Using Medicaid to Support Working Age Adults with Serious Mental Illnesses in the Community: A Handbook. Endnotes


  1. Kaiser Commission on Medicaid and the Uninsured (1999). Medicaid 101: A Primer. Washington DC

  2. Brian Burwell, Kate Sredl, and Steve Eiken (May 2004). Medicaid Long-Term Care Expenditures in FY 2003. The MEDSTAT Group (Cambridge MA).

  3. P.L. 89-97 (Social Security Amendments of 1965).

  4. The Social Security Act Amendments of 1950 provided for federal financial participation in state “vendor payments” for health care services furnished to Aid to Families with Dependent Children (AFDC) and “aged, blind and disabled” cash assistance recipients. However, the amount of such payments was limited by formula. This state-managed “vendor payment” approach shaped the structure of the Medicaid program. The Kerr-Mills Program was created in the Social Security Bill of 1960. This program provided open-ended federal matching payments for state expenditures for health and other services provided to indigent older persons and, subsequently, people with disabilities. States had wide latitude in deciding what services they would furnish to individuals. Prior to the enactment of Medicaid, there were wide variations in state programs and ten states did not purchase health care services of any type for cash assistance recipients. The history of the enactment of Medicaid and its early implementation period is found in: Robert Stevens and Rosemary Stevens (1974). Welfare Medicine in America: A Case Study of Medicaid. New York: The Free Press. See also Rowland, D. & Garfield, R. (2000). Health Care for the Poor: Medicaid at 35. Health Care Financing Review, 22(1): pp. 23-34.

  5. P.L. 92-603 (Social Security Amendments of 1972).

  6. P.L. 90-248 (Social Security Act Amendments of 1967).

  7. P.L. 92-223 (Act of December 14, 1971).

  8. The expansion of Medicaid eligibility mandates and options began in 1988 when Congress mandated that states provide Medicaid coverage for pregnant women and infants with incomes up to 100 percent of the Federal Poverty Level (FPL). In 1989, mandatory Medicaid coverage of children under age 6 in households with incomes up to 133 percent of FPL was mandated. In 1990, Congress mandated the coverage of children ages 6 through 18 in households with incomes of up to 100 percent of FPL; this mandate was phased in and fully took effect in 2002. These mandates also were accompanied by options for states to expand coverage to children and pregnant women in households with incomes in excess of the FPL minimums.

  9. P.L. 97-35 (Omnibus Budget Reconciliation Act of 1981)

  10. P.L. 100-203 (Omnibus Budget Reconciliation Act of 1987)

  11. P.L. 101-239 (Omnibus Budget Reconciliation Act of 1989)

  12. P.L. 104-193

  13. The §1931 family coverage was established. States were required to continue to cover families who met July 1996 AFDC-related eligibility criteria but also could provide for higher eligibility thresholds.

  14. The legislation stipulated that individuals with legal resident status who entered the United States on or after August 22, 1996 are ineligible for SSI, Medicaid and other public benefits until they have been in the country at least five years. Immigrants who entered before that date -- as well as those who have remained through the five year window -- are coverable at state option. Most states have exercised this option.

  15. P.L. 105-33 (Balanced Budget Act of 1997).

  16. The ceiling on DSH payment adjustments and restrictions on the use of provider taxes and donations were contained in P.L. 101-234 (Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of 1991.) DSH ceilings also were lowered in the Balanced Budget Act of 1997 but modified in the Medicare, Medicaid, and SCHIP Improvement and Protection Act (P.L. 106-554).

  17. P.L. 105-33 (Balanced Budget Act of 1997) and P.L. 106-170 (Ticket to Work and Work Incentives Improvement Act of 1999)

  18. CMS: Medicaid Managed Care Enrollment Report

  19. This section draws from The Kaiser Commission on Medicaid and the Uninsured (May 2003). Medicaid: Fiscal Challenges to Coverage. Washington, D.C.

  20. The Kaiser Commission on Medicaid and the Uninsured (April 2001). Medicaid’s Role for the Disabled Population Under Age 65. Washington, D.C.

  21. Federal statutory provisions concerning the state Medicaid plan are contained in §1902 of the Social Security Act.

  22. A list of CMS Regional Offices is at

  23. Located at

  24. Located at

  25. Located at

  26. Some of this guidance takes the form of “state Medicaid director” letters. These letters are located on the web at More guidance also is found at

  27. There are a few services (e.g., family planning) for which there is a uniform rate of federal financial participation set in statute. In the Jobs and Growth Tax Reconciliation Act of 2003 (P.L. 108-27), Congress temporarily increased each state’s FMAP (including states at the FMAP minimum) by 2.95 percent for the period April 2003 through June 2004 to provide states additional federal assistance.

  28. However, in the case of the territories, federal financial participation is limited to a specific amount set by Congress.

  29. See 42 CFR 457.220.

  30. The Kaiser Commission on Medicaid and the Uninsured (May 2003), op. cit.

  31. Based on the number of Medicaid enrollees at any given time during the year. The categories of children and adults do not include beneficiaries with disabilities; the category of people with disabilities does not include adults 65 and over (they are in the Older Adults category).

  32. The Kaiser Commission on Medicaid and the Uninsured (May 2003), op. cit.

  33. 42 CFR 440.230(b).

  34. 42 CFR 440.230(c).

  35. 42 CFR 440.240.

  36. §1902(a)(1) of the Social Security Act; 42 CFR 431.50.

  37. Also, 42 CFR 431.51.

  38. §1902(a)(23) of the Social Security Act; also 42 C.F.R. 431.200-.250.

  39. These waivers are "named" after the respective sections of the Social Security Act that authorize their use. From here on, they are referred to simply as 1115, 1915(b), and 1915(c) waivers.

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