Medical Insurance and Medicaid

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.

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

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

Large populations of Americans are uninsured mainly because of the high cost of insurance. Majority of the uninsured are the low-income working families’. The adults represent a higher percentage of the uninsured than children. Before the law, you could be denied coverage or treatment because you had been sick in the past, be dropped mid-treatment for making a simple mistake on your application, hence, the Affordable Care Act was implemented into law on March 23, 2010 by President Barrack Obama to make sure that every American irrespective of their status will be insured and have full access to proper health care benefits, rights and protection(1). To understand the

ACA expanded Medicaid to all Americans below 133% of the federal poverty level from the previous cut-off at 138 percent. The enrollment for Medicaid and CHIP has been simplified. ACA prohibits insurance companies from denying coverage based on pre-existing conditions. This is known as guaranteed issue. ACA also extends dependent coverage for young adults unto the age of 26; so they can stay insured on their parent’s insurance. Individuals upto 400% of the federal poverty level are entitled to tax subsidies in order to assist them in having a health insurance. The subsidy is meant to achieve 2 goals: (1) provide sufficient funds to ensure that people can afford their health insurance premiums and (2) provide a financial incentive for people to choose lower-cost plans. These two goals are opposing, but both are essential. Families who earn more than 400% of the FPL can also purchase health insurance from the exchange, but they receive no subsidy.

Before the ACA was passed, all states decided to raise the eligibility for children under Medicaid and Children Health Insurance Program (CHIP). North Carolina raised the Medicaid FPL for families with children greater than 6 years old up to 216% (Milstead, 2013, p. 203). However, now that North Carolina has not chosen to expand the Medicaid program non-disabled adults are limited to 43% FPL and childless adults are ineligible (Kaiser Family Foundation, 2014). Those not eligible for Medicaid and CHIP that have incomes between 100% and 400% FPL may be entitled to tax credits if they purchase insurance in the marketplace (Kaiser Family Foundation, 2014). This raises another problem in North Carolina’s uninsured population. The ACA is written by the principal of low income people receiving coverage through the Medicaid expansion, therefore people below FPL are not eligible for Marketplace subsidies (Healthcare, 2015). North Carolina’s uninsured adult population is around 319,000 which is 20% of the uninsured in the state (Kaiser Family Foundation, 2014). This population qualified for the Medicaid expansion under the ACA and all fall below the FPL and now will remain uninsured.

As a health policy analyst for the state of Texas which has not elected to expand Medicaid as part of the Affordable Care Act (ACA) and now has been notified that the state leaders have taking into reconsideration their recent decision during an upcoming session in order that we begin gathering data on the benefits of adapting the Medicaid expansion. As a health policy analyst our goal is to assure data quality, interpret data, and discover new information in the data. Medicaid is a federal and state partnership with shared authority that is a health insurance program for low-income individuals, children, their parents, the people with disabilities and the elderly. Nationally Medicaid covers health care for over 72 million people. Even though participation is optional, all 50 states participate in the Medicaid program. However, Medicaid benefits eligibility varies widely among the states all states must meet federal minimum requirements, but they have options for expanding Medicaid beyond the minimum federal guideline (http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx). In this research we will identify the state of interest which is Texas, compare the state’s decision, determine the alternate approaches to expanding access and provide a recommendation on whether or not the state should opt in to the Medicaid expansion.

Expansion of the Medicaid program is an important part of the PPACA (Vincent & Reed, 2014). To decrease the number of Americans without health insurance coverage, the Medicaid expansion is designed to provide coverage for individuals with incomes of up to 138% of the federal poverty level (FPL). Individuals with incomes of 100% to 400% of the FPL, who did not qualify for Medicaid, would be eligible for subsidies in the Insurance Marketplaces mandated by the passage of the PPACA (Sommers, 2015) . In the states that do not expand Medicaid, Sommers (2015) notes that individuals who do not qualify for Medicaid and have incomes below the criteria to receive insurance subsidies in the healthcare marketplace will remain uninsured. The Medicaid program is jointly funded by the federal

The Affordable Care Act expanded the existing Medicaid program to help cover those Americans living below the current poverty line; this includes adults who were previously excluded from the program benefits. The Affordable Care Act also offered new options for people earning 100 percent to 400 percent of the poverty line to buy private insurance. The Supreme Court made the decision to leave Medicaid expansion up to the states so each state has a choice to expand the program or to leave it as is. Not all states chose to expand the program, this left a large population of low-income people unable to obtain Medicaid and unable to qualify for subsidies in the insurance marketplaces because they earned too little.

In this research paper it will identify how Medicaid came about and what Medicaid used for, the different between Medicare and Medicaid, the benefits and disadvantage in the use of Medicaid. Medicaid is a state administrated program that provides medical support for a broad range of people. Medicaid was established in 1965 through the Social Security Act, which was an act to provide for the general welfare by creating a system of senior citizen benefits as well as low income people not all but limited to and by enabling that many states to make more acceptable provision for aged people, blind, dependent and crippled children, maternal and child welfare, and public health. Medicaid program was one of many programs created to

With the implementation of the ACA, many states have expanded their Medicaid programs to include a larger population of low income individuals and families that were not able to obtain health insurance prior to the law. Some of the issues that state legislators struggle with are the overall cost of providing services for the additional recipients, staying within budget, determining an adequate approach of offering quality care, and providing adequate coverage for each recipient. Even though the cost of Medicaid expansion within each state has increased the budget for the program, new appraisals has shown that Medicaid programs spend less per enrollee than commercial health insurance and much of the increase in Medicaid expenses originate from the increase in enrollment in the programs (Coughlin, Long, Clemens-Cope, & Resnick, 2013).

The primary social problem that the Affordable Care Act (ACA) was enacted to address was for everyone to have insurance. The goal was to make insurance accessible to everyone and decrease the number of people without health insurance. The most important provisions of the law were preventive care, birth control, and prohibit exclusion of an individual with preexisting conditions, and Medicaid expansion. They addressed these problems by covering all well visits, making birth control free, allowing people with preexisting conditions get the help they need, and expanding Medicaid for the childless adults that are poor. According to Sanger-Katz and Bui (2016), the uninsured rate has gone down but there have been some difficulties with the Medicaid

The Affordable Care Act (ACA) highlighted the importance Medicaid played in insuring every American receive healthcare coverage. (42 U.S.C., 2010) Medicaid provides health benefits to over 71 million across the country. While involvement is optional, all 50 states participate in the program and requirements differ across the nation. The flexibility given to each state has allowed them to make their own decisions to work towards improvements that they believe would best benefit their region (Feldstein, 2015, p. 125-126).

The Affordable Care Act tremendously expanded the Medicaid program to cover more uninsured Americans. Prior to the ACA, many low-income childless adults were left without healthcare coverage. However, the ACA expansion brought access to healthcare coverage to most adults under the age of 65, which have an income at or below 138% of the federal poverty level, equivalent to less than $16,245 for an individual. Under the ACA, states have the option to further expand Medicaid themselves. However,