Policy Implications Of Budgetary Control
Given the inexorable growth in services and dollars under Medicaid, a variety of cost-control strategies have been initiated at both Federal and State levels. Public and private sector efforts to encourage more rational, efficient utilization of services have not yielded big savings thus far. In fact, most of Medicaid’s control and reduction strategies have targeted the groups that represent the least cost to the system.
Throughout the eighties, States have tested administrative reforms, utilization controls, and managed-care arrangements in order to promote greater efficiency and cost savings. Many of these problems were modeled after similar innovations in the private sector.
The principal means of fiscal restraint under Medicaid is cost avoidance through restrictive eligibility, benefits, and payment policies. The lack of uniform Federal standards beyond the minimum prescribed levels permits States to exercise broad discretion over who and what they cover. This flexibility has been used to control the fiscal dynamics of State Medicaid programs. Given the link to public assistance, Medicaid is also hostage to the budget politics of each State’s welfare programs. Recent Federal mandates have curtailed States’ flexibility in some areas. Nevertheless, the Medicaid patchwork is still defined primarily by annual State budget and legislative battles, or imposed on States without complementary changes in regulation of the broader health care financing structure.
How Much Does Medicaid Cost
For most health care services, you won’t pay anything, or you’ll have just a small copayment at the time of your visit. Most often, you show your Medicaid coverage card, and the state pays the full cost of your care to your doctor directly.
Some states, under a federal waiver, charge a monthly premium for certain eligibility categories.
Are There Special Medicaid Programs For Women
Yes, if you have been diagnosed with breast or cervical cancer through a state screening program and you have a low income. You can get medical treatment through your state’s Breast and Cervical Cancer Prevention and Treatment Program.
Most states will cover pregnant women and may allow you to get Medicaid, even if you have a higher income than what is required to be eligible for the program.
You May Like: Does Medicaid Cover Assisted Living In Michigan
How Do I Find A Doctor Who Takes Medicaid
You can usually look up doctors on your state’s Medicaid web site. Or call the number on the site to talk with someone about finding a provider. Usually, Medicaid is administered by a private insurance company. In this case, call your insurer or look on its web site to find a participating provider.
Medicaid Is The Nations Public Health Insurance Program For People With Low Income
Medicaid is the nations public health insurance program for people with low income. The Medicaid program covers 1 in 5 Americans, including many with complex and costly needs for care. The program is the principal source of long-term care coverage for Americans. The vast majority of Medicaid enrollees lack access to other affordable health insurance. Medicaid covers a broad array of health services and limits enrollee out-of-pocket costs. Medicaid finances nearly a fifth of all personal health care spending in the U.S., providing significant financing for hospitals, community health centers, physicians, nursing homes, and jobs in the health care sector. Title XIX of the Social Security Act and a large body of federal regulations govern the program, defining federal Medicaid requirements and state options and authorities. The Centers for Medicare and Medicaid Services within the Department of Health and Human Services is responsible for implementing Medicaid .
Figure 1: Medicaid plays a central role in our health care system.
Recommended Reading: Is Everyone Eligible For Medicaid
The Majority Of The Public Holds Favorable Views Of Medicaid
Public opinion polling suggests that Medicaid has broad support. Seven in ten Americans say they have ever had a connection with Medicaid including three in ten who were ever covered themselves. Even across political parties, majorities have a favorable opinion of Medicaid and say that the program is working well . In addition, polling shows that few Americans want decreases in federal Medicaid funding. In addition to broad-based support, Medicaid has very strong support among those who are disproportionately served by Medicaid including children with special health care needs, seniors, and people with disabilities.
Figure 10: Large Shares Across Parties Say They Have a Favorable Opinion of Medicaid
Medicaid Eligibility Requires Jumping Through Hoops
While the purpose of Medicaid is to help those who cant afford health care, many middle to upper-class Americans plan to rely on Medicaid to pay for their long term care needs as well. The program is jointly funded by federal and state governments and run by each state to meet differing needs and policies for eligibility. Many states require you to spend down to $2,000 before being eligible. Check the eligibility requirements in your state for a complete list.
Recommended Reading: Iowa Dhs Medicaid Income Guidelines
Oregon Study Shows Why Adding More People To Medicaid Is A Bad Idea
Grace-Marie Turner is the president of the Galen Institute, a nonprofit research organization focusing on free-market ideas for health reform. She served on the Medicaid Commission from 2005 to 2006.
September 26, 2013, 5:13 PM
Evidence from the latest Oregon Medicaid study shows that the program is not helping, and numerous other studies show that in some cases Medicaid may even be harming, the very people it is designed to assist.
President Obama argued during the health care debate that we can’t keep adding “more people to Medicare or Medicaid … in the absence of cost controls and reform,” putting them in a “broken system that doesnt work.
Medicaid recipients and taxpayers deserve better.
But that is just what Congress and the president did in enacting the health law. Expanding Medicaid means that patients who are already enrolled in the program many of whom have nowhere else to go for coverage will be competing for medical services with up to 20 million more people. And the most vulnerable patients who have the greatest needs are likely to have the hardest time getting care.
A father in Iowa wrote me saying that his handicapped daughter, who is on Medicaid, has to wait more than two months for a doctors appointment to treat her bladder problems: She will have to wait six months next time if hundreds of thousands more people are added to Medicaid in her home state. No one takes into consideration what will happen to those who are currently on Medicaid.
Is Using Medicaid A Bad Idea Not Necessarily
July 12, 2017 by Matt Young
A lot of people wonder whether or not it is worth it to pursue having Medi-Cal or Medicaid pay for senior care. The answer will differ from family to family, but regardless of your situation, there are a few general things that are worth knowing about allowing a government sponsored insurance policy like Medicaid to cover a parents senior care expenses. While this might not be a comprehensive list, this is a breakdown of a few of the bigger and more frequently occurring issues that I have noticed people experience.
Choices are Limited
When you rely on any insurance to pay for your coverage, your choices for care become limited. When you rely on Medicaid, those choices are even more limited. Some places readily accept Medicaid, while others do not. Know what your choices are and what the payment plans are before you commit to anything.
Just because your choices are fewer in terms of care, this does not that they are not good choices. Many skilled nursing facilities that accept Medicaid are great places and fulfill all of the needs that your mom or dad might have. The issue is that this isnt true for all places, and it takes some discernment on your part to know which nursing homes are ideal for the specific needs of your mom or dad, and which will not be as helpful.
Change Can be Slow
Care Types Change
Medicaid can be a good idea in many cases, but its not ideal for everyone.
Don’t Miss: Nursing Homes In Maryland That Accept Medicaid
Montana: Checking All The Boxes
Montana has experienced significant savings in its traditional Medicaid program and modest savings outside Medicaid related to expansion. To help pay for it, the state has imposed provider taxes and premiums. Research also documents significant economic impacts and associated tax revenues tied to expansion.
Eliminating Medicaid expansion in Montana would increase spending and reduce revenues by an amount approximately equal to 123 percent of the states expected share of Medicaid expansion in FY2021. While actual impacts and costs will likely deviate from these estimates, Montana has a variety of pathways to pay the full statutory cost of Medicaid expansion without needing to cut programs or raise additional revenues.
Notes: All savings are estimates except hospital tax obtained from Ward and Bridge . Hospital tax estimates obtained from MTN News, Hospitals Pay Tax in Medicaid-Expansion Bill But Make Millions More Through Other Means, KPAX, Mar. 28, 2019 updated Mar. 29, 2019. Expected state costs are for state FY 2021. We note that these estimates are crude. Multiple parties have developed estimates for some of the impacts included here, and their estimates do not always precisely align .
Revenue Impacts From Increased Economic Activity
States that decide to expand Medicaid turn on a spigot of federal funds. States that do not expand Medicaid do not receive a special tax break or grant equal to the amount of federal Medicaid dollars they have forgone. Thus, at the margin, the decision to expand Medicaid is in part a decision to bring a substantial amount of money into the states economy.
When new money enters a states economy, it boosts employment and income. Several studies have calculated the impact of Medicaid expansion on states economies.20 Most employ a statistical model used to estimate the number of jobs and amount of income generated by an event like Medicaid expansion. Using this method, researchers have estimated the economic impacts of Medicaid expansion in Michigan, Montana, Louisiana, Colorado, Kentucky, New Mexico, and Arkansas.21 These studies consistently find that Medicaid expansion generates significant economic impacts.
One national study uses a difference-in-differences approach to estimate the effect of Medicaid expansion on total employment in states where expansion had a large effect on overall insurance coverage.22 This study finds similar results as do the economic impact analyses. Medicaid expansion leads to significant increases in the size of expansion states health care sector and total employment .
You May Like: Humana Medicaid Long Term Care
Work Requirements And Medicaid In 2018 And Beyond
In April 2021 President Joseph Biden began unwinding the previous administrations attempts to create and implement new eligibility requirements for adults without children or disabilities. These requirements would have allowed states to remove Medicaid coverage from childless adults who are not disabled, who do not have jobs, or are not involved in work-related or volunteer programs. Even states that received approval had not enforced work requirements as of April 2021, because federal courts invalidated the rules.
In an effort to encourage states to expand Medicaid, President Bidens 2021 American Rescue Plan contains more matching of federal funds as an incentive. The U.S. Department of Health and Human Services has now revoked work requirements in the Medicaid programs of Arizona, Arkansas, Indiana, Michigan, New Hampshire, Ohio, South Carolina, Utah and Wisconsin. Kentucky and Nebraska withdrew their applications for work requirements after initially receiving approval.
According to the Pew Charitable Trusts, at least 15 states either applied for or received permission to impose work requirements during the previous administration. The nonpartisan research and policy Center on Budget and Policy Priorities reported that in 2018, Arkansas removed more than 18,000 Medicaid beneficiaries off the rolls because they did not meet new eligibility requirements.
Seven Reasons States Should Just Say No To Medicaid Expansion
WASHINGTON, DC – MARCH 26:
Democrats are desperately hoping the states will accept the Medicaid expansion being foisted on them by President Obamas health care law, but they may be be disappointed.
The primary reason for their concern is blatantly self-serving: ObamaCares success, like its RomneyCare prequel in Massachusetts, will be judged solely by how many uninsured people get coverage. The pretense of increasing quality and lowering costs was abandoned months ago now its all about reducing the uninsured.
If states refuse the Medicaid expansion, which the U.S. Supreme Court has ruled they can, the whole idea of universal coverage goes out the window. And ObamaCare will be judged a failure.
Currently, nine states have rejected the Medicaid expansion and six are leaning against it 13 have said yes and four are leaning toward it. For states that are still undecided, here are several reasons they should reject the expansion.
The problem highlights a serious misunderstanding among Democrats pushing the legislation: Access to health insurance is not the same as access to health care. ObamaCare goes to great strides, and even greater expense, to ensure people have coverage. That does not mean they will be able to get care.
While Medicaid is better than having no insurance, expansion only exacerbates Medicaids many problems. Coverage for the poor should not be synonymous with poor coverage.
Don’t Miss: How Much Does Medicaid Cover For Childbirth
Unrealized Intention Unpredicted Results
Medicaid was intended to improve health care access for the poor. It has yielded substantial benefits. There were approximately 23.5 million Medicaid recipients in 1989, about 16 million adult family heads and dependent children, and 8 million aged, blind, and disabled. . Those who have participated in the program have certainly benefited, as demonstrated by dramatic increases in utilization and improved health status in the period immediately following Medicaid’s enactment, particularly when compared with the poor without coverage .
However, Medicaid was never designed to serve everyone who is poor, nor to meet all health care needs of those eligible. Generally, Medicaid eligibility is linkedand limitedto the categorical groups and income levels defined for the cash assistance programs with limited exceptions, the standard of poverty for Medicaid is not the Federal poverty level. And, beyond a core set of mandatory, essential services, each State has, and has exercised, considerable discretion in offering additional types of health services to its Medicaid-eligible population.
Can I Get Medicaid And Medicare At The Same Time
You may in some situations. Medicare is a health insurance program for:
- People ages 65 and older
- People younger than age 65 who are disabled
- People with end-stage kidney disease
With Medicare, you have to pay monthly premiums and other costs, such as copays and deductibles, when you go for medical care. If you are on Medicare and have a limited income, you may qualify for help from Medicaid to pay the costs of Medicare. If you have both Medicaid and Medicare, you may hear people refer to you as being dually eligible.
Don’t Miss: What Doctors Take Florida Medicaid
States Experiences Confirm Harmful Effects Of Medicaid Work Requirements
Beginning in 2018, the Trump Administration encouraged states to adopt policies taking Medicaid coverage away from people not meeting work requirements. While 12 states received approval for these policies, several were blocked by the courts, and none are currently in effect. But data from Arkansas ten-month implementation of its policy and brief implementation in Michigan and New Hampshire provide direct evidence of these policies harmful effects.
Tennessee Is 1st To Be Approved For Medicaid Block Grant
Gov. Bill Lee says Tennessee has become the first state in the nation to be approved to receive funding in a lump sum for its Medicaid program through a block grant program
NASHVILLE, Tenn. — Tennessee has become the first state in the nation to be approved to receive funding in a lump sum for its Medicaid program through a block grant program, Gov. Bill Lee said Friday.
Republicans contend that states need more flexibility to shape their Medicaid programs while also being given the opportunity to rein in spending. Democrats, however, have expressed concern that spending caps might cause states to purge their rolls or reduce services. They instead want to widen Medicaid eligibility.
President-elect Joe Biden has opposed block-grant efforts and can rescind the change.
Addressing concerns about the block-grant model, Steve Smith, director of Tennessee’s Medicaid program, said there will be no reduction in services, in eligibility or in the amount paid to providers.
For the first time, we have an agreement that rewards efficiency, he said on a conference call with reporters. This is about more, not less.
TennCare, Tennessee’s Medicaid program, provides health insurance to approximately 1.5 million low-income Tennesseans, including pregnant women, children, caretaker relatives of dependent children and older adults, and disabled adults.
You May Like: Family Of Three Income For Medicaid
Expanding Medicaid Is A Bad Way To Provide Health Care Heres Why
This fall, Nebraskans will be asked if they want to expand Medicaid to more recipients. The answer to that question should be a resounding no.
Obamacares Medicaid expansion does more harm than good. Every state that has expanded Medicaid has put an undue burden on taxpayers. Enrollment in the programs is always higher than expected, meaning taxpayers are on the hook when states run out of money to fund Medicaid.
Thats especially bad for Nebraskans. The Cornhusker State has thetwelfth highest state and local property taxes in the country. If Medicaid is expanded to include working-age, able-bodied adults, Medicaid funding will inevitably run out and lawmakers will turn to hiking taxes even higher to make up the difference.
But the problem isnt just feasibility. Expanding Medicaid hurts those who truly need the program and benefits insurance companies and providers. Researchers from Harvard, Dartmouth and MIT reported that Medicaid recipients receive about 20 to 40 cents of every Medicaid dollar spent.
Whats more, expanding the pool of Medicaid recipients to able-bodied, childless, working-age adults crowds out the most vulnerable Nebraskans who are then left with less access to health care because the pool of recipients is just too large.