Explain state vs federal funding for entitlements

IrishCoffee7

I feel a little emabarrassed asking this because I should understand it better already but...can someone break down which entitlements are state-funded vs federally funded, and how it works when they are state-run programs that receive federal money?

Specific example, Medicare/Medicaid.  They are discussed as federal programs but run by the states right?  I know with healthcare reform some states are considering refusing federal money to increase the minimum threshholds to qualify for those programs...but those prgrams are ultimately state run.  I know other types of welfare like food assistance programs are state run.

Is there a simple breakdown on who pays for what?  This stems from a conversation DH and I were having while watching the RNC last night. 

kmm2150

I doubt you'll find a simple breakdown of who pays for what, but my understanding is that all most federally funded programs are administered at the state level by state agencies, and there are federal regulations of how this money is spent, accounted for, who qualifies, etc. Within those regs, states can have some room to apply funds and programs to situations and conditions that are particular to their state. I believe that often states are required to come up with matching funds for federal funds, but this varies by program.

So, for example, the federal govt. has Housing and Urban Development (HUD), that encourages things like low-income housing, but HUD funds are administered at the state level by state agencies that can creat their own additional criteria and priorities.

As for what's funded by a state, that will vary widely from state to state.

quidditchcapn1120

IrishCoffee7:

I guess I'm curious more what's NOT federally funded, or if there are programs that are primarily state funded and only receive a small amount of federal money. 

Like do the states pay for medicare/medicaid at all?  Or just distribute federal money?

It's a little of both. I have read statistics that say that states contribute approximately half of medicaid funding and the federal government provides the rest.

write2nicole

Medicare is federally funded and comes out of payroll taxes. https://en.wikipedia.org/wiki/Medicare_%28United_States%29#Financing (Medicare is for people 65 or older or people on disability.)

Medicaid has both state and federal funding. It's a federal matching program, which means that states choose which programs to fund, and the federal government matches the states' funding for those programs according to a formula. The formula is based on per capita income for the state.  https://en.wikipedia.org/wiki/Medicaid#Budget (Medicaid is generally for low-income adults and their children.)

write2nicole

Also, here's an article that covers the ACA aspect of Medicaid based on the Supreme Court's ruling. Specifically:

The Supreme Court decision gives individual states the option of expanding Medicaid by changing enrollment requirements. Under the expansion, anyone 133 percent above the federal poverty line will qualify for increasing coverage to low-income individuals, meaning that 17 million currently uninsured would gain Medicaid coverage. The new law will simplify eligibility for enrollment by eliminating the pre-existing categories that one must currently fall under to qualify for Medicaid. Moreover, before the ACA, the federal government shared Medicaid costs with the states, with the federal government paying roughly 57 percent of the total amount. If individual states accept this provision to expand Medicaid, the federal government will cover the total cost for Medicaid expansion for three years. States that consent to the Medicaid expansion will receive funds to pay their residents? health care bills, which could also reduce the number of hospitals and physicians left with uninsured patient bills. The 100 percent match rate from the federal government will decrease after the first three years: in 2017, the federal government will pay 95 percent of the cost, and in 2020, the federal government will cover only 90 percent of the bill.

jamieaustin

If you look on the federal medicaid website, you can see how much the fed gov't pays for each state.  In MS, the fed gov't pays for 75% of our medicaid program.  But we are poor, esp. in the delta.