Who decides eligibility for Medicare and Medicaid?

• A. Federal government
• B. The state
• C. Local county health department
• D. Private insurers

Answer: (B)

Medicaid eligibility is determined at the state level. Medicaid operates as a joint federal-state program, with federal guidelines, but the states decide who qualifies based on factors like income, family size, and certain circumstances. The federal government sets the minimum standards and funds a portion of the program, but the day-to-day determination of who is eligible happens in each state.

Medicare, by contrast, is a nationwide, federal program where eligibility criteria are set by the federal government (typically age 65 and older or certain disabilities). The question as a whole often emphasizes Medicaid’s state-based eligibility, which is why the state is the focus for who decides eligibility.