How Medicaid Is Financed By The Federal Government

Compare and contrast Medicare and Medicaid; including funding sources, fraud and/or abuse, and eligibility requirements for recipients

The benefits and drawbacks of having state health programs verses one that is uniform across the country can vary on a broad basis. Medicare and Medicaid are state and federally funded health programs; programs that must be fair and allow access to everyone across the country that are enrolled and eligible to receive such benefits. In addition, these programs have unlimited caps so that there is flexibility to continue financing care without delay. The Medicare program was designed to provide access to health care for those who are not able to afford appropriate health care and meet the needs of vulnerable communities. If it were not for the assistance of the federal government in providing states the necessary funds to continue providing health

The purpose of this paper is to give an overview of two federally and/or state funded programs. The programs that will be discussed are Medicare and Medicaid. In this paper will be information about who receives Medicaid/Medicare, the services offered by these programs, and those long term services that are not.

According to Barton (2010) Long-term Care “emphasized continuous care over a period of at least 90 days for a range of acute and chronic conditions. Regardless of the length of time (i.e., from weeks to years), LTC is an array of services provided in a range of settings to people who have lost some capacity for independence because of an injury, a chronic illness, or a condition” (pg. 349). This is the description of someone who may have been in a debilitating car accident, an elderly person with Alzheimer’s and dementia, a person diagnosed with chronic mental illness, and individuals who are developmentally delayed or “disabled.” People who are placed in these type of long-term care facilities are usually screened using two different

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).

Affordable care act is a law that was passed in March of 2010 to help decrease health care cost and make it more affordable for all Americans. The affordable care act is set to decrease the number of uninsured Americans, qualify more for Medicare and Medicaid, increase the quality of care, promote prevention, extending funding for the children, and help with funding in the communities. The goal for affordable care act is to have everyone insured, no matter what income class you are in. The affordable care act is there to insure everyone so that prevention will increase. It will increase by being able to get check ups and children being able to receive vaccination. If you are not able to qualify for Medicare or Medicaid there

One of the states that have not participated in the Medicaid expansion is Florida. States that are opting out in the Medicaid expansion can leave several citizens uninsured and their health will be at risk. Currently, since the America’s Supreme Court has given the states more flexibility relating to the Affordable Care Act, some states are opting out of the Medicaid expansion plan that is intended to give low-income citizens in the state dependable healthcare. To reasons the state of Florida opting out the Medicaid expansion, the governor of Florida stated, that Floridians are more interested in economic growth and employment, better quality of education for their children, and that they keep the cost of their living low. Florida State is

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 new law added to a per-existing hospital provider tax, which lawmakers love because it leverages federal matching funds that help pay for the state's Medicaid program. Critics objected to the increase because it added a new tax on health insurance.

Medicaid initially established that each state is responsible for designing their medical costs to pay medical care for the poor. Also, Medicaid created as a voluntary program for each state; they have to have the choice to participate. For one thing, because of the rising costs of healthcare, it has been difficult to bring Medicaid recipients into the “mainstream” of United States (U.S.) medical care. Donald R. Barr notes, “between 1975 and 1989, the cost of the Medicaid program increased by an average of 11.9 percent per year before adjusting for inflation” (172). The rising costs of healthcare are necessary for each state to determine if it is beneficial for them to participate in the Medicaid program. As the government level of payment is determined by each state economic condition. For instance, a state with lower per capita income will receive more government funding. A state with higher per capita income receives less reimbursement for program costs. Therefore, on December 31, 2010, many states continued to experience budget cuts. As a result on August 2010, Congress increased reimbursement rates through June 2011.

The federal part of Medicaid is known as the federal medical assistance percentage (FMAP) (Hegar). The FMAP annually reviews comparison of average state and U.S. per capita income. This means in Texas the federal government pays 60 percent of every dollar spent on Medicaid services (Hegar).

As per the law United States legal citizen whose income is 133 percent lesser than the poverty line can be enrolled for Medicaid. Operated by state government but Medicaid is funded jointly by state and federal governments. Funding to Medicaid is by federal government called as Federal Medical Assistance Percentage is calculated based on state per capita income and typically varies between 50 to 75 %. But the Obama care act provides Medicaid expansion through which federal government will pay 100 % of Medicaid costs during 2014, 2015, 2016 but 95 % of costs during 2017, 94% during 2018, 93% during 2019 and 90 %during 2020. Not essentially all states accept this Medicaid expansion program, typically states ruled by democrats implement this expansion but states ruled by republicans deny the expansion. As per study health reform monitory survey4, those states who accepted Medicaid expansion has uninsured rate of only 7.3% but in not accepted states have uninsured rates of 14.1% which constitutes half of nations uninsured population.

The South Carolina Title XIX State Plan, also known as Medicaid, was designed to maintain the provision of “quality health care to low income, disabled, and elderly individuals” (South Carolina Department of Health and Human Services, 2016). The South Carolina Department of Health and Human Services (SCDHHS) acts as the designee for this administration, managing the state and federal reimbursement of funds for approved medical providers. Services are designed to provide services for diagnosis, treatment, and management of illnesses. The Management Care Organization program provides insurance coverage through a network comprised of contracted, providers who are paid a “per member per month capitated rate” (SCDHHS, 2016). These

The ACA states that the federal government will pay 100% of the cost of a newly enrolled Medicaid participants until 2016 for all states that expand their Medicaid program up to 138% of the federal poverty level and will pay90% by 2020 (Kincaid, 2013). Other concerns include whether the federal government will give state enough flexibility to manage Medicaid program, whether hospitals will receive adequate compensation to care for more patients and whether the physician workforce can accommodate the increased demand for care (Kincaid, 2013).

If Texas expands Medicaid coverage, the largest number of newly eligible Texas would be adults without children. Currently, these individuals are not covered under Medicaid. In addition, parents who have incomes at or below 133% of the federal poverty level (FPL), up from 12% previously. With a 90% federal reimbursement rate going forward, for every $10 of health care services obtained under the program, the State pays $1 and the federal funds pay the other $9. It is estimated that the State would contribute about 15.6 billion, while the federal