Medicaid History

Under Medicaid, "except for those over age sixty-five, the federal government would only provide benefits to persons not in state hospitals, to shift financial burden to the federal government, states had to send the patients back into the community." (Davoli, 2003).

The Social Security Act of 1935, signed by Franklin D. Roosevelt, created a program that included social insurance programs, as well as public assistance. Both programs came about due to the depression and were created as part of the New Deal to benefit the citizens who needed assistance. While both programs were created to assist the public, each program had different eligibility requirements and accomplished different tasks.

The Social Security Act of 1965 established Medicare and Medicaid which are health insurance programs for the poor and elderly people of the United States. It is funded by a tax on the earnings of employees and contributions by the employers. “It is now broadly apparent that those who opposed Social Security in 1935 and Medicare in 1965 were wrong in their fears…” (Nicholas Kristof  “The Wrong Side of History”).

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).

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.

Those who utilize the Medicaid system range from low income families to the over 65 age group. Within this population is also those who are disabled due to physical or mental problems. This is among the sickliest of our American population. A paper based on a study in Oregon stated that “Medicaid significantly increased the probability of being diagnosed with diabetes, and being on diabetes medication as well as high blood pressure and high cholesterol.”(Baicker et al., 2013, p. 1715). Much of this is due to the struggle that the Medicaid beneficiary has

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

Medicare has gone through many changes through the years since President Johnson signed the programs, including Medicaid into law in 1965. Almost ¾ of the senior population, over 65 were uninsured. Even before that President Truman was eager to start a national health insurance plan, in 1945. In 2003, President GW Bush added a prescription drug plan to Medicare. Even President Teddy Roosevelt proposed a national health insurance plan when he was running in 1912. In 1972, President Nixon signed a bill allowing people with long-term disabilities under the age of 65 and patients with ESRD (End Stage Renal Disease), to be covered. Over the years more services were accepted for Medicare coverage, including hospice and home health. 2010 brought good

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 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.

A landmark change in providing for the elderly came in 1935 with Franklin D. Roosevelt 's Social Security Act. While this provided aid to people with disabilities and mothers with children, aid was also mainly intended for the elderly. The premise of the act was that an individual would pay into the government through the years that they worked and upon retiring that person would receive benefits. Elderly Americans relied on this system to help pay for expenses that they might incur after they reached an age where they could no

Medicaid is one of the most widely acknowledged sources of health insurance coverage in the United States, benefiting over 48 million low-income children and parents (Hansen, 2012). It also supports those over the age of 65 who may also receive Medicaid. By providing essential health insurance protection, Medicaid supports the growing un- and under- insured population. This federal program for the financially needy is administered at the state level. Coverage varies and each state creates its own rules, typically offering support through county social services, welfare, or other department of human services offices (Goodman, 1991).

To be eligible for federal funds, however, states are required to provide Medicaid coverage for certain individuals who receive federally assisted income-maintenance payments, as well as for related groups not receiving cash payments. In addition to their Medicaid programs, most states have additional "state-only" programs to provide medical assistance for specified poor persons who do not qualify for Medicaid. Federal funds are not provided for state-only programs. The following enumerates the mandatory Medicaid "categorically needy" eligibility groups for which federal matching funds are provided: Limited-income families with children, as described in section 1931 of the Social Security Act, are generally eligible for Medicaid if they meet the requirements for the Aid to Families with Dependent Children (AFDC) program that were in effect in their state on July 16, 1996. Children under age 6 whose family income is at or below 133 percent of the FPL. (As of January 2011, the FPL has been set at $22,350 for a family of four in the continental U.S.; Alaska and Hawaii's FPLs are $27,940 and $25,710, respectively.). Pregnant women whose family income is below 133 percent of the FPL. (Services to these women are limited to those related to pregnancy, complications of pregnancy, delivery, and postpartum care.). Infants born to

The social security act was created by President Franklin D. Roosevelt so that he could put in place provisions in order to help the elderly. The social security act a document that helps impoverished citizens, such as the elderly and physically impaired receive benefits after retirement. Citizens’ in America during the great depression where expected to work weather elderly or physically disabled. These citizens weren’t afforded the financial stability to retire so work was a necessity to acquire money. “Prior to social security, the elderly routinely faced the prospect of poverty upon retirement” (U.S SSA). This effect of the great depression led to a lot death and homes turning into singled parent homes with no income. “The widespread

After establishing Medicare and Medicaid in 1965, Congress saw the need to protect the programs from fraudulent activities and practices of unscrupulous providers. The laws on health care fraud were enacted at different time during the history of the health care programs. However, the overall congressional intent has been the same, and the objective is to strengthen existing laws to protect the federal government health care programs from fraudulent activities.