The Difference between Medicare and Medicaid

There are two programs that are often confused by the general population.  Most people do not know or understand the differences including most politicians.  Medicare is administered by the Federal Government .  I should qualify that statement by saying that all the rules on Medicare are dictated by the Federal Government and are the same from state to state.    They use what is called MAC’s to administer the claims process strategically located across the United States.

For Medicaid each state administers it’s own Medicaid and every state will have different benefits.  The Federal Government funds a portion of Medicaid to each and every state and mandates a specific amount of requirements that each state has to adhere to but each state sets the policy guidelines.   That is why when a patient who is on Medicaid in one state will have to reapply when moving to another state.   Medicaid is a state to state program.  Eligibility criteria will differ from one state to another as do the benefits.  In addition, provider eligibility will differ from state to state as well.

In simple terms, eligibility for Medicare depends on age or disability while Medicaid is determined by a financial criteria.  Each state sets those limits.  In one state an eligible recipient has to have income less than 11,700 while another state might say 7,000.  Those numbers are purely examples and not linked to any state criteria known.

My point is that although both programs come under the CMS umbrella, they are very different in the way they are managed.  Medicare is funded by the Social Security Trust Fund and member participation while Medicaid is funded partially by the Federal government and the rest being the responsibility of the State.   Medicare benefits are the same all over the country while Medicaid is different from State to State.

In Florida there is no provider status for licensed master level providers while in other states licensed master level providers are recognized by Medicaid.  For Medicare licensed clinical social workers are recognized in all states.  Next time a little thought process on the problem with the Social Security Trust Fund.