare Context
Full name: Medicaid Federal-State Health Coverage Program
Medicaid is a joint federal-state health insurance program that provides coverage to low-income individuals and families, including children, pregnant women, elderly adults, and people with disabilities. Authorized by Title XIX of the Social Security Act, Medicaid is administered by states within federal guidelines. CMS oversees federal Medicaid policy and matching payments. In 2024, Medicaid and CHIP combined covered approximately 90 million individuals, making it the largest source of health insurance coverage in the United States.
Last updated: 2026-06-17Reviewed by: Dr. Jennifer Montecillo, MD — Gullas College of Medicine, 2019. Non-practicing medical reviewer.
How it’s used
- OIG LEIE (oig-leie): OIG exclusions bar providers from Medicaid participation, making LEIE cross-referencing essential for state Medicaid compliance programs.
- CMS PECOS Medicare Provider Enrollment: states use PECOS-adjacent systems to manage Medicaid provider enrollment, with federal oversight.
- HRSA Health Professional Shortage Areas (HPSA): HPSA designations influence Medicaid reimbursement incentives for providers in underserved areas.
Frequently asked questions
- What is Medicaid?
- Medicaid is a joint federal-state program providing health insurance to low-income individuals and families. States administer Medicaid within federal guidelines set by CMS.
- How is Medicaid different from Medicare?
- Medicare is a federal program primarily for people 65+ or with disabilities. Medicaid is income-based and covers low-income individuals of any age, jointly funded by federal and state governments.
- Who qualifies for Medicaid?
- Eligibility varies by state, but federal rules require coverage for low-income children, pregnant women, elderly adults, and people with disabilities.