Medicaid とは？③

Who pays for services provided by Medicaid?
Medicaid does not pay money to individuals, but operates in a program that sends payments to health care providers. States make these payments based on a free-for service agreement or through prepayment arrangements such as health maintenance organizations (HMOs).
メディケイドは個人に現金が支払われるものではなく、州が医療提供者に医療費を支払う仕組みです。

Each State is then reimbursed for a share of their Medicaid expenditures from the Federal Government. This Federal Medical Assistance Percentage (FMAP) is determined each year and depends on the State's average per capita income level. Richer states receive a smaller share than poorer states, but by law the FMAP must be between 50% to 83%.
その後、各州は政府から償還を受けることができます。償還金額は年度毎に見直されます。裕福な州は少ない割合、貧しい州は多い割合の償還受けることができますが、割合は50%から83%の間でないといけないと法律で定められています。

States may impose nominal deductibles, coinsurance, or copayments on some Medical beneficiaries for certain services. However, the following Medicaid beneficiaries must be excluded from cost sharing:
* Pregnant women,
* Children under age 18, and
* Hospital or nursing home patients who are expected to contribute most of their income to institutional care.
州は特定のサービスについて、メディケイドの受給者に一部負担を求めますが、妊婦、１８才未満の子供、所得の大部分が入院費で使われてしまう者、は一部負担の対象外となります。

All Medicaid beneficiaries must be exempt from copayments for emergency services and family planning services.
救急サービスは、家族計画サービスについては、全ての受給者が一部負担の対象外となります。

http://www.medicalnewstoday.com/info/medicare-medicaid/