Most countries in the world can get and provide good and ample medical coverage to each of their citizens throughout and give good healthcare facilities by the provision of universal health care coverage. Though this may be a factor that helps in the inclusion of all ages and all people in these countries, the United States of America offers a new and all-round system towards healthcare. This has impacted more than just the inclusion of all ages but also it has been able to give a hand in citizens in states that have a low life expectancy, a high mortality rate and most preventable hospital admissions. This leads to most of the states’ citizens to have a lack of medical health insurance amongst most of their populations. This system of provision of health care that has been developed in the United States is known as the Medicaid program.
History of the Medicaid Program
Accordance to the Title XIX of the Social Security Act that was signed into law in 1965, Medicaid was authorised and since then has been the largest health insurance program across the United States. As it was passed into law, Medicaid was designed to provide health coverage to low-income individuals that helped millions of these individuals with a massive healthcare boost. Federal guidelines that have been set by the United States Department of Health and Human Services (HHS) that assist each state individually to set their own Medicaid programs that fall under the Centers for Medicare and Medicaid Services (CMS) – a federal agency that governs the whole of the countrywide Medicaid program (2012, Kaiser Family Foundation).
Initially, the Medicaid program was intended and offered to people who were receiving cash assistance, but slowly through the years has been expanded to include and cover more population. As early as 1967, the Medicaid program provided health services for all children who qualified and slowly with federal laws being introduced in 1986, pregnant women were also added into the program under the Federal Poverty Level as a state option. 1989 became a revolution for all pregnant women and children under the age of six and proper coverage of up to 13.3% of cover. In 1990, children of all ages from the age of 6 to 18 were included by the federal government in the insurance program covering up to 100% of the cover (CMS, 2015). As the years progressed, the Children’s Health Insurance Program (CHIP) was established in 1997 and helped cover children in families with high incomes who do not qualify for Medicaid (Medicaid.gov.(n.d.). Program History).
Eligibility for the Medicaid Program
The state and federal governments take part in jointly financing the Medicaid program which constitutes of a vast set of laws that help not only to provide medical cover to the population but also offers benefits that help innovate the program for more potential applicants in society. Each state is eligible to determine all policies and programs individually and accordingly and then approved by the CMS so that each state is viable to receive the federal and state funds (CMS, 2017).
The Obamacare – also known as the Affordable Care Act – was passed as law in 2010 in and enacted under the Medicaid program. This law helped the society to access medical care without various medical insurances charging more or denying health insurance to people who had pre-existing conditions. The law also provided 100% of the federal government’s funding. This also went on to the fact that the law authorised other states to simplify and modernize their health plan processes of enrolment. With this law passed into the Medicaid program, there was no longer a preference in who got privileges of the Medicaid program but almost everyone was eligible. This included low-income families, pregnant women, children, individuals with disabilities, seniors, individuals in need of long-term care, and some states low-income adults ages 18-65, without dependent children, commonly referred to as childless adults (CMS, 2013).
Benefits of the Medicaid Program
The Medicaid program was expanded with the inclusion of Obamacare into law that had held more benefits into anyone eligible to it that the previous package that Medicaid offered. These benefits were set up as mandatory benefits in most states and optional benefits in some that offered more than what the CMS had put out as a must for each individual to get.
Mandatory benefits as per the Medicaid program include inpatient and outpatient hospital services, Nursing facility services, Home health services, Physician services, Rural health clinic services, Laboratory and X-ray services, Ambulatory patient services, Hospitalization, Mental health services and addiction treatment. This also included rehabilitative services and devices, paediatric services, transportation to medical care and Prescription drugs.
Optional benefits included eyeglasses, hospice and personal care, respiratory and TB related services, occupational therapy and speech, hearing and language disorder services. All of these and much more differed from state to state depending on which state provided what (Ellis, 2004).
Advantages and Disadvantages of the Medicaid System
Through Medicaid coverage, in an attempt to achieve insurance coverage all around Texas for low-income individuals, there has also been the following as advantages to the introduction and integration of Medicaid to the state:
- The cost of health care services has been cut by half with the federal government taking care of the other half. (p. Milbank Memorial Fund )
- The State of Texas has designated networks that help foster the provision of the Medicaid program through administrative networks.
- There is a reduced number of uninsured individuals in the state.
- There has been a reduced burden of cost-shifting to employers and also other purchasers of private coverage, and health care providers.
Though with these advantages, there have been downward spirals into the Medicaid program which may include:
- Some of the citizens of the state prefer to seek health care services in the private sector and choose to go over the government’s initiative to lowered healthcare services.
- In helping the backing of the federal government to help in the program, at times state funds may be a factor in them being inadequate to help fund the n program fully.
- The future may seem dark with some of the eligible individuals being pushed off the list in new future as the state seems to believe they do not qualify for the same benefits as others who are already eligible (Milbank Memorial Fund, 2005).
The Medicaid program has evolved from one that covers specific categories of very low-income people bringing to light expanded coverage and flexibility. The program has started out targeting children from low-income residences now has come up to include a vast majority of eligible individuals across the state of Texas. With the escalating costs of the Medicaid program in proportion to the increase in eligible beneficiaries and health care costs, there are discussions about potential opportunities to reform the program. Proposals to reform Medicaid often consist of common themes, such as resetting eligibility limits, changing the required benefits, redesigning delivery systems, incentivizing providers to improve quality of care with value-based initiatives, and shifting the balance of federal and state financing and responsibilities.