Medicaid is a health program by both the state and the federal government of the United States that helps individuals with limited resources and low-income families with health care costs. Medicaid offers benefits beyond what Medicare covers. The benefits include personal care and nursing home care services. The major difference between Medicare and Medicaid is that while Medicare primarily helps the elderly with health coverage, Medicaid covers the costs of health care for low-income families and individuals. Individuals can register for the dual health plan that covers both Medicare and Medicaid. The health insurance association of America describes Medicaid as " a government insurance program for four persons of all ages whose income and resources are insufficient to pay for healthcare " ( Franco et al., 2018 ). Medicaid covers more than 72 million disabled and low-income individuals by providing free health insurance as per statistics provided by the American Association of Physicians in 2017. The vast number covered by the insurance policy and its largest funding source for health-related and medical services for low-income families within the United States. The Medicaid program covered the health costs for half of all the 2019 births in the United States.
Medicaid is managed by the States but jointly funded by both the federal and the state governments. The individuals eligible for Medicaid coverage are identified by the States, determining how the program is implemented. The States contributed an additional 230 billion dollars to the 375 billion dollars contributed by the federal government towards Medicaid in 2017. Eligible members today Medicaid programs include people with specific disabilities, children, and low-income adults. Qualified non-United States citizens are allowed to access the program ( Benitez & Seiber , 2018 ). The federal funding and the eligibility of Medicaid have been significantly expanded by the patient protection and affordable care act. The law states that all United States citizens and qualified non-citizens with income up to 130% of the federal poverty line, including adults without dependent children, qualify for the Medicaid program .
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Background
The author's position on Medicaid is that the program should service the coverage foundation for low-income families, adults, and children regardless of the categorical eligibility. The minimum eligibility standards for the Medicaid product should be nationally universal, and the federal government should fully subsidize the federally mandated Medicaid coverage expansions. The new Medicaid program policies developed by policymakers should refrain from closing out on vulnerable persons.
A paper published in 2008 by The American College of Physicians on achieving affordable health insurance coverage for all within seven years proposed that the United States should look forward to expanding the Medicaid program and enabling it to be accessible to all members despite the categorical eligibility. The dollar-to-dollar FMAP should be used in covering the extra Medicaid program expansion costs ( Fairbrother et al., 2018 ). On March 23rd, 2010, a law was signed by the PPACA that improved access to the Medicaid program for all individuals despite the categorical eligibility. Some legislators have expressed their desires to modify and repeal the law. Therefore, it is unclear whether more changes are likely to happen affecting individuals' access to the Medicaid program based on categorical eligibility. The standpoint of this paper is that the Foundation of health coverage for low-income families and individuals in the United States should entirely rely on the Medicaid program. Any future legislation and a repeal of the law should not interfere or endanger the Medicaid coverage to the individuals who need it the most.
The author supports Medicaid coverage expansions and has a standpoint that the policymakers must identify sources through which the government can obtain funds to ensure the expansion of the Medicaid program without creating any deficits in the state budget. The federal government should provide the funding for all the Medicaid newly eligible members during these initial stages of the program. The government should not pull out once on funding the program but instead gradually decrease its input to a minimum threshold of 10% towards expanding the population's average cost. There have been concerns that the budget allocated towards expanding the Medicaid program will strain the federal government and is most likely to create a deficit.
Evidence
The government set specified categories for individuals eligible for the Medicaid program. The federal matching funds are available to 25 different eligibility categories identified by the federal Medicaid statute. The 25 different eligibility categories can be classified into five major categories: the elderly, individuals with disabilities, adults, and families with dependent children, pregnant women, and children ( Manchikanti et al., 2017 ). Most elderly individuals in the United States have disabilities and potentially meet the categorical eligibility requirements for the Medicaid program based on their conditions. The federal government is keen on avoiding the administrative burdens and costs associated with the disability determination and therefore decides the categorical eligibility of elderly persons based on their age. Other categorical eligibility categories identified by the federal Medicaid statute are based on particular conditions or diseases such as breast cancer and tuberculosis ( Ojinnaka & Suri, 2020 ). According to the American College of Physicians, the Medicaid program covered roughly 8.6 million low-income adults and more than 21 million children in 1998. The majority of the individuals covered by the Medicaid program within this period Were women.
The study also mentioned that most individuals eligible for cash assistance through government programs such as the Aid to Families with Dependent Children are more likely to be eligible for the Medicaid program. In 1996, the law was repealed, and the Aid to Families with Dependent Children program was split from the Medicaid program. As it currently stands, less than 37% of the children enrolled in the Medicaid program are eligible for the Aid to Families with Dependent Children program. More than 4 million Americans were covered by the Medicaid program in 1998. The number has swollen to 75 million as of 2020. Most of the elderly in the United States become eligible for the Medicaid program because they receive cash assistance through the supplemental security income program. Other individuals aged 65 and over have long-term care expenses and income high medical costs but automatically become eligible for Medicaid despite having higher incomes to qualify for the supplemental security income. The elderly are covered for all the Medicaid services that include prescription of drugs and nursing home care. In 1998 nearly 7 million individuals with disabilities registered and enrolled in the Medicaid program ( Centers for Medicare and Medicaid, n.d ). The number has swollen to slightly over 22 million, according to the American College of Physicians. All the disabled persons who receive cash assistance through the supplemental security income become automatically eligible for the Medicaid program. Numerous regulatory and statutory pathways establish the eligibility for every group to the Medicaid program. The state relies on the already existing federal guidelines and policies to define the pathway for each group based on the unique resource and income requirements.
The eligibility criteria set by the state and federal governments on the Medicaid categorical eligibility prove a significant obstacle to receiving health care coverage to the individuals who need it the most. If passed, there are several pending legislations that would address the gaps in Medicaid coverage within the United States. Previous literary studies published by reputable authors illustrate the substantial gaps in Medicaid health care coverage.
The havoc caused by hurricane Katrina left behind survivors who genuinely required health care coverage more than anyone. Several federal policies and law restrictions resulted in a denial of Medicaid health coverage to most hurricane Katrina survivors ( U.S. Department of Health and Human Services, 2020 ). The sole reason why the survivors were considered ineligible for the Medicaid coverage is that they did not fall into any of the Medicaid eligibility categories. Heated discussions on how the eligibility criteria for Medicaid should be set to cover groups' unique needs during emergencies such as the hurricane have cropped up. Max Baucus and Charles Grassley subsequently introduced bipartisan legislation not allowed the Katrina survivors to access Medicaid coverage for several months ( Crowley et al., 2020 ). The legislation has published in the Emergency Health Care Relief Act simplified the Medicaid eligibility rules for the hurricane Katrina survivors through a temporary suspension of the categorical eligibility. However, it is essential to note that there are numbers of poor individuals who still do not qualify for Medicaid despite needing it the most. A survey done by the Harvard University and Kaiser Family Foundation discovered that 680 Katrina’s survivors who lived in shelters in Houston were low-income individuals who require healthcare but never fitted into any Medicaid category. The reported number of uninsured survivors who are under the age of 65 surpassed 55%. More than 40% of the evacuees who are not older than 65 years suffered from various chronic conditions and most prescription drugs ( Seewaldt , 2021 ). Many of the survivors of Hurricane Katrina lost their jobs and homes. Most of the individuals were injured and required immediate medical attention. The survivors had a higher risk of developing respiratory conditions and contracting infections, amongst other illnesses. Most of them could not pay for the medical care they required.
These Katrina survivors could have just been one group in many. There are other individuals in the United States without jobs and live in poor conditions. Most of these individuals do not access their desired quality of health care ( Toseef et al., 2020 ). Medicaid does not cover individuals because they do not fall into any of the categories specified by the affordable healthcare act.
Discussion
The Medicaid program was mainly developed to target people in financial need. Law reforms and set policies have, however, added criteria other than income for determining eligibility. All applicants must promptly demonstrate that they fit into any of the five categories or groups set by the Affordable Healthcare Act before accessing Medicaid ( Gee et al., 2021 ). It is vital to understand that the five categories of Medicaid categorical eligibility developed when the program was still connected to the receipt of cash welfare assistance. The cash welfare assistance acted as an extension of Medicaid to low-income working families. The five groups were also developed before the 1996 welfare law enactment ( Butkus et al., 2020 ). The five major categories of Medicaid include the elderly, individuals with a severe disability, adults in families with dependent children, pregnant women, and children. There are additional restrictions added to these categories. For example, for an individual to access Medicaid through disability eligibility, they must prove that the disability prevents them from working and is likely to impact the lives for more than 12 months, resulting in death. A person could break multiple limbs and cannot work, but if projected to recover within 12 months, it cannot be covered by Medicaid.
Many individuals who do not have access to the affordable health coverage of their own are left out of the Medicaid categories. One of the most apparent groups is poor adults under 65 years who do not have any dependent children. Some individuals suffer from severe medical conditions but are not eligible to be covered by Medicaid because their conditions are not sufficiently severe to meet the Medicaid disability criteria. In emergencies such as hurricane Katrina, consider a 50-year-old diabetic male without dependent children and whose shelter has been destroyed by the hurricane. The man does not fall into any of the five categories and cannot be covered by Medicaid. There is minimal possibility that uninsured individuals word find care at local hospitals or community health centers.
Conclusion
In the past five years of state and federal legislation adaptation, how many first aids have the most exciting and dynamic in the 25-year Medicaid program history for the state officials. The social policy precious for leniency and expansion of the program and the fiscal pressures for stringency and expenditure control have proved to be very frustrating. The benefits brought by Medicaid over ways on the challenges that the stakeholders face as they implemented. It is therefore vital for every stakeholder to overcome these challenges and ensure the continuity of the program. The author's position for this paper is that the Medicaid program must aim at serving as the coverage Foundation for the poor and low-income families regardless of the categorical eligibility. A favorable and universal eligibility criterion should be developed for all the states. Several concerns have been raised by the various States questioning the challenge of how the healthcare needs of the poor and low-income families could be met from the perspective of Medicaid. The benefits of Medicaid must go to those who need it the most. Therefore, all stakeholders must come together and develop policies that restructure the criteria that determine how individuals fall into the various Medicaid categories. The federal government must develop ways to find the Medicaid program to expand and cover those who need it.
References
Benitez, J. A., & Seiber, E. E. (2018). US health care reform and rural America: results from the ACA's Medicaid expansions. The Journal of Rural Health , 34 (2), 213-222.
Butkus, R., Rapp, K., Cooney, T. G., & Engel, L. S. (2020). Envisioning a better US Health Care System for all: reducing barriers to care and addressing social determinants of health. Annals of internal medicine , 172 (2_Supplement), S50-S59.
Centers for Medicare and Medicaid. (n.d.). Financial Management | Medicaid. Medicaid.Gov. Retrieved July 6, 2021, from https://www.medicaid.gov/medicaid/financial-management/index.html
Crowley, R., Daniel, H., Cooney, T. G., & Engel, L. S. (2020). Envisioning a better US health care system for all: coverage and cost of care. Annals of internal medicine , 172 (2_Supplement), S7-S32.
Fairbrother, G., Raphael, J. L., Chung, P. J., & Szilagyi, P. G. (2018). Medicaid in Transition: Proposed Changes in Funding Mechanisms and Their Consequences. Academic Pediatrics, 18(2), 125–128. https://doi.org/10.1016/j.acap.2017.11.008
Franco Montoya, D., Chehal, P. K., & Adams, E. K. (2020). Medicaid Managed Care’s Effects on Costs, Access, and Quality: An Update. Annual Review of Public Health, 41(1), 537–549. https://doi.org/10.1146/annurev-publhealth-040119-094345
Gee, R. E., Shulkin, D., & Romm, I. (2021). A blueprint for comprehensive Medicaid reform. JAMA , 325 (7), 619-620.
Manchikanti, L., Benyamin, R. M., & Hirsch, J. A. (2017). Evolution of US Health Care Reform. Pain physician , 20 (3), 107-110.
Musumeci, M., & Young, K. (2017). State variation in Medicaid per enrollee spending for seniors and people with disabilities. Kaiser Family Foundation, May , 1 .
Ojinnaka, C. O., & Suri, Y. (2020). Impact of Medicaid Expansion on Healthcare Access Among Individuals Living with Chronic Diseases. American Journal of Preventive Medicine, 59(2), 149–156. https://doi.org/10.1016/j.amepre.2020.03.012
Seewaldt, V. L. (2021). Time for action: The Patient Protection and Affordable Care Act Medicaid expansion significantly improves breast cancer care for women in Louisiana.
Toseef, M. U., Jensen, G. A., & Tarraf, W. (2020). Medicaid managed care and preventable emergency department visits in the United States. PLOS ONE, 15(10), e0240603. https://doi.org/10.1371/journal.pone.0240603
U.S. Department of Health and Human Services. (2017, February 21). A Brief History of Medicaid. ASPE. https://aspe.hhs.gov/report/using-medicaid-support-working-age-adults-serious-mental-illnesses-community-handbook/brief-history-medicaid
