Medicaid Intervention In Health Care

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 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,

The 2010 Affordable Care Act (ACA) is the most current governmental effort to bring a national health care plan to the United States (U.S.). Policy makers in the U.S. are hopeful the ACA will be able to extend health care coverage to 47 million nonelderly uninsured citizens (Kaiser Family Foundation, 2014). The ACA broadens the Medicaid eligibility for low income individuals at or below the 138% Federal Poverty Line (FPL) and adds tax credits to assist people to purchase insurance in the Health Insurance Marketplace (U.S. Department of Health and Human Services, 2015). In 2012, the Supreme Court the upheld the constitutionality of the ACA requiring most people to maintain a minimum level of health insurance, however they left the

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

With slight similarities, federal matching grants were provided by Medicaid to finance medical cost for the low income who were on welfare, disable, and elderly (Rowland, Summer 2015). At first, Medicaid was initially for the welfare population but was extended to be used by other low-come individuals that needed health insurance for medical care (Rowland, Summer 2015). Throughout the years, Medicaid has grown with an array of services it provides and with its population of those utilizing it and has extended to provide coverage to low-income individuals, the permanently disable, and those in need of Long Term Care (Rowland, Summer 2015).

Ozark Medical Center (OMC) in West Plains, Missouri is one of them. It is considered a Disproportionate Share Hospital or ‘DSH’ and provides charity care. As Jennifer Davidson describes it in her Health and Wealth Update story on KSMU, “Charity care is healthcare that isn’t paid for, usually because the patient doesn’t have money or insurance” (p.1). Today the DSH designated hospitals do not receive the same amount of federal funds (DSH payments) they did before the ACA from 2010 was enacted. A supreme court decision in 2012 ruled the forced Medicaid expansion, which was included in the ACA, unconstitutional for all states and as a result the expansion is now an option for the states. However, Jennifer Davidson explains that when the remaining parts of the ACA were passed, “it included a 75 percent cut in those DSH payments. That’s because another part – the Medicaid expansion part – was supposed to make up for that reduction. So: more people covered by Medicaid, less charity care – and less need for DSH payments” (p.1). There are also cuts in the ACA to Medicare payments, which in addition to the reduced DSH payments could affect a hospitals finances by a large percentage. In Jennifer Davidson’s story, Ozarks Medical Center’s CEO David Zechman explained that “OMC could see a 60% reduction in its bottom line if Medicaid doesn’t get expanded”. OMC is not the only small rural hospital in Missouri which sees

The healthcare reform had different effects in different states, but overall it had effects on Medicaid’s cost and coverage. Some states could see the effects of the reform as good and some as bad depending on how it affected the state itself. Since Medicaid programs among the states have different

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

Medicaid developments for low-income adults have shown to improve health insurance coverage and access to care among the target population. During 2011, 15.2 million people received Medicaid reimbursable outpatient hospital services. 1.6 million people received care in nursing

However, Medicaid’s effects on health remains surprisingly sparse, especially for adults (Sommers, Baicker, & Epstein, 2012). Previous research has shown that Medicaid expansions in the 1980s reduced mortality among infants and children,

The Affordable Care Act (ACA) caused some of the issues central to the expansion of Medicaid. Some of the major challenges in Affordable Care Act (ACA) the improved access to more individuals. According to Levitt, Claxton, and Damico (2013), the Affordable Care Act expansion increase limitation to families under 65 whose income is at or below 133% of federal poverty guidelines. This leads into significant growth in eligibility of newly coverage populations. Medicaid provide an opportunity to identify successful enrollment and renewal practices, strategies to ensure access to care, effective models of person-centered and coordinated care, and payment systems that align financial incentives with goals for quality and cost. (Paradise, 2015). Especially

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 over

An Urban Institute analysis found that if all states expanded Medicaid to individuals at or below 138% FPL, more than 15 million adults will be eligible to enroll (Kenney, Dubay, Zuckerman and Huntress, 2012). If a state failed to implement the expansion, it faced the possible loss of all federal Medicaid funding, making it an offer the states could not refuse. However, the U.S. Supreme Court ruled that Congress could not intimidate states into expanding Medicaid. As a result, the ACA Medicaid eligibility expansion is now optional for each state. States still await official guidance from CMS, including revised ACA regulations to match the court’s ruling. It is also likely that states may opt into or may subsequently opt out of Medicaid eligibility expansion at any time in the future. Although the Supreme Court upheld the ACA as constitutional, it determined that the Medicaid expansion would be a state option rather than mandatory (Kaiser Family Foundation, 2012). At the same time, 4.3 million adults in the United States are currently eligible for Medicaid but not enrolled (Kenney et al., 2012). Because of state expansion discrepancies and past experiences with enrollment among eligible populations, the Congressional Budget Office has projected that only eight million will enroll in the first year (2014) and only 11 million two years after implementation (Congressional Budget Office, 2013).

These new entities included critical access hospitals (CAH), freestanding cancer centers, pediatric hospitals, community hospitals, and rural referral centers. Due to this expansion, “there have been more than 1,100 of the 1,600 eligible under the new provision that have enrolled in the 340B program. Currently, these entities account for about 9 percent of the total 340B drug sales and thus represent a notable increase in the 340B program” (Vandervelde, 2014). The ACA’s expansion of Medicaid will continue to create newly eligible entities. It has been estimated that as many as 350 hospitals could become eligible entities by 2019 bring in an increase sale for the 340B program of $1.4 billion. The more patients that are approved for Medicaid, the more they will seek treatment in return increasing the number of hospitals that are eligible for the 340B

Since the ACA took effect on October 1st 2013, three to six million have signed up, costs have dropped significantly for many, but to the working poor in this country living pay-check to pay-check the 171.37 dollars a month it would cost a healthy 25 year old in Tacoma, Washington for coverage; could be the breaking point for a minimum wage worker; let alone the cost of a plan to cover a couple or family (WA HealthPlanFinder). An analysis of US Census Data conducting by The New York Times says eight million of the people the ACA is intended to help will not be able to receive assistance under the ACA due to their state rejecting the expansion of the current Medicaid program (Tavernise, Gebeloff). Of the 26 states that rejected this expansion, they are home to just under half of the US population but are home to 68 percent of the nations poor (Tavernise, Gebeloff). Along with not expanding Medicaid those states also did not set up a state heath exchange, limiting their citizens to the more problem ridden federal heath exchange site, and leaving them in limbo between making too much money to qualify for Medicaid but not enough to qualify for government