Role of Medicaid - Research Paper Example

Medicaid Medicaid is a special type of health program, operational in the US. It serves families who are poor and vulnerable. The Medicaid program is financed by the government and managed by the various states. Despite the fact that Medicaid is a beneficial program to the American’s, its weaknesses cannot be overlooked. The major parties served by this program include adults with low income, permanent residents, and people with disabilities. Being poor alone is not a criterion to be a Medicaid beneficiary. For a long time, Medicaid has been the leading source of funding in order to boost the provision of health services for citizens with low level of income. Medicaid is also a means tested program, which is responsible in the provision of quality health care to Americans who are eligible to the program. In particular, the Medicaid serve those people who are disable, poor as well as those who cannot afford their medical care. It serves as a complement to the Medicare by ensuring that people in low-income category are accessible to medicines and high quality care. The program’s supplemental health coverage assists many poor and elderly households to access health care and provides financial security by shielding them from the exorbitant costs of health care. Generally, most elderly people are less healthy and are vulnerable to various health complications hence requiring greater health needs and attention than the young. Almost a third of America’s elderly population frequently report that their health status is poor, compared to 18 % of the young (44 years and below) who does not have frequent health problem (Goldman 134). A little history to the Medicaid program will enable us to understand its role in US health system. It was formed in 1965, under Social Security Act. (Goldman 134). Every state in USA runs their separate Medicaid policies while the Centers for Medicare and Medicaid Services performs the role of monitoring the programs and also laying foundations for the quality, service delivery, eligibility standards and funding. Through these programs, the issue of medical care become relatively affordable to most of the people. Most states in US have different ways of naming Medicaid, for example, in California Medicaid is called Medical, in Oregon, it is called Oregon Health Plan, and in Tennessee it is referred to as Tenncare. Participation in Medicare in most states is voluntary and different Medicaid programs exist in various regions. Medicaid in New York provides health care programs to people aged 65 years and above, regardless of their income. The Medicaid also serves those who are disable and are poor. The program assures them of easy access to health system and more so the protection from any kind of financial catastrophe whenever a particular serious disease strikes (Goldman 134). Under hospital insurance, Medicaid covers all eligible residents of New York State in issues like inpatient hospital care, hospice services and nursing facility care. It also offers assistance to those who are in need and are eligible. These include the elderly, the poor and the disabled. People who have literally exhausted all their personal finances or resources catering for their health services to the extent that their income comes far below cash aid income standards are eligible for the Medicaid benefits. They are funded by the respective states in the provision of health service coverage for minors and indigents (Goldman 134). A number of states have apportioned the service delivery of Medicare programs to companies. This means that Medicaid service delivery charter have been extended to the point where companies are allowed to offer much needed health care assistance like procession health benefits and insurance covers such as health insurance. Wal-mart, for example gives Medicaid services to I its workers in all branches in USA. This has enabled the insurance companies to transact easily with Medicaid department using a specified price. This is very important as it makes the medical care affordable both to the poor and the disable. Insurance companies collaborate with Medicaid by processing insurance covers to the eligible Americans (Ketler 136). To provide medical assistance in offsetting uncovered Medicare services and more so Medicare cost sharing most elderly citizens have supplemental coverage. In US, 36 % of all Medicare beneficiaries possess employer-sponsored retired person’s coverage. The coverage itself, is very generous as it covers diverse benefits and reducing the beneficiaries costs of meeting health care needs. Medigap policies are a source of supplementary coverage in which Medicare beneficiaries hold. Medigap are policies, which are provided in most States in the United States, give a chance parties who cannot be covered by Medicaid to enjoy this program. Beneficiaries, under this coverage pay monthly premiums of $ 100, although the cost of policies ranges from $1400 to $4700 per annum, and depends on where an individual lives, the coverage status and their age (Ketler 136). Just like Medicaid, Medicare beneficiaries vary directly with the income level. Those higher income beneficiaries most likely could have worked very hard during their working years in jobs that offer retiree coverage. Medicaid best serves as a social insurance cover, and the federal government finances it. It focuses primarily on young children and aging population in order to ensure that their health needs are met.. Medicaid serves the elderly that is those aged above 65 years and the young children who are from poor family backgrounds (Ketler 136). According to CMS website, health insurance under Medicare provides services to older people (those aged over 65 years) people living with disabilities, and people suffering from acute renal disease .Medicare also provides Medicare Part A, which takes care of hospital bills while Part B is concerned with issues of covering insurance, and Part D deals with covering drug prescription. Though the funding of Medicaid program does not come entirely from federal government, states are required to contribute to the Medicare kitty.. This will ensure that the Medicare role of satisfying the social welfare will be achieved (Goldman 134). Due to limited finances, Medicare program has not been able to gather for each American citizen with health issues, but have been able to comprehensively cover people who are within the program. . Compared with Medicare, Medicaid covers more ranges of medical services like drug purchase and meting partially costs incurred when an individual undergoes surgery Medical facilitates insurance cover for almost 59% of children from low-income families. This insurance enables them to get good access to quality medical services and other primary services such as health examination and health education. In 2001, at least 90% of children were insured in the program, though almost 9 million children have not been able to be insured since they have not been enrolled to the program (Hammaker, et al, 77). Once children are enrolled to Medicaid program, the role of the program is to ensure that they get high quality dental care. It ensures that utilization of dental care has been significantly improved in all age groups. Medicaid program also tries to ensure that the number of dentists serving these children is increased in order to improve the quality of services (Hammaker, et al, 77). Insurance with Medicaid will ensure that children having serious dental problems are well taken care of. Medicaid also tries to ensure that dental care administration is streamlined so that every child is served or helped. Medicaid have has also contributed a lot in assuring the access to care and prevent financial burdens for the elderly population. The program is the main source of assistance to almost five million Americans who are living in abject poverty (Hammaker, et al, 77). This are those individuals who cannot afford their basic needs. Medicaid tries to bring the idea that not all Americans are actually rich enough to cover their health plans and programs as some of them are seriously in need of basic health care. Medicaid does not assume this fact and tries to bring the reality of the American health problem to the government and even to the world.. Medicaid also provides financial assistance in order to provide health care for people living with AIDS. The conditions for people to qualify for this assistance depend on their eligibility in terms of ability to afford as well as ability to look for resources that would help them cater for their medical care services (Hammaker, et al, 77). This people should proceed to full-blown AIDS, where the T-cell count comes below 200, before they should be considered to be a disabled group so that they can get Medicaid services. A number of HIV positive people in the USA usually get Medicaid payments, which will enable them to get medications and buy food. Besides Medicaid, programs like Supplemental Income and Social Security Insurance give financial support to people living with HIV. It offers them finances that would help them meet their nutritional and medical requirements and hence prolonging their lives Medicaid also enables beneficiaries to receive a fraction of monthly premium from the government in order to effectively cover their health plan. The premium would assist in meeting the medical requirements such as expenses, transport cost as well as medical bills. This health plan will consequently be charged with providing the beneficiary’s health needs. There have been concerns of the effect of Medicaid on drawing families away from their private coverage. Medicaid also plans to extend its coverage to individuals above the poverty level, and hence many states have been encouraged by the government to implement this policy. Meeting this plan would boost the general state of the Medicare in US by greater heights. Poverty level in America is concealed by its massive wealth, and Medicaid has tried so much to reach to all individuals earning less than 5000 dollars per month (Hammaker, et al, 77). Medicaid ensures that it provides all its services inclusively to the needy persons of the society. For example, in hospitals, Medicaid assists in giving services to the outgoing patients, x-ray services, and laboratory services. It also takes part in streamlining the provision of physician services and nursing services. Efforts to ensure that all people with disabilities are allowed to participate fully in their communities have lead to Medicaid increasing its role in serving this people. In the field of mental health, Medicaid has ensured that programs that are more creative are implemented in order to promote system evaluating and transformation. Provide examples. ???? Indeed this initiative is very effective because when clear-cut health programs have been improved, then there will be high quality health care management. Medicaid benefits programs create financial incentives, which are used in maintaining traditional but established modes of health care (Hammaker, et al, 77). Medicaid has become a great force in development and implementation of mental health programs for children and adults in USA. In every state, there is a particular Medicaid agency, which develops a Medicaid plan to be used for determining which persons are to be covered using which type of service. It also ensures that policy incentives of how to develop plan for covering people based on the qualification of the Medicaid plan is developed. Medicaid ensures that mandatory services in the Medicaid plan have been in various states. Concerning mental problems, Medicaid only recommends medical care to be given by psychiatrists or Early Screening Diagnosis and Treatment. Other basic adult treatment like outpatient therapy, inpatient care, psychiatric medications, and rehabilitation are optional factors that states may or may not include in their plans for Medicaid implementation (Smith 201). Since in the local community mental health provision is not compulsory, there is a diverse variation existing within the states and is covered by Medicaid. This will promote the coverage and the accessibility of the Medicare by greater extend. Medicaid waiver is available in most states, which have an impact in the delivery and the administration of mental services.. Medicaid in 2003, accounted for a greater percentage of public funding to both mental and other general hospitals. As a result, public hospitals have gradually evolved in the same direction in order to accommodate individuals covered with Medicaid. Since state appropriation funds have been in the past used for diverse community health policies, mental health services have been changed to funds, which match with Medicaid funds (Shi et. al. 90). Medicaid is also a major source of income to nursing homes, meaning that health insurance is not a major source of revenue, even though there are observable efforts that are being undertaken in order to expand the resource. Medicaid constitutes up- to almost one-half of the entire nursing home care. Additionally, the Congress and the Social Security Administration ‘s Health Care Finance Administration (HCFA ) is always in the forefront in collaborating with Medicaid. The government and states also contribute to the Medicaid kitty. For those who are unable to cater for their long-term health care either through cash or insurance arrangements, and have not been registered for health care programs, the only available source of help is the Medicaid. A larger percentage of financing comes through this program, for all Americans who are eligible (Rushesky 22). It does not however, pay for all inclusive home-care services, which are needed for most Patients who are dependent on other family members. State run Medicaid programs give reimbursements for patients who are under medication - that is they only provide medical zed services, which are vital in order to maintain or sustain long-term care to the patient at home. Though many patients are poor enough to qualify for Medicaid, a good number of them experienced deterioration of the standard of living after being institutionalized. Persons who have not been registered to enjoy Medicaid services, deplete all their material resources in order to satisfy their needs, eventually reduce their expenditure, and become poor in order to qualify for Medicaid (Rushesky 22). The implication is the reducing standard of living since as people deplete their assets, they will not have income hence become poor with time. Others also can become viable to receive Medicaid benefits through sheltering their assets, either legally or illegally with the help of their attorneys specializing in Medicaid estate planning. For example, Since those assets, which are sheltered, are not counted when determining eligibility to Medicaid, those people are now able to enjoy the program for the poor, without necessarily being poor (Rushesky 22). In recent years, proposals to reform Medicaid have been discussed by states and organizations like National Conference of State Legislatures, National Commission on Medicaid and National Governors Association. In most parts of rural USA, any change implemented in the Medicaid policy will have many implications on people, places, and providers (Shi et. al. 90). Medicaid is a critical source of major insurance policies coverage in US, filing the gaps existing in either Medicare medical coverage or the presence of private insurance, which are common in rural areas. Providers of health care, for example those who serve a larger percentage of those eligible to Medicaid, depend on Medicaid payments in order to offset the marginal cost of caring or treating the patients. State and federal finances contribute greatly to the development of the rural community through providing health care jobs and by providing more health coverage to most low- salaried workers (Shi et. al. 90). Medicaid serves the highest percentage of USA population more than any other health program, giving health insurance to the poor and those who are in eligibility categories. This health program is a partnership between the states and the federal government. The state designs and runs Medicaid at boundaries designed by the state (Shi et. al. 90). In rural America, Medicaid is a major safety enhancing policy to some low income individuals who could have otherwise be uninsured, and thrives to close the insurance coverage gaps for low- income earners. Rural people who are below the age of 65 years are always the best group to be enrolled in Medicaid. Since the Medicaid program is the major source of health insurance for many Americans, particularly residing in rural areas, it becomes an important source of revenue to any people . Despite the fact that in many states this program is not taken to be a sufficient source, Medicaid payments are still beneficial to most Americans. Without Medicaid, many individual patients will be left uninsured, hence leaving the providers with limited income or revenue since those patients in the low-income group will not be able to pay the Medicaid rate. The main consequence of this is that individuals will not be able to enjoy high quality health and may eventually become vulnerable to any health problem they were having (Shi et. al. 90). Medicaid, in 2003, financed 40% of the $ 151 billion national expenditure on long-term care like caring of the elderly and cancer treatment (Ketler 136). With the absence of Medicaid coverage, an individual covered by the Medicaid program would decide to use the long-term health care services. The other major role of Medicaid is to ensure that the barrier existing in accessing payment to providers is removed by ensuring that all providers get access to their incomes every time they require. Additionally, Medicaid contributes in community well being through ensuring that the implementation of strong health care is done. It leads overall development through providing good opportunities for accessing health care, which will later affect the health status and hence the productivity of the citizen’s lives Medicaid provides patient income that assists in the retention of health professionals (Ketler 136). Medicaid contributes to the development of the entire economy. Revenue generated from members’ subscription fees will be used in other sectors of economy. Besides, people employed as officials in the Medicaid program will get their source of income. The little payments from the Medicaid will help make the many primary care practices to be viable in most parts of the country. The payments will also ensure that providers of this program contribute evenly to the community’s financial base, hence resulting to extra employment in the health care sector and other related occupations like retailers or suppliers serving the Medicaid employees (Ketler 136). Medicaid therefore, appears to be closest to the America’s poor since their comprehensive health policies are directed at them. The uninsured and the working poor who are eligible for Medicaid membership can also benefit from Medicaid activities. However, there must be a balanced commitment on how the policies should be undertaken so that the health care sector will not be compromised (Morrison, et. al. 62). Medicaid should therefore, streamline its objectives in order to ensure that each American benefits from its roles. Political attacks should be minimized as fast as possible, so that effective implementation of Medicaid programs will be achieved. Medicaid roles are general and as such, it affects all other sectors of the economy. Medicaid should aim at providing social security to Americans without bias or prejudice, and to tirelessly reform the provision of health care related services to all citizens. This is a noble task, which Medicaid should follow so that its roles will become more satisfactory and comprehensive (Morrison, et. al. 62). Works cited: De Vita ,Carol. Who speaks for America's children? The role of child advocates in public policy, New York: Urban Publishers, 2001. Print. Goldman, Howard and Buck, Jeffrey. Transforming Mental Health Services: Implementing the Federal Agenda for Change, New York: American Psychiatric Pub, 2009. Print. Hammaker, Donna and Tomlinson, Sarah. Health Care Management and the Law: Principles and Applications, New York, Cengage Learning, 2001. Print. Ketler, Sophia. Medicaid: Services, Costs and Future, New York: Nova Publishers, 2008. Print. Morrison, Eileen and Monagle, John. Health care ethics: critical issues for the 21st century, Seattle, Jones & Bartlett Learning, 2009. Print. Morrison, Eileen. Ethics in health administration: a practical approach for decision makers, Boston: Jones & Bartlett Publishers, 2011. Print. Rushefsky, Mark. Public Policy in the United States: At the Dawn of the Twenty-First Century, New York, M.E. Sharpe, 2007. Print. Shi, Leiyu and Stevens Gregory. Vulnerable Populations in the United States, New York: John Wiley and Sons, 2010. Print. Smith, David. Medicaid Politics and Policy: 1965-2007,New York, Transaction Publishers, 2009. Print. Sparer Michael. Medicaid and the limits of state health reform, New York: Temple University Press, 1996. Print. Read More