A Timeline of Medicaid Coverage and Change

August 18, 2021

Medicaid has fundamentally changed the American healthcare system. Since its inception, it has continued to expand coverage to those who may not otherwise have access to healthcare. Still hotly debated, but continuing to be a viable option for many, Medicaid is here to stay, even if its future is somewhat uncertain.

Where It Began

In 1965, Medicaid was signed into law alongside Medicare as Title XIX of the Social Security Act by former President Lyndon B. Johnson. Its original intent, which has been preserved over the last 50 years since its inception, was to provide healthcare access to low-income individuals and families and authorized non-citizens. A joint federal-state public health program, Medicaid was to be and remains funded by both the federal government and individual state governments (though the percentage of funding from both has changed over time). The federal government would determine the standards for healthcare, which the states would adopt or modify to implement within their borders.

Medicaid coverage has undergone many changes as government leadership has changed, healthcare needs have increased, and new ideas have been brought to the table.

Medicaid Over Time

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  • Early 1970s: People with permanent disabilities and end-stage renal disease became included as eligible recipients of Medicaid.
  • 1972: Supplemental Security Income (SSI) was created, and eligibility for this program was linked to eligibility for Medicaid.
  • 1977: The Health Care Financing Administration was created for the purpose of taking, handling, and managing Medicare and Medicaid plans.


  • 1983: Medicaid provisions were expanded to include hospice/long-term care, particularly for those who wanted to receive hospice treatment in their own homes rather than a hospital or managed care facility.
  • 1986: Pregnant women with incomes at 100 percent of the federal poverty level (FPL) became eligible for Medicaid.
  • 1987: An Omnibus Budget Reconciliation Act (OBRA) brought about nursing home reform.


  • 1993: Former President Bill Clinton signed “OBRA ‘93”, which changed Medicaid eligibility rules so that people could not rearrange their assets to become eligible, though other provisions were also made (primarily to benefit individuals with disabilities).
  • 1997: The Children’s Health Insurance Program (CHIP) was signed into law, extending healthcare coverage to children of low-income families (income up to at least 200 percent of the FPL).
  • 1999: Work requirements to maintain healthcare coverage began to appear.


  • Early 2000s: Different option levels for care became available for people to choose from.


  • 2010: Former President Barack Obama signed the Affordable Care Act (ACA, colloquially known as “Obamacare”) into law, opening up the Health Insurance Marketplace, where people can enroll in private health insurance plans, which are often federally subsidized.
  • 2014: Benefits of ACA began, implementing federal regulations that people making 133 percent of the FPL may be eligible to receive healthcare coverage. The ACA also standardizes rules for determining eligibility and benefits.
  • 2015: Medicare and Medicaid celebrated 50 years of operation.
  • 2014-2019: Federal and state regulations in relation to the ACA continued to update and change. Many states implemented changes, while others still have not. The Trump Administration encouraged states to experiment with coverage options, but also dialed back certain regulations.


  • 2020-2021: As a result of the effects of the COVID-19 pandemic, the election of President Biden, states’ gradual acceptance of federal healthcare programs, and the Supreme Court’s continued defense of the ACA, Medicaid is continuing to expand. 39 states and Washington, D.C. have now implemented Medicaid expansion. Medicaid enrollment has also continued to climb since the beginning of 2020, as the COVID-19 pandemic and resulting economic downturn has caused people to need affordable healthcare options. The Biden Administration hopes to continue expanding Medicaid even further to offer health coverage to even more people. It has also withdrawn support for certain waivers and regulatory adjustments, such as state-by-state work requirements.

Where Medicaid Now Stands

Medicaid has come a long way in over 50 years. One thing is for sure, however: it will continue to evolve over time as lawmakers bring new ideas to implement and as the needs of the public change. In fact, some officials today (including the Biden Administration) are more heavily considering a “Medicaid for All” plan that will allow all uninsured Americans to use Medicaid programs.

Since every state does Medicaid differently, we’ve created a state-by-state Medicaid regulations guide for your convenience. If you have any other questions about Medicaid and how it can help your healthcare organization’s revenue cycle management system, don’t hesitate to contact us!