According to USA.gov, eligible Medicaid recipients include individuals and families from qualified low-income groups that do not have health insurance coverage. Medicaid is a federal program with strict rules and regulations that each state must follow, although these rules and regulations vary by state and by group. Though varied, each state is monitored and required to cover base mandatory benefits and each state has the option of including optional benefits to offer Medicaid recipients. Applicants must apply at their state Medicaid office to qualify (Eligibility Requirements). In addition, the Affordable Care Act of 2010 includes a Medicaid eligibility expansion slated for 2014; however, states can elect to choose to implement this initiative before 2014. This acts will expand eligibility to Amerians under the age of 65 who fall below 133% of the FPL (federal poverty level). This changes Medicaid eligibility criteria on a federal and state level (Medicaid).
As mentioned, each state has its own set of eligibility criteria, based on compliane with federally regulated guidelines. Following is a Medicaid eligibility comparison between two states: Virginia and Kentucky. This comparison highlights the similiarities and differences between two states regarding Medicaid eligibility.
Virginia Medicaid Eligibility and Covered Services
Virigina’s state Medicaid healthcare services fall under the authority of the Department of Medical Assistance Services. This department aims at offering cost-effective, high-quality services to those in Virginia who qualify for Medicaid.
According to the state’s website, income and resource eligibility requirements for Virginia vary by category. Eligible recipients in the state fiscal year of 2012 included 604,442 children; 216,734 disabled individuals; 195,681 pregnant women, children’s caregivers, or parents; and 79,613 elderly persons (DMAS, 2013). The Medicaid program in Virginia Medicaid covers services with some minor cost sharing for some beneficiaries.
Federally mandated coverages in Virginia include: hospital, physician, and midwife services; health centers and rural health clinic services; Lab and x-ray services; transportation services, family planning services; nursing facility services; home health services; health screenings, diagnoses, and treatment programs for children; and routine dental care for persons under age 21. Optional services include: certified nurse practitioner services; prescription drugs; rehabilitation services; occupational therapy and speech language pathology services; hospice services; select mental health services; select substance abuse services; and intermediate care facilities services (DMAS, 2013).
Kentucky Medicaid Eligibility and Covered Services
According to the state of Kentucky’s website, the state healthcare program is under the Cabinet for Health and Family services. Currently, the state’s Medicaid eligibility includes individuals and families with dependent children such as pregnant women, dependent children under at 19, parents of dependent children if unemployed or underemployed or if one parent is deceased. Income and resource requirments vary by family size and income, and this is even more varied for pregnant women and children (Programs and Services, 2012).
Covered Medicaid programs in Kentucky include the Early Periodic Screening, Diagnosis and Treatment Services (EPSDT) program; Kentucky Children’s Health Insurance Plan (KCHIP); Kentucky Transitions (for those transitioning from long-term care to the community); Kentucky Women’s Cancer Screening Program; Medicaid Works (work program for the disabled); Medicare Savings Plan Program (financial assistance with Medicare premiums); Presumptive Eligibility (program for pregnant women who do not yet have Medicaid); and Title V (serving children in state custody). Covered services in Kentucky include: nurse practicioner, child advocacy, chiropractor, dental, medical equipment, family planning, hearing, vision, hospice, laboratory, medical transportation, organ transplant, pharmacy, podiatry, preventive, and dialysis services (Programs and Services, 2012).
Virignia vs. Kentucky
In comparison, it appears that both states have similarities in the required federally funded mandated coverages; though, they do have some variations in how they are administrered. For example, Kentucky offers some creative options for Medicaid recipients that do not appear in Viriginia’s offersings, in some areas, such as special programs offered such as Medicaid Works and Kentucky Transitions. However, Virignia’s website shows they are putting in effort to keep abreast of how their Medicaid dollars are allocated with posting their statistics. There is adequate information on Medicaid expenditures and delivery of services options shown in a report from their website.
Recently, Medicaid eligibilty requirements have expanded to include more Americans under the age of 65, thanks to the implementation of the Patient Protection and Affordable Care Act, also known as Obamacare, which was signed into law by President Barack Obama in 2010. This enactment will go into effect in 2014 and help save the lives of many Americans who would otherwise die, due to not having any health insurance. This initiative will also save the United States money from preventing healthcare emergencies and diseases of the indigent and manyh people with low incomes, living below the poverty line. Many who are not eligible under the current Medicaid plan will be eligible under the new plan. Also, as mentioned, each state has the option of putting Medicaid expansion initiatives in place prior to 2014.
Programs and Services. (2012). Retrieved from Kentucky Cabinet for Health and Family Services: http://chfs.ky.gov/dms/services.htm
DMAS. (2013). The Virginia Medicaid Program at a Glace. Department of Medical Assistance Services. Virginia.gov.
Eligibility Requirements for Medicaid Benefits. (n.d.). Retrieved from USA.gov: http://answers.usa.gov/system/selfservice.controller CONFIGURATION=1000&PARTITION_ID=1&CMD=VIEW_ARTICLE&ARTICLE_ID=10265&USERTYPE=1&LANGUAGE=en&COUNTRY=US
Medicaid. (n.d.). Affordable Care Act: Eligiblity. Retrieved from Medicaid.gov: http://www.medicaid.gov/AffordableCareAct/Provisions/Eligibility.html