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The Medicaid Program, Term Paper Example

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Term Paper

What is Medicaid?

According to Medical News Today, Medicaid is a government medical and health program that provides health and dental services to eligible low-income groups in the United States, and it is managed by the U.S. Department of Health and Human Services. Medicaid is a federal program; however, it is managed at state levels regarding eligibility standards, scope of services, and payment rates for services (MNT). Medicaid is made available to help low income families, children, the elderly, and the disabled.

How Medicaid is Financed

Each state receives federal funding for there Medicaid programs; however, all states must adhere to mandatory requirements that include required services that must be offered to eligible individuals. These required services under Medicaid include hospital and physician services, prenatal are, vaccinations, home health services, lab and radiological services, diagnostic services, preventive health services, and ambulatory services (MNT). This list is not all inclusive, but it represents a significant part of what Medicaid covers for those who qualify.

Medicaid Eligibility

The federal government oversees state Medicaid programs to ensure compliance with federal requirements and guidelines; however, each state is responsible for its own adherence. States must screen Medicaid applicants to be sure they are in a group that meets eligibility requirements such as low income, having dependent children under 6 in a low income household, pregnant women with low family incomes, and recipients of Supplemental Security Income. This list is not all inclusive but it shows the basic requirements for qualifying for Medicaid, based on need (MNT).

The Patient Protection and Affordable Care Act

This act is also known as Obamacare and was signed into law by President Barack Obama. It is an amendment to the United States healthcare system and is designed to insure all low-income Americans up to age 65 by decreasing healthcare costs and access problems. This act expands Medicaid coverage to more people. The expansion includes a minimum income eligibility level of 133% of FPL (federal poverty level). One significant change about this is adults without children, who fall below the FPL, will qualify for Medicaid insurance. This act also makes provisions for enrollment, an earlly option prior to 2014, maintenance, former foster care children, and family planning (Medicaid).

In addition, those people whose incomes are over the eligiility level may still quality for Medicaid on a medically needy basis. This is an option that allows for the extension of Medicaid eligibility to people in this group. There eligibility is calculated by a spend down option. This spend down amount is incurred by people in this group with medical expenses that exceed their income, as determined by their state’s medically needed income level.

Design of Medicaid Programs

According to the National Conference of State Legislature (NCSL), Medicaid is both a federal and state partnership program. Both entities share authority of the program, as well as financing of the program. On the federal level, the state Medicaid programs are monitored, based on how individual states manage their Medicaid programs. This includes service quality measurements, as well as measurements of delivery methods and eligibility criteria. In addition, with the onset of the Patient Protection and Affordable Care Act, the Medicaid program design has expanded that changes policies at the state level with specific provisions. State policymakers are charged with innovating the Medicaid programs in their states to improve quality and delivery of service (NCSL).

Conclusion

There are millions of uninsured or underinsured people in the United States because they cannot afford health insurance and previously did not qualify for Medicaid. The Patient Protection and Affordable Care Act has changed this dynamic and will allow more people to get the care that they need. Many would argue that healthcare is not just a privilege for those with a certain amount of money or a certain level of income, but it is a right that all Americans should have. Medicaid covers most physician, hospital, and dental services for those who qualify and gives various options for community-based care.

Some people may not understand the difference between Medicaid and Medicare. The difference is Medicare is associated with Social Security and is currently offered to people 65 years of age and over. Medicaid is not tied to Social Security and is for people up to age 65. This is significant because there are many people who are too young for Medicare, but may not qualify for Medicaid, except under the new Affordable Care Act. This will save many lives and help many sick people who suffer needlessly because they have nowhere to turn for healthcare services. Medicaid is there to help even more people with the expansion provided by the Affordable Care Act, and this will help decrease medical care costs throughout the United States, because many health problems can be averted because of prevention options available to those who previously had not option.

References

Medicaid. (n.d.). Affordable Care Act: Eligiblity. Retrieved from Medicaid.gov: http://www.medicaid.gov/AffordableCareAct/Provisions/Eligibility.html

MNT. (n.d.). What is Medicare / Medicaid? Retrieved from Medical News Today: http://www.medicalnewstoday.com/info/medicare-medicaid/

NCSL. (n.d.). Medicaid. Retrieved from National Conference of State Legislature: http://www.ncsl.org/issues research/health/medicaid-home-page.aspx

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