Promulgated over half a century ago along with Medicare, Medicaid was initially conceived as a framework for states to access federal funding for services provided to the elderly. Between then and now, this program has generated criticism around its design and financing structure, leading to alternative approaches in the provision of healthcare to the ageing. The lack of requisite political and social consensus needed to affect universal healthcare coverage notwithstanding, Medicaid continues to offer services to the elderly. The Medical Assistance Program (Medicaid) enjoys a public assistance heritage lacking in Medicare, a heritage that began around the 1950’s. Coincidentally, there were specific circumstances that led to the formulation of Medicaid like a growing elderly population, sharp increases in medical costs, increasing clamor for health insurance along with growing clamor for the same.
Since its enactment, Medicaid has remained a significant entitlement program for both beneficiaries as eligible elderly individuals have the legal right to have payments made in their stead to healthcare providers for services covered (Moore & Smith, 2006). Likewise, states enjoy an open-ended entitlement to receive matching payments from the federal government for their spending on services covered. However, as states implement the program according to minimal federal requirements, federal funds are implicitly conditioned on specific objectives. Despite the persistent association with a welfare program, Medicaid has had some significant success that are not sufficiently highlighted. Specifically, the program has made contributions that transcend better risk management for the uninsured elderly. For example, around 1993, following amendments to the Medicaid Act to enact the Vaccine for Children program (Moore & Smith, 2006). This program made vaccines free and accessible to all uninsured minor on Medicaid. Again, through out the 1980’s Medicaid contributed significantly to reductions of infant mortality rates via the provision of ambulatory care services for infants and children as well as prenatal services for expectant women (Moore & Smith, 2006). Notably, Medicaid also facilitated the development of home and community-based programs targeting the frail elderly and developmentally disabled.
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Current political and budgetary pressures favor the reduction of federal funding are considerations that will equally inform the future of Medicaid. Evidently, the diversity of actors associated with the program increase the likelihood of disagreements over the current and future state of Medicaid. Under the Affordable Care Act, Medicaid has several benefits targeting the ageing. First, the act has stabilized insurance premiums for older adults using private insurance by limiting insurance companies from varying premiums based on age, a practice that was prohibitively costly (Machledt, 2017). Secondly, ACA stops the exclusionary and prohibitive health plan practices that exclude individuals with pre-existing conditions. Notably, such policy designs disproportionately and negatively affected the ageing. Moreover, the Medicaid home and community-based service has been expanded under the ACA. This allows for the protection and enhancement of social networks among the elderly, enhancing their well-being while better managing Medicaid costs (Machledt, 2017). Considering the complex health care needs of the elderly, the patient-centered approach of both Medicare and Medicaid strengthens their connection while improving quality of care among the elderly patients. These examples help highlight the current state of Medicaid in the context of aging services.
Despite the obvious benefits in the reduction of financial risks for the elderly, there are challenges affecting Medicaid presently and will continue well into the future. Historically, the entitlement program has been the subject of intense cost and political pressure (Perkins, 2002). According to the 2006 census results, there are approximately 78 million Americans born between 1946 and 1964, this means that by around 2030, approximately 70 million Americans will be at least 65 years of age (Institute of Medicine, Board of Health Care Services, Committee on the Future Care Workforce for Older Americans,2008). Critically, these monumental demographic changes are not unique to the future, for similar changes have generally contributed to an aging population. It is this pattern of demographic change that is significant to the increases both in costs and need of Medicaid services. Unfortunately, this increased longevity has the seemingly unintended consequence of increased chronic disease prevalence among the aging population (Novak, 2015). Notably, such diseases increase health care services consumption, are associated with death and depression, and require lengthy care. Again, the elderly has increased vulnerability to physical injury, acute illnesses, and significant limitations on their daily activities. Generally, these are some of the factors that have led to increased dependence on Medicaid. Notably, this pattern of population growth is projected to double by around 2030, creating an unprecedented demand for Medicaid and medical services (Institute of Medicine, Board of Health Care Services, Committee on the Future Care Workforce for Older Americans,2008). How this escalation of demand will be addressed and the possible changes to Medicaid that will accompany remain problematic to predict.
Despite its current lack of political will, Medicaid has made contributions beyond reducing the financial risks of the uninsured elderly citizens. Historically, Medicaid has been associated with welfare due to its nature as an entitlement fund. Again, the fund has remained susceptible to prevailing political philosophy and economic conditions. That Medicaid costs have been increasing remains majorly a function of improved mortality that has created an aging population. Undoubtedly, cost, and political pressure on Medicaid are telling, however, none can predict how to handle the unprecedented demand for medical services by this gradually aging population. It is evident from the demographic changes that Medicaid expenditure increases will reflect increases in the ageing population. This observation demands for modification of the program in a manner that will not eliminate the numerous gains it has made. Notably, policy decision makers should be alive to the value of and preserve the entitlement aspect of Medicaid as it affects individual elderly citizen: it affords them the platform to enforce the insurance rights in a manner like their privately insured peers.
References
Institute of Medicine, Board of Health Care Services, Committee on the Future Care Workforce for Older Americans. (2008). Retooling for an aging America: Building the Health Care Workforce . Washington D.C: National Academies Press.
Machledt, D. (2017). Ten ways the Affordable Care Act Helps Older Adults and People with Disabilities. National Health Law Program . Retrieved from http://rrtcadd.org/wp-content/uploads/2017/03/TenWaysACAHelpsOlderAdults.pdf . Retrieved on April 30, 2018.
Moore, D., J & Smith, G., D. (2006). Legislating Medicaid: Considering Medicaid and Its origins. Health Care Financing Review, 27, 2. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HealthCareFinancingReview/downloads/05-06Winpg45.pdf . Retrieved on April 30, 2018.
Novak, M. (2015). Issues in Aging . London: Routledge
Perkins, J. (2002). Medicaid: Past Successes and Future Challenges. Health Matrix: The Journal of Law- Medicine, 12,1 . Retrieved from https://scholarlycommons.law.case.edu/cgi/viewcontent.cgi?article=1405&context=healthmatrix . Retrieved on April 30, 2018.
