Health Care Programs For The United States

Adults, 65 years old and older and people with disabilities are eligible for Medicare and Medicaid. Physician services and hospitalizations are covered by medicare. An additional supplemental program may be purchased to cover prescription drugs. Low income families and children may qualify for Medicaid and Children’s Health Insurance Program (CHIP). Medicaid has significantly lower copays and out of pocket expenses compared to private insurance. Unemployed individuals may qualify for Medicaid depending on the state.

Although Medicaid may sound generous, the program has many narrowing limitations. Numerous restrictions prevent the program from being offered to everyone who is poor and cannot afford medical care. Eligibility for the program is not based on need alone, but is also affected by age, family status, and medical condition. Beyond the federal programs Medicare and Medicaid, inhabitants of the United States must look to private organizations to provide their healthcare. People may enroll in these independent health insurance plans through their employer or on their own if they can pay for it.

I chose to compare and contrast Ohio and Michigan State Medicaid. Medicaid is a state and federally funded entitlement program that pays for medical services to qualified low-income Michigan residents. It is one of the largest programs at the state level, providing services to over one million Michigan residents annually. All of the health care programs in Michigan have an income test and some of the programs also have an asset test. These income and asset tests may vary with each program. For some of the programs, the applicant may have income that is over the income limit and still be able to obtain health care benefits when their medical expenses equal or exceed their deductible (formerly known as spend-down) amount. Below are two examples of Michigan Medicaid plans that are available.

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.

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).

Medicaid is a joi8nt federal and state program. It provides health coverage to nearly 60 million Americans including children, pregnant women, seniors, and individuals with disabilities. As well as those people who are eligible to receive federally assisted income. Eligibility does however vary state to state.

Medicare program in the U.S. covers the cost of healthcare of those over the age of 65. Medicaid

For those adults with children that are not eligible for Medicaid but their income is not enough for private insurance, KidsCare was an option until it froze in January 2010 due to a cost-cutting effort. KidsCare is a state sponsored insurance program for low-income families that is part of the federal Children’s Health Insurance Program (CHIP). Arizona is currently the only state that does not have a CHIP program which forces families that were on the program to partake in the health care exchange and pay for private insurance or forgo health coverage and be uninsured (Whiteman, M., 2014). The number of children covered at the time of the program freeze went from 45,000 to about 2,000, which was a ninety-five percent drop (Whiteman, M., 2014). Governor Jan Brewer proposed to restore coverage to thousand of children through KidsCare II, where Phoenix Children’s Hospital, Maricopa Integrated Health System, and the University of Arizona Health Network would pull money together and receive extra federal funds. The federal funds that the

Each state has their own policies for Medicaid eligibility, services and payments. Medicaid plans have three eligibility groups such as categorically needy, medically needy and special groups. Children's Health Insurance Program (CHIP) is a program that offers health insurance coverage for uninsured children under Medicaid. If Medicaid does not cover a service, the patient may be billed if the following conditions have been met such as the physician informed the patient before the service was performed that the procedure was not covered by Medicaid and if the patient has signed an Advance beneficiary Notice form. However, there are also conditions where the patient cannot be billed if necessary preauthorization was not obtained or service

Eligibility for Medicaid expanded to groups like childless parents, all children and other parents not entitled to the Medicaid. To kick start this reform, the state would cover the whole cost for the non-eligible population for a period until they can cover the costs. Enrolment to the Medicaid made easy through websites and those who are disabled would get care in the community.

The federal Affordable Care Act (ACA) together with Illinois Public Act 98-104 will increase access to health coverage as a critical step toward improving the health of the people of Illinois (HFS, 2014). Illinois residents can use the health insurance marketplace, but easily compare health plans and see what costs are better for them before buying a plan. Every plan is covered essential benefits such as preventive care, doctor visit prescription drugs, maternity care, emergency services, hospital stays and more. Residents can succeed for financial help through the Marketplace to lower monthly premiums and out-of-pocket costs. Insurances companies’ cannot reject residents that apply for coverage for they are sick or have a preexisting health condition. People can receive Medicaid for the first time low-income adults who are legal residents, regardless of parental or health status may be eligible for health coverage through Medicaid. Adults that have incomes at or below 138% of the federal poverty level on the family may be eligible. Application for benefits Eligibility is an easier to apply for Medicaid, SNAP, and the Medicare Savings. Indiana purpose of healthcare reform for residents is enrolling adults in its new Healthy Indiana Plan. The plan was offered in the state of Indiana. With the plan,

Medicaid has gaps in coverage for adults because eligibility was restricted to specific categories of low-income individuals such as children and their parents, pregnant women, the elderly, and the disabled. As of 2014, coverage gaps existed in the following areas in Utah: 0% FPL to 100% FPL for childless adults, and 46% FPL and 100% FPL for parents. In Utah, 58,000 uninsured adults who would have been eligible for Medicaid under expansion, fall through the cracks. These individuals are all below the poverty line and have very limited incomes.

In order to qualify for Medicaid individuals must meet certain regulations. Eligibility depends on each state, age and whether the individual is a U.S. Citizen, blind, pregnant, single parent, or suffers from any disabilities; all of this plays a huge role in the Medicaid eligibility criteria. Although, some immigrants may be able to benefit from this program, if the immigrant is a woman whose labor and delivery of child is taken care of inside the U.S. that is enough to make them eligible for Medicaid (Medicaid, 2012). Even though the states are allowed to provide their own regulation guidelines along with other decisions for this health program, there are certain mandatory federal requirements that must be met by each state in order to receive funding. Some of those requirements include; inpatient hospital service, prenatal care, vaccines for children, rural health clinic services, transportation services and many others that according to the federal government are extremely essential for the management of this program ("What is medicare/medicaid?," 2012).

Medicaid provides a comprehensive benefit package for those who enroll. The federal government requires coverage of thirteen services, including inpatient and outpatient hospital services, nursing home and home health care, and for children under the age of twenty-one. The benefits do not end there, Medicaid offers a

Variability: First, Medicare is more or less the same in every state, but Medicaid rules vary widely state