Medicaid Variations In The United States

Medicaid, sometimes called Medical Assistance, is a health care program for the poor and disabled Americans (mostly uninsured) begun in the mid-60’s. It was authorized under the Title XIX of the Social Security Act. Medicaid is administered by each state, although it is partly funded by the U.S. Centers for the Medicare and Medicaid Services. In the Medicaid program, no two states Medicaid programs are the same, although there are certain federally set standards common to all Medicaid programs across the nation. In order to receive federal funds, each state has to provide a certain set of services and cover certain individuals. Otherwise states have other services and eligibility requirements that might be covered; in fact, some states have extended their eligibility to additional groups that are not eligible for federal financial participation.

Medicaid programs covered 34 million low-income people in 1994, a total program spending amounted to almost $140 billion, spilt between state and federal sources. Children and adults in families with children together account for about three-quarters of the Medicaid population, with elderly and disabled person making up the remaining quarter. According to the Urban Institute, a nonpartisan economic and social policy research organization, speaks about the differences between the regard to coverage and benefits in both acute and long-term care. In which it explains that the acute care spending per beneficiary depends on the composition of beneficiaries, the scope of a state’s coverage of mandatory and optional benefits, the cost of health care in the state, and its provider payment policies. It also states that long-term care spending depends on the number of elderly and disable people in need of long-term care services, the state’s willingness to meet this need through population and benefit coverage, and its policies toward payment rates and utilization.

Since Medicaid is a means-tested program, it is seen as spending per low-income person. Medicaid spending averages slightly over $2,000 per low-income individual for the nation. Although the spending is much more in the New England area and middle Atlantic states than the rest of the nation. For example, Connecticut, Massachusetts, New Hampshire, New York, and Rhode Island spend over $4,000 per low-income person, and the rest of the states like, Arkansas, Florida, Idaho, New Mexico, and Oklahoma spend less than $1,300 per low-income individual. The acute services that Medicaid covers are for example are, hospital inpatient care; physician, laboratory, and X-ray services; also outpatient services such as, early and periodic screening, diagnosis, and treatment, and payments to HMOs. The amount of money being spent in acute services averages in the United States to about $1,060. The long-term services that Medicaid covers are usually institutional care, which means nursing homes, and intermediate care facilities for the mentally retarded, which averages in the United States to over $30,000 per year; actually it is the largest component of long-term care spending.

When speaking about the topic of Medicaid, one has to think about the amount and duration of the services. According to the Centers for Medicare and Medicaid Services, the state determines the amount and duration of services offered under their Medicaid programs. The amount, duration, and scope of each service must be sufficient to reasonably achieve its purpose. The states may place appropriate limits on a Medicaid service based on such criteria as medical necessity. Although a State’s Medicaid plan must allow for the applicant to choose their own health care providers that are participating with Medicaid. Also the States may provide and pay for the services through various prepayment arrangements, such as health maintenance organization, also known as HMOs. HMO is a health plan that is also involved in how your health care is delivered. Managed care refers to health plans coordinating your health care with you and the providers that participate in the health plan. HMOs are the most common type of managed care. In general, States are required to provide comparable services to all needy eligible persons.

Another factor to the Medicaid program is its payment services. Medicaid operates as a vendor payment program, with payments made directly to the providers. Each State has a broad way of determining the reimbursement and resulting rate for services, with three conditions, which are; for institutional services, in which payments may not exceed amounts that would be paid under Medicaid payment rates; also for disproportional share hospitals different limits apply, and lastly for hospice care. Certain States sometimes might impose nominal deductibles, coinsurance, or co-payments on some Medicaid recipients for certain services. In some cases certain people are excluded from this rule, the people who fall under this category are pregnant women, children under age 18, hospital or nursing home patients who are expected to contribute most of their income to institutional care, and needy HMO enrollees. All these expenses are being paid by Federal government and the State itself. The amount that the Federal government outlays matches what the individual State decides to provide, within law, for its eligible recipients. The portion of the Medicaid program which is paid by the Federal government, also known as, Federal Medical Assistance Percentage (FMAP), is determined each year for the State by a formula that compares the State’s average per capita income level with the national average. Actually, the FMAP cannot be lower than 50 percent nor greater than 83 percent, so the wealthier the state the less amount of money they receive.

To give a few examples of the differences between States, and their eligibility, their percentage of the population on Medicaid, and the services covered, I researched states from different regions, such as Middle Atlantic, South Atlantic, East South Central, and West South Central regions. In which these States represent different sections of the nation, from the most needy to the least.

In the state of Oklahoma, in order for someone to be eligible they have to be children under nineteen, adults with children under eighteen, pregnant women, the aged, and the blind or disabled. The way in which people know if they fall into any of these categories is if they match up to certain requirements. For example, adults with children under eighteen have to follow certain income guidelines such as this:

Family Size Monthly Income

1 $291

2 $364

3 $471

4 $583

5 $682

6 $780