Texas Medicaid Case Study

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.

Felland, L., Lechner, A., & Sommers, A. (2013, June 6, 2013). Improving access to specialty care for Medicaid patients: policy issues and options. The Co

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

Texas, which currently has a large uninsured population and limited Medicaid eligibility, forfeits billions of dollars from the federal government every year by not expanding its Medicaid program as implemented in the Affordable Care Act. In contrast, Medicaid expansion could benefit the state exponentially and give its citizens the fullest potential of what this country offers. A substantial amount of federal funding that could increase uninsured coverage, improve healthcare costs, and provide economic stimulus is left on the table. Additionally, the nation benefits when each state participates, contributing to the success of the healthcare reform.

In Texas, the uninsured rate dropped from 37 percent to 27 percent due to many adults meeting the low poverty criteria to become insured. The adults that were eligible for the Medicaid program were adults who were eligible for a tax credit to buy the coverage on the federal health insurance programs. Texas decision not to expand Medicaid also made it hard for low income families to receive health care and pay for health medications. According to the study and observations of other states who have expanded Medicaid, it is proven that many low-income adults have less trouble paying for and obtaining health care while on the Medicaid program. In states with the Medicaid program in full effect compared to Texas where there is no expansion on Medicaid, many Americans are struggling with household responsibilities and finances due to having to pay for the private insurance and receive the health care that is needed for their condition.

The amount of money the state is leaving on the table over the next decade due to the lack of expansion is $5.3 billion. Medicaid is available for pregnant women with incomes 139% of FPL, children with incomes up to 200% of FPL, and parents with incomes up to 51% of

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

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).

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

Medicaid has grown exponentially after healthcare was expanded under the Affordable Care Act. However, this did not guarantee an increase in access to health care services, as many providers do not accept Medicaid beneficiaries, one of many reasons being low reimbursement rates. This discrepancy in rate reimbursement is further underscored when compared to those

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).

Over 2.4 million Texas residents had the Original Medicare insurance by 2015 while more than 675,000 had acquired Medigap insurance by 2014. The number has now increased over the years with Plan F gaining more popularity over the other plans. The Texas Department of Insurance standardizes the insurance plans, but the private companies are responsible for selling the insurance covers to the residents. This means that the insurance benefits across all plans sold by the companies in Texas are similar. However, TDI only regulates the plans meaning that the premiums vary from one company to another.

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

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

Most view medical and dental coverage as the most important option within their benefits package. Medical coverage usually includes doctors visits,