Medicaid

By Author: Henry Ford
Total Articles: 189
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As healthcare in the United States become costly, most people have not been able to get basic healthcare due to their economic status. There are millions of Americans who today live in fear of getting sick because they are not sure of how they will meet their healthcare needs. Good health is important for all people and for a productive nation. Medicaid was established to provide healthcare for the low income individuals and their families. As the number of people who were not insured increase, it became concern to the government and it was necessary for the federal and state government to put in place a program that would insure low income individuals and their family. Medicaid is available for all low-income individuals and families who fit in the eligibility criteria. Medicaid does not pay money to individuals but it sends the payment directly to healthcare care providers after healthcare services have been provided. In some states, individuals have to share the cost of medical care with the government (co-payment) which means individuals have to meet a part of their medical expenses. Medicaid is a means tested program, ...
... which means its effectiveness in meeting healthcare needs of the population has been tested and proved. It has become the backbone of public healthcare in the country, being the largest source of funding for public healthcare.
Social problem in Medicaid
Medicaid is one of the programs that have been established in the history of the country to respond to the growing social problems. Since the turn of the century, United States government had made several unsuccessful attempts to change the healthcare system in the United States. The private sector had continued to frustrate government efforts to reform the healthcare to enable the government play a central role in the healthcare system (Weil, 2010). All government attempts to come up with a centralized healthcare system had failed and there was growing number of people especially the low-income group and the elderly who could not meet the cost of healthcare. The private sector, which controlled the healthcare system, had continued to change prices at their will and healthcare was going beyond the reach of most Americans.
In 1960s, the government foresaw the growing danger that most Americans were not able to meet their healthcare needs. The cost of healthcare had escalated beyond the reach of most Americans. After the Second World War, countries like Britain and other had put in place social welfare programs that took care of the needs of its people. With the social security program now gaining form in the country, the government recognized the need to expand this program to cover Americans who could not afford the rising cost of healthcare (Rosenbaum, 2010). This means that establishment of Medicaid was in response to the growing social problem.
Despite the establishment of Medicaid policy, the social problem of access to quality healthcare services still rooms. Medicaid current provide coverage for more than 60 million people in the country but there are other 46 million who are not covered by any insurance program (Kaiser Family, 2010). This means that although the program has been expanded over the years, it is still to meet the healthcare need of the country. Access to healthcare still remains a major social problem in the country. However, analysts point out that the recently enacted healthcare reforms may go a long way to increase healthcare insurance coverage for low income Americans. Although the reforms are yet to take shape, it still remains theoretical that they will mitigate the social problem of access to healthcare. As has been the target of Medicaid program to decentralize control of healthcare from the hands of the private sector, the future of Medicaid and healthcare in American may remains a piped dream if necessary factors will not be taken to tackle the problem from its roots.
Description of medical policy
Medicaid can be defined as a federal-state entitlement program that is meant to provide insurance coverage for low income individuals and their families. This program is a part of the 1965 Title XIX act. It provides federal matching funds to all states to offset cost which are incurred paying healthcare providers who serve all individuals covered under the program (Medline Plus, 2010). Although state participation is voluntary, all 50 states have participated in Medicaid since 1982.
Medicaid provides medical benefits covering basic healthcare and also long-term healthcare services for all individuals who are eligible. More than 50 percent of Medicaid spending usually goes to cover hospitals and acute care expenses. The remaining 52 percent of Medicaid expenses usually covers nursing home and long term care. Any state that chooses to get Medicaid has to offer the below given services (Medline Plus, 2010):
a. Hospital care, provided for inpatient and outpatients
b. Nursing home care
c. Physical caser services
d. Laboratory and diagnostics services like X-ray services
e. Immunization
f. Family planning services
g. Nurse and midwife services
h. Physical assistant services
i. Health center and rural health clinic
States participating in the program may offer blow optional services and get federal matching funds (U.S Department of Health & Human Services, 2010):
a) Drug prescription
b) Institutional care for the mentally retarded patients
c) Home or community based care
d) Disabled personal care
e) Dental and vision care
Since every state has the freedom to design its own benefits package, so long as the benefits meet the minimum federal requirements, Medicaid benefits there vary from state to state depending on state-specific design.
In eligibility, Medicaid covers about three major groups of low income individuals including (Medline Plus, 2010):
(i) All recipients including all individuals who qualify through the eligibility criteria
(ii) Parents and their children who qualify under the different criteria - Medicaid covers more than one fifth of children in the United States. It provides coverage to more than 10 million low income adults, most of who include adults.
(iii) Elderly individuals - Medicare provides coverage to more than five million adults aged above 65 yeas. It is the single largest purchase of longer-term nursing care in the country
(iv) Disabled individuals – More than 17% of Medicaid recipient include blind and disabled individuals. Most of the receive Medicaid through Supplementary Security Income (SSI) program
For individuals to qualify for Medicaid, they must prove their resources and incomes fall below the federal specified eligibility levels. However, these levels varies from state to state and depend on the local cost living. For example in 2001, federal poverty levels (FPL) stood at $14,630 for a family of three members. In Hawaii, it was estimated at $16,830 in Hawaii and in Alaska it was $18,290 (Finuf, 2010). This shows that federal poverty level varies from one state to another. To qualify under the specified criteria, individuals must be citizens of the United States. Legal immigrants also qualify depending on the date they entered into the United States (New York Department of Health, 2010). However, illegal immigrants are not eligible to Medicaid except in cases of emergency. To receive Medicaid, individual are required to fit into the eligibility criteria, even if they are coming from low income families (Surgery Encyclopedia, 2010). Childless couples and single childless adults also do not qualify for Medicaid unless they are disabled or elderly.

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