Medicaid Coverage for the Lowest Income Populations.

Medicaid Coverage For The

Lowest Income Populations.

Medicaid is one of the largest federally funded programs in the United States; it was conceived as a sort of bookend to Medicare in 1965. The role of Medicaid is to provide medical assistance for certain individuals with little or no income, and Medicare does the same, but for the elderly. Since the inception of Medicaid, the United States has covered approximately fifty-five million people for various health care needs (Iglehart, 2010). Individuals with an income at or below 133 percent of the poverty level are eligible for the coverage under Medicaid, which provides for medical services, such as doctor office visits, prescription drugs, dental and vision care, family planning, mental health care, surgeries, and hospitalizations (The Role of Public Programs, 2010). The federal and state program covers an enormous area of responsibilities, by offering comprehensive health care for children, adults with low-income, working families, and long-term care.

The federal government pays “on average” 57 percent of the Medicaid costs, and the remainders of these fees are with the states, some jurisdictions, and counties (Medicaid.gov, 2015). Federal Medical Assistance Percentage (FMAP) varies by state based on criteria such as per capita incomes, i.e. regular average state 57%, wealthier states 50%, and up to 75% in lower states. However, to keep the states on board with the expansion, Congress also sweetened the deal at the federal government’s expense by asking them to contribute more than the 57 percent. Congress also asked the federal government to cover all of the cost for the new enrollees, such as single adults with no dependent children.

Unfortunately the uninsured currently cost hospitals billions in unpaid hospitals bills and a portion of these costs are passed on to the taxpayers with insurance. One of the main causes for rising premium costs is due to unpaid hospital bills (ObamaCare Medicaid Expansion, 2014). The cost has been the largest reason for not expanding Medicaid because it cost the taxpayers a lot of money. Although, the states that have opted out have the highest uninsured rates, and the expansion would help them most.

However, for patients to be eligible for Medicaid coverage, they must belong to an eligible group (children, pregnant women, parents, blind or disabled, and the elderly. They must meet all the financial eligibility requirements for that group. Each group falls under a specific federal government mandated eligibility rule, children, and pregnant women 100-133 percent, parents eligibility can be much lower, and states are not required to cover adults without children at all (ObamaCare Medicaid Expansion, 2014). About 20 million patients fall in between the gaps, not being able to qualify for Medicaid and not able to afford insurance. Children who do not qualify for Medicaid may qualify for CHIP (Children’s Health Insurance Program). In some states, the elderly Medicaid patients automatically qualify for help to pay for their Medicare prescriptions drug coverage under “Part D”. Medicaid also offers benefits, like nursing home and personal care services, not normally covered by Medicare (ObamaCare Medicaid Expansion, 2014).

With the new Affordable Care Act, Medicaid has a large growing role in health care needs of its beneficiaries. The assessment of the program’s impact on access to care, health outcomes, and quality of care is of major interest (The Kaiser Family Foundation, 2013). Access to health care and health insurance has been an uphill struggle in the United States, due to the lack of guaranteed insurance for all citizens and thereby ensuring access to health services (McLaughlin, 2015). As stated in our book state Medicaid programs consider disease management programs to help their chronic illness costs, hospitals, and insurance companies. The provider group’s work with catastrophic care management programs to limit their losses from catastrophic medical events.

Growing concerns about insufficient physician participation in Medicaid is mainly due to the low fees paid by the state Medicaid programs (The Kaiser Family Foundation, 2013). Many Medicaid patients have “access to care problems”, from lengthily wait times to difficulty getting an appointment to see a doctor. At least 51 percent of the listed providers could not schedule an appointment. Some providers could not be found at the location listed, or some were no longer participating in the plan, while others were no longer taking new Medicaid patients (Cato Institute, 2014). With the Medicaid expansion, the demand for health care services will only create more problems for enrollees getting access to health care. The relationship between reimbursement rates and the percentage of doctors seeing new patients has increased since 2012. In states with higher Medicaid fees, more doctors accepted new patients while fewer doctors accepted new patients