The US Medicaid Program—Coverage, Financing, Reforms, and Implications for Health Equity

JAMA Network September 20, 2022
Julie M. Donohue, PhD; Evan S. Cole, PhD; Cara V. James, PhD; Marian Jarlenski, PhD, MPH; Jamila D. Michener, PhD; Eric T. Roberts, PhD

Key Points

Question Who does Medicaid insure, how is the program financed and delivered, how have policies evolved, and how could reforms address racial and ethnic health equity?

Findings In 2022, Medicaid insured approximately 80.6 million individuals (56.4% from racial and ethnic minority groups in 2019). In 2020, estimated Medicaid spending was $671.2 billion (16.3% of total US health spending). The proportion of beneficiaries enrolled in Medicaid managed care was 69.5% in 2019, 45 states have pursued 139 Medicaid delivery system reforms from 2003 to 2019, and 38 states and Washington, DC, have expanded Medicaid under the Affordable Care Act. Racial and ethnic health disparities are common within Medicaid, and evidence on the association of Medicaid policies and reforms with...

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