Essay On Dual Eligible

There have been a few proposed changes to Medicaid Expansion in Florida and other states. These proposed changes have included 1915 and 1115 waivers, including long-term care programs. Florida has an uninsured rate of 20 percent (Rose, 2015). This represents a great need for insurance coverage expansion and cost savings in Florida. Previous proposed changes have been successful in some aspects, but do not answer all of these elements.

Implementation of the ACA would require an extensive expansion of the Medicaid program to low income adults in each state.³ The Congressional Budget Office projects that a previously 30 million uninsured Americans, approximately 92% of the legal, non-elderly population, will have coverage by 2022.³ The federal government will pay for 100% of the costs of expanding Medicaid programs until 2016, and then gradually fade their contribution to 90% by 2020.³ Currently, expansion of the Medicaid program is voluntary and several states have stated that they intend to turn down their share of the billions of dollars that has been made available to each state solely for the expansion of this program.³ States deciding to not expand their Medicaid program will not only exclude many poor, vulnerable families from access to an important health care program, but will also exclude themselves from an economic stimulus for their state and thereby decrease the strength of their health care delivery systems by not allowing them to be more financially stable for the long

As stated in the article “Medicaid Spending: A Brief History”, the Omnibus Budget Reconciliation Act (OBRA-1981) decreased federal contributions in states where growth exceeded certain goals; this was a three-year reduction which cut matching rates by up to 4.5% in 1982, 1983, and 1984. Eligibility changed as well which made it increasingly difficult for families to receive Medicaid coverage. Reductions in federal contributions led to flexibility provisions that “broadened State options for providing and reimbursing Medicaid benefits, as well as State authority to limit coverage under medically needy programs” (Klemm, 2000). This led to experimentation with alternative options such as Health Maintenance Organizations to manage services and costs because most

Dual eligible beneficiaries are among the poorest and sickest of those covered by either Medicare or Medicaid and, subsequently, they account for a disproportionate share of spending in both programs. Yet unfortunately their care is disjointed, with little to no coordination. State and federal agencies, managed care organizations and advocates all agree that the misalignment between Medicare and Medicaid must be addressed. The varying rules, overlapping benefits and conflicting financial incentives between the two programs greatly affect the nearly 10 million beneficiaries nationwide who are dually eligible for both programs.

The Medicare and Medicaid federal programs were put in place as a way to help the less fortunate. Individuals with severe disabilities or over the age of 65 qualify for Medicare. This program helps them with health coverage, so the disabled and elderly who have Medicare do not have to worry about their medical bills and not going to the hospital when they are sick. Medicaid is a similar program, however, it only applies to low income families who cannot provide for their children. Similar to Medicare, this program covers any health related problems and takes away the worry and troubles that come with hospital bills.

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

The potential opportunity for the state to opt into the Medicaid expansion is the fact that low-income citizens will be insured. The decision of the state to opt into the Medicaid expansion will also impact the state’s budget, and this is the main challenge (Frakt, 2013). The government will cover majority of all the cost even as Medicaid expansion provides coverage for the low-income uninsured citizens. Expansion of the Medicaid is also a broken system that has poor outcomes, not severe federal strings, high inflation and no incentive for the personal responsibility of the citizens who

In Texas, the uninsured rate dropped from 37 percent to 27 percent due to many adults meeting the low poverty criteria to become insured. The adults that were eligible for the Medicaid program were adults who were eligible for a tax credit to buy the coverage on the federal health insurance programs. Texas decision not to expand Medicaid also made it hard for low income families to receive health care and pay for health medications. According to the study and observations of other states who have expanded Medicaid, it is proven that many low-income adults have less trouble paying for and obtaining health care while on the Medicaid program. In states with the Medicaid program in full effect compared to Texas where there is no expansion on Medicaid, many Americans are struggling with household responsibilities and finances due to having to pay for the private insurance and receive the health care that is needed for their condition.

States are being pressured to expand Medicaid to families earning up to $30,000 a year, just like the Affordable Care Act permits. While several respected governors have agreed to expand the program, many other governors and state legislators are cautious. These officials do not want to deny Americans their access to health care, however they do want to slow the expansion of a program that will provide them with limited access to quality care while destroying state budgets. One of the strongest arguments that can be made against the expansion of Medicaid is the fact that States simply can not afford it. The appeal to states to expand Medicaid is that the federal government will cover 100% of the cost through 2016 and eventually lowering to

     The preventative care also follows to Medicaid problems. As Medicaid only covers some people like children and people with disabilities, it only covers half of the medical expenses. For the elderly and the disabled, it doesn’t cover long-term nursing home care or prescription medications. (Reese) If things weren’t bad enough, Bush administration has opposed broad cuts to Medicaid by up to ten billion dollars. This is

In a traditionalist state, such as Texas, the financial toll that Medicaid would have on its taxpayers was on the frontlines. The Texas legislature was worried about whether or not its taxpayers would face a tax increase to cover the increased cost of those covered by Medicaid. These taxpayers would inadvertently pay for the hospital bills of those who are uninsured in Texas through an average $1,800 rise in the cost of their premiums (Rapoport, 2012). In support of expanding Medicaid, Texas would receive federal funds in order to ease the cost that accompany the expansion. Since Texas decided not to expand Medicaid, Texas “would be leaving billions and billions of federal dollars on the table” according to Anne Dunkelberg (Rapoport, 2012). Not only does this monetary incentive give Texas an extra push to participate towards expanding Medicaid but it would also help the residents of the state to get insured. Texas legislators understood that this monetary incentive would not fully cover the cost of the newly enrolled Medicaid recipients. In the end, they would have to rework the annual budget and increase taxes in order to cover these extra recipients.

Critically analyze the implications of the state’s decision to opt out of Medicaid expansion on the citizens of the state.

Medicaid is a social health care program that covers nearly 60 million Americans, including children, pregnant women, seniors, parents and individuals suffering with disabilities. Medicaid is the biggest source of funding for health related services and medical needs for the people with low income in the United States. This program is funded jointly by the state and federal level governments, but it is the state’s responsibility to manage this program. The Medicaid program is not a required program that states have to use, but all 50 states have implemented this program. With the introduction of the Affordable Care Act (ACA), and its passing in 2010, the ACA unveiled its plans to expand Medicaid eligibility to nearly all low-income adults as an addition to the other groups that fall into the Medicaid eligibility. The Medicaid program had “many gaps in coverage for adults” because it was only restricted to the low income individuals and other people with needs in their own specific category. In the past, the majority of the states who had adults that did not have children dependent on those parents were not eligible for Medicaid. These low income adults without dependent children would be without medical insurance assistance before the ACA was introduced. Medicaid is now available to all Americans under the age of 65 whose family income is at or below the federal poverty guideline of “133 percent or $14,484 for an individual and $29,726 for a family of four in 2011” (NSCL).

Any decision naturally means there must be at least two options from which to choose. The decisions made concerning the Affordable Care Act (ACA) are certainly no exception. Certainly politics enters into the mix, as does associated costs, availability of medical care, quality of care and numerous other factors. While the idea medical care for all seems quite simple on the surface, the devil is in the details. My father, Dudley Plaisance, worked in healthcare for many years, even co-founding a company whose role was to find sources of funding for patients without resources to pay medical

Medicaid is for low income: pregnant women, children under the age of 19, people 65 and over, people who