	Overview

Medicaid is jointly financed by the federal and state governments, but each state designs andadministers its own version of the program under broad federal guidelines. The complexity ofMedicaid can present an enormous challenge in meeting the needs of Hurricane Katrina's victims,especially when evacuees cross state lines. State variation in eligibility, covered services, and thereimbursement and delivery of services is the rule rather than the exception. Furthermore, althoughMedicaid is targeted at individuals with low income, not all of the poor are eligible, and not all thosecovered are poor. This report begins with a discussion of Medicaid's rules on eligibility, benefits, and financingin the context of current questions and issues raised by Hurricane Katrina, many of which could arisein the wake of other emergency situations (e.g., Hurricane Rita). In addition, within federal guidelines, states set functional requirements forindividuals seeking Medicaid-covered long-term care services. Issues Raised by Hurricane Katrina

Variation in Benefit Coverage Across States. Payment and Financing

		Background

The Medicaid program is jointly financed by the federal government and the states. Following the terrorist attacks on September 11, 2001, New York requested and receivedapproval for a Section 1115 waiver known as "Disaster Relief Medicaid." Below is a briefdescription of the information that is currently available regarding each of these waiver actions. The conference agreement would appropriate $2 billion (in addition to any funds madeavailable for the National Disaster Medical System under the Department of Homeland Security forhealth care costs related to Hurricane Katrina) for use by the Secretary of HHS to pay eligible states(those that have provided care to affected individuals or evacuees under a Section 1115 project) forthe following purposes:
the non-federal share of expenditures for health care provided to affectedindividuals (those who reside in a major disaster area declared as a result of Hurricane Katrina andcontinue to reside in the same state) and evacuees (affected individuals who have been displaced toanother state) under approved multi-state Section 1115 demonstrationprojects;
reasonable administrative costs related to such projects;
the non-federal share of expenditures for medical assistance provided toindividuals under existing Medicaid and SCHIP state plans; and
other purposes, if approved by the Secretary, to restore access to health carein affected communities.
Medicaid is jointly financed by the federal and state governments, but each state designs andadministers its own version of the program under broad federal guidelines. The complexity ofMedicaid can present an enormous challenge in meeting the needs of Hurricane Katrina's victims,especially when evacuees cross state lines. State variation in eligibility, covered services, and thereimbursement and delivery of services is the rule rather than the exception. Furthermore, althoughMedicaid is targeted at individuals with low income, not all of the poor are eligible, and not all thosecovered are poor.
As a federal-state program that helps to finance health care services for people with limitedresources, Medicaid is an obvious avenue of quick response for support of victims in the aftermathof a disaster. The program's federal budgetary status as mandatory spending means that federalfunding is available to support coverage for all people who meet the program's eligibility criteria,without the need for a supplemental appropriation.
However, the ability of Medicaid to respond to a disaster -- in terms of the numbers and typesof people who can rely on it for health care support -- may depend on a number of factors, includingcongressional action to modify statutory provisions (e.g., the level of federal Medicaidreimbursement offered to states), the Secretary of Health and Human Services' ability to waivecertain program requirements administratively (e.g., regarding eligibility and benefits), and actionsof the states (each of whom operates its own unique Medicaid program within federal guidelines).
This report, which will be updated as events warrant, discusses the following:
Medicaid's rules on eligibility, benefits, and financing in the context of currentquestions and issues raised by Hurricane Katrina.
Recent state actions in response to Medicaid issues raised by thehurricane.
Federal Medicaid waiver authority, including information on current activityin this area and the New York Disaster Relief Medicaid waiver granted in response to the September11 terrorist attacks.
Current federal legislation related to Medicaid and Hurricane Katrina reliefefforts.