What Does Medicaid Do
To put this in perspective, this is about the same number of individuals as the nations two largest commercial insurers combined.
Roughly half of all enrollees are children.
Medicaid helps many Americans who are generally not considered needy. For example, the Katie Beckett program provides support to families with children with significant disabilities without regard to parental income.
Indeed, the vast majority of costs in the Medicaid program, about two-thirds, are incurred by elderly or disabled individuals who make up only a quarter of enrollment.
American Social Policy’s Rotten Core
medical equipment such as a wheelchair, incontinence supplies, and assistive technologies
a wheelchair-accessible place to live and a wheelchair van for transportation.
2) Public assistance for these needs is spotty.
And then we found out that one crucial piece of information we had learned about Medi-Cal was wrong. Nearly two years after the accident, I got access to state-level Medi-Cal officials, who pulled up Marcella’s records and told me that she wasn’t enrolled in Share of Cost Medi-Cal. She was in SSI-linked Medi-Cal. So her health insurance is free. She has no Share of Cost requirement.
No caseworker had ever mentioned this crucial fact. The key question became: If Dave returned to his pre-accident income of $3,250 per month, would Marcella still be eligible for free Medi-Cal? Or would they be subject to Share of Cost and back in the same boat? Medi-Cal officials wouldn’t tell me, and referred me to the calculators on the World Institute on Disability website.
Could we approach Marcella’s caseworker to run the what-if scenarios and see how much income Dave could earn without threatening her eligibility? No, state officials told me: County caseworkers are incredibly busy, particularly with Medi-Cal expansion under the Affordable Care Act. This would be a low-priority request. Just look at the calculators and figure it out, they advised.
This article is adapted from Andrea Louise Campbell’s Trapped in America’s Safety Net.
Effective Date Of Coverage
Once an individual is determined eligible for Medicaid, coverage is effective either on the date of application or the first day of the month of application. Benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.
Recommended Reading: Can A Person Have Medicaid And Private Insurance
Is Medicaid Bad For Your Health
Under the Affordable Care Act, millions of the uninsured have gained Medicaid coverage. But is Medicaid good for their health, bad for their health, or does it make no difference from being uninsured? All three claims found a political champion recently, and all refer to the same study for support.
According to Republican presidential candidate Rick Perry, the health outcomes for people on Medicaid are no better than for those without insurance.
Fellow candidate Sen. Ted Cruz went further, saying health outcomes are markedly worse when people get on Medicaid and that peoples life expectancy goes down on Medicaid.
President Obama and others in his administration, meanwhile, credit the Medicaid expansion for improving peoples health and saving thousands of lives.
The academic evidence is heavily on Obamas side. But both the president and Perry are cherry-picking from the same study, while Cruz distorts it.
Perry and Cruz claim the expansion of Medicaid through the Affordable Care Act is a waste of money because, they say, studies show Medicaid doesnt work. The Rand Corporation estimated that 6.5 million people who newly enrolled in Medicaid from September 2013 through February 2015 were previously uninsured. Other estimates from both the Kaiser Family Foundation and the Urban Institute say about 4 million additional uninsured could gain coverage if all states expanded Medicaid. There are currently 21 states that have not expanded.
Medicaid Facilitates Access To Care
A large body of research shows that Medicaid beneficiaries have far better access to care than the uninsured and are less likely to postpone or go without needed care due to cost. Moreover, rates of access to care and satisfaction with care among Medicaid enrollees are comparable to rates for people with private insurance . Medicaid coverage of low-income pregnant women and children has contributed to dramatic in the U.S. A growing body of research indicates that Medicaid eligibility during childhood is associated with reduced teen mortality, improved long-run educational attainment, reduced disability, and lower rates of hospitalization and emergency department visits in later life. Benefits also include second-order fiscal effects such as increased tax collections due to higher earnings in adulthood. Research findings show that state Medicaid expansions to adults are associated with increased access to care, improved self-reported health, and reduced mortality among adults.
Figure 7: Nationally, Medicaid is comparable to private insurance for access to care the uninsured fare far less well.
Read Also: How Can I Check If I Still Have Medicaid
Medicaid Eligibility And Costs
The federal and state partnership results in different Medicaid programs for each state. Through the Affordable Care Act , signed into law in 2010, President Barack Obama attempted to expand healthcare coverage to more Americans. As a result, all legal residents and citizens of the United States with incomes 138% below the poverty line qualify for coverage in Medicaid participating states.
While the ACA has worked to expand both federal funding and eligibility for Medicaid, the U.S. Supreme Court ruled that states are not required to participate in the expansion to continue receiving already established levels of Medicaid funding. As a result, many states have chosen not to expand funding levels and eligibility requirements.
Those covered by Medicaid pay nothing for covered services. Unlike Medicare, which is available to nearly every American of 65 years and over, Medicaid has strict eligibility requirements that vary by state.
However, because the program is designed to help the poor, many states have stringent requirements, including income restrictions. For a state-by-state breakdown of eligibility requirements, visit Medicaid.gov and BenefitsCheckUp.org.
What Would The Republican
Overall, the American Health Care Act cuts more than $800 billion from Medicaid by 2026. The cuts focus on two major components.
First, the AHCA significantly reduces funding for the Medicaid expansion under the Affordable Care Act. These changes reduce the federal governments contribution from 90 percent to an average of 57 percent. The large associated costs for states would virtually eliminate the expansion in most if not all states.
However, the American Health Care Act goes further. Specifically, it alters the funding mechanism for the entire Medicaid program. Instead, it provides a set amount of funding per individual enrolled in Medicaid. In doing so, it ends the federal governments open-ended commitment to providing health care to Americas neediest populations.
Over time, these per capita payment are adjusted based on the Medical Consumer Price Index. In states like West Virginia, these increases will not keep pace with rising costs for the states sick and disabled.
In addition to the more than $800 billion in cuts to Medicaid under the AHCA, the proposed budget by President Trump would further cut Medicaid by more than $600 billion over ten years.
One major way to achieve this is to further reduce the growth rate of the per capita payments.
Recommended Reading: Michigan Medicaid Income Limits 2020
Medicaid Covers 1 In 5 Americans And Serves Diverse Populations
Medicaid provides health and long-term care for millions of Americas poorest and most vulnerable people, acting as a high risk pool for the private insurance market. In FY 2017, Medicaid covered over 75 million low-income Americans. As of February 2019, 37 states have adopted the Medicaid expansion. Data as of FY 2017 show that 12.6 million were newly eligible in the expansion group. Children account for more than four in ten of all Medicaid enrollees, and the elderly and people with disabilities account for about one in four enrollees.
Medicaid plays an especially critical role for certain populations covering: nearly half of all births in the typical state 83% of poor children 48% of children with special health care needs and 45% of nonelderly adults with disabilities and more than six in ten nursing home residents. States can opt to provide Medicaid for children with significant disabilities in higher-income families to fill gaps in private health insurance and limit out-of-pocket financial burden. Medicaid also assists nearly 1 in 5 Medicare beneficiaries with their Medicare premiums and cost-sharing and provides many of them with benefits not covered by Medicare, especially long-term care .
Figure 4: Medicaid plays a key role for selected populations.
Whos At Risk Of Losing Coverage
If the public health emergency ends in April, millions of Americans would be at risk of losing their Medicaid coverage. Under the Families First Coronavirus Recovery Act, states were able to have the federal government pay an additional 6.2 percentage points of their Medicaid costs. This increase came with strings attached: states could not make their eligibility requirements less generous than they were on January 1, 2020, and they could not remove people who were eligible for coverage from that coverage until the end of the PHE. These rules were put in place to prevent states from receiving additional Medicaid funds while removing people from the program.
As a result of these policies, millions of low-income people are enrolled in Medicaid or CHIP: in September 2021, nearly 78 million people were enrolled in Medicaid. When the PHE ends, however, states will begin the process of redetermining eligibility for these programs. While federal law generally requires states to attempt to redetermine eligibility based on information already available, for many Medicaid enrollees, this information doesnt exist. And in most states processing these automated renewals, less than half of renewals are completed based on these processes.
Sign up for updates.
You May Like: Apply For Pregnancy Medicaid Alabama
Those Who Need Help Most Fall Into Gap
Many of the people Price helps have chronic health conditions that are not being treated because they have no health insurance. And Price describes the cruel irony of the fact that the impoverished people who fall into the coverage gap tend to be the ones most likely to need medical treatment for a variety of conditions.
Like Plummer, Price reminds consumers to list all income, including Social Security, disability, unemployment and odd jobs. He recently worked with a woman whose annual income put her about $1,000 under poverty level. After discussing her finances, Price found out that she regularly cuts hair on the side, to the tune of $100 per month. That extra $1,200 in annual income bumped her over the threshold and she became eligible for a subsidy and cost-sharing reduction. She was able to find a plan for around $20 per month.
But those happy endings often elude even the most shrewd navigator. If theres no extra income there to find, theres nothing they can do to make a consumer eligible for subsidies. So they hunt for other possibilities: If the person is under 26, is a parents policy available? Or could a family member claim them as a dependent? Price notes that most of the time, these options dont work either.
Oregon Medicaid Health Experiment And Controversy
In 2008, Oregon decided to hold a randomized lottery for the provision of Medicaid insurance in which 10,000 lower-income people eligible for Medicaid were chosen by a randomized system. The lottery enabled studies to accurately measure the impact of health insurance on an individual’s health and eliminate potential selection bias in the population enrolling in Medicaid.
A sequence of two high-profile studies by a team from the Massachusetts Institute of Technology and the Harvard School of Public Health found that “Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years”, but did “increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.”
The study found that in the first year:
Also Check: Does Walgreens Take Medicaid For Prescriptions
Falling Into The Coverage Gap
Navigator Grayson Price works four days a week at the Crisis Assistance Ministry in Charlotte, North Carolina. Nearly one out of every four consumers he assists falls into the coverage gap, but thats a low-end figure, because as he explains, there are undoubtedly thousands more in the area who are either unaware of the law, unaware that they need to take some action, or already know that they do not qualify, and thus, are not seeking help.
None of Prices consumers who fall into the coverage gap have purchased full price insurance, simply because they cannot afford to do so. And Prices experience with catastrophic plans is the same as Plummers: Even though the catastrophic plans are less expensive than metal-level plans, theyre far out of reach for people living below poverty level.
When Price explains to his lowest-income consumers that they are not eligible for any assistance, their reactions vary from weary resignation to anger, but most consumers are not aware that North Carolina did not expand Medicaid. A lot of these people have already been denied from other services, so it comes as no surprise that they are not eligible for yet another program.
Medicaid Provides Poor Quality Care: What The Research Shows
Select a Section 1/0
Abstract:While targeted public assistance can work, Medicaid has become far too large and unwieldy to serve those who truly need it. A variety of research shows that Americans enrolled in Medicaid have less access to health care, and when they do receive care, the quality is often inferior to the care provided to other similar patients. This Heritage Foundation paper lays out the research, and shows how Medicaid is failing current enrollees and taxpayers and must be fundamentally reformed. The Medicaid expansion contained in Obamacare will further weaken the programhurting those who really need it, as well as unduly burdening the taxpayers who pay for it.
Medicaid is a costly and unsustainable welfare entitlement program that delivers low-quality health care to many of its enrollees. Low provider payment rates in many states mean that Medicaid recipients have a hard time finding a doctor, forcing many to rely on expensive and overcrowded hospital emergency rooms for non-emergency care. Medicaid patients frequently receive inferior medical treatment, are assigned to less-skilled surgeons, receive poorer post-operative instructions, and often suffer worse outcomes for identical procedures than similar patients both with and without health insurance.
Low Quality: Findings from the Professional Literature
Poor Access, Worse Care
Expansions Erode Overall Quality
Dont Expand Medicaid, Reform It
Currie and Gruber, Saving Babies.
Recommended Reading: Apply For Emergency Medicaid Utah
Pros And Cons Of Accepting Medicaid
One of the essential aid programs in the United States is Medicaid. It allows families who meet certain income or status qualifications the chance to receive health care services. Each program is managed individually at the state level so that individualized needs have a better chance to be met. As with any national program of support, there are some key pros and cons of accepting Medicaid that must be considered by medical providers.
Restraining Costs And Addressing State Diversify
One of the biggest challenges facing the Medicaid program is how to meet the growing need for health and LTC coverage within the constraints of Federal and State financing. Although Medicaid is jointly financed by the Federal and State governments, many of the basic coverage and provider payment decisions that determine overall expenditures are made at the State level. Because States make different decisions about whom to cover, what benefits to provide, and what to pay for services, the scope and cost of the program vary widely across States.
But beyond the financing tensions, split responsibility with State discretion over major aspects of program eligibility and coverage inevitably lead to differences across States. Medicaid is not a uniform national program for health care for the poor where one lives determines the scope and availability of Medicaid coverage. In recent years, federally mandated expansions for pregnant women and children have leveled the playing field across States by establishing eligibility floors linked to the Federal poverty level. However, States still have the option to extend coverage to higher levels, vary the benefit package, and set payment levels for care.
Recommended Reading: Does Medicaid Pay For Vyvanse
Expansion Is Optional And Some States Continue To Say No
But in 2012, the Supreme Court, while upholding the rest of the ACA, struck down the Medicaid expansion requirement, leaving it up to each state to decide whether or not to participate. As of late 2021, 38 states plus the District of Columbia had expanded Medicaid.
There are still 12 states where Medicaid eligibility has not been expanded under the ACA, although Wisconsin has a unique situation and does not have a coverage gap . So there is still a coverage gap in 13 states: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, and Wyoming.
But Medicaid expansion continues to slowly spread across the remaining states, as we knew it would. Voters in Oklahoma and Missouri approved Medicaid expansion ballot measures in 2020, so Medicaid expansion just took effect in those two states in 2021.