Chapter 7 Federal Statutes and Regulations That Impact Healthcare 121 Copyright Goodheart-Willcox Co., Inc. Medicaid Medicaid is a federal program funded by both federal and state funds, yet the program is administered only by the states. The states estab- lish eligibility criteria to determine who can qualify for Medicaid ben- efits. As a result, not all people with low incomes qualify. Some states provide healthcare for low-income individuals who do not meet the federal Medicaid eligibility criteria. If available, these programs can be accessed through state health insurance exchanges and may be supported by tax subsidies. The criteria for Medicaid eligibility often include factors such as pregnancy, blindness, or disability and may depend upon the individual’s age, income, assets, resources, or lawful immigration status. Although state law determines eligibility and distribution of Med- icaid services, federal law limits state discretion. For example, federal law forbids states from reducing state welfare benefits based on the receipt of federally funded Medicaid services. Undocumented immi- grants and immigrants who are in the United States on a temporary basis (those who have temporary work visas or student visas, for exam- ple) are not eligible for Medicaid in most states, regardless of how long they have been in the United States. However, emergency treatment is available to all immigrants, regardless of their legal status. Legal and undocumented immigrants who meet all eligibility requirements can receive Emergency Medicaid. This service covers the costs of emer- gency medical treatment. Medicare Unlike Medicaid, which provides medical benefits, Medicare is an actual insurance program that provides coverage for hospital and ­ medical ser- vices. Funding for the Medicare system comes from taxes and fees paid by eligible individuals. All workers pay taxes to support this program during their careers and, when eligible to participate, most people must pay a monthly premium for the medical services portion of Medicare. An optional pre- scription drug plan (Medicare Part D) covers­ prescription medication (Figure 7.3). Fraud and Abuse There are several federal laws related to health- care business practices that are considered to be fraud and abuse. Fraud consists of intentional acts of deception. Abuse refers to improper acts that are not consistent with ­ standard practice Diego Cervo/Shutterstock.com Figure 7.3 Some Medicare plans pay for medication that older adults need.