Medicaid Medicaid is a state administered health insurance program financed and is operated jointly by the federal and state government. The program gears towards helping low-income people of all ages who do not have the money or insurance to pay for health care. This program pays for medical care to assist persons and families who cannot afford it.
History Medicaid was established under President Lyndon B. Johnson through the Social Security Amendment of 1965, to provide medical coverage to all elderly aged 65 and over and to the poor. In 1972, the social security Act were more developed creating federal Medicaid benefits to disable people and persons in the end stages of renal disease.
Eligibility Medicaid is the nation’s largest health coverage program for over 60 million Americans including children, pregnant women, parents, seniors and individuals with disabilities. For someone to be eligible for Medicaid one must satisfy federal and state criteria regarding residency, immigration status and documentation of United States citizenship. Medicaid aims at providing medical and other health care services to eligible people so that they are able to remain as self-sufficient as possible.
Medicaid payments for medical expenses are paid directly to physicians, hospitals and or treatment facilities. Medicaid eligibility rules are different for each state but similar in numerous areas, however, Medicaid benefits are solely connected to the main factor ‘income’. Each State have its own guidelines that are subject to federal rules and regulations, therefore, certain services must be covered by the state in order to receive federal funding. On the other hand, some services are optional and are elected by states.
In some states, people with disabilities qualify automatically if they get Supplemental security Income benefits. Children are automatically eligible and enrolled in Medicaid when they are born until their first birthday if the mother is enrolled in the medical program when baby is born. Special Medicaid for Women Pregnant Women Medicaid eligibility is varied by states. Pregnant Women with income up to $20,000 per individual annually must be covered by Medicaid. In some states pregnant women with higher incomes are covered under Medicaid and some under Children’s Health insurance Program (CHIP).
The coverage for infants and pregnant women are at little or no cost if their incomes are limited. Breast and Cervical Cancer Prevention and Treatment (BCCPT) Medicaid program are available to eligible women who are diagnosed with breast and cervical cancer through state screening program. Income does not play a role in this instance. Who pays for services provided by Medicaid? Medicaid does not pay money to individuals. The system is organized in such a way that the Program directly sends payments to the health care providers instead.
States make these payments based on a fee-for-service agreement or through prepayment arrangements such as health maintenance organizations (HMOs). Each State is then reimbursed for a share of their Medicaid expenditures from the Federal Government. This Federal Medical Assistance Percentage (FMAP) is determined each year and depends on the State’s average per capita income level. States that tend to be richer receive a smaller share than poorer states. However, by law the FMAP must be between 50% and 83%. Many States are known to have imposed nominal deductibles, coinsurance, or copayments on some Medicaid beneficiaries for certain services.
However, there are certain Medicaid beneficiaries who must be excluded from sharing this cost. These include pregnant women, children under age 18, and hospital or nursing patients who are expect to contribute most of their income to institutional care. Significantly, all Medicaid beneficiaries must be exempt from copayments for both emergency services and family planning services. Medicaid in Texas Medicaid in Texas is administered by Texas Health and Human Services. It is referred to as an ‘entitlement program’.
What this means is that neither the State nor Federal government can limit the number of persons who enroll, once these persons meet the eligible requirement they should be awarded the benefits of Medicaid. As previously mentioned Medicaid is a jointly funded program, so too is the case in the State of Texas, both the State and Federal Government contribute a share. The population of Texas is almost 26 million persons. For the fiscal year 2011 3. 5 million were enrolled in Medicaid. Significantly, 55% of them were females and 77% were under the age of 21. The number of enrollees on Medicaid is expected to continue to rise.
In the State of Texas this has resulted in a constant struggle between the different political parties. The Democrats who are advocates of the welfare system strongly support this cause. On the other hand, the Republicans would prefer certain reforms to the system. Statistical data has shown that eliminating Medicaid in the State of Texas would potentially save them $40 billion biannual. However, this fight goes beyond the political arena. If this were to happen it would be a much debated legal battle between the State and Federal Government. Medicaid is a Federal law and rightfully Federal law should take precedent over all else.
Impact on the economy For the fiscal year 2011 the U. S. National Budget was $3. 6 trillion. The Federal tax revenue largely financed this budget. Over 23% of the budget was attributed to Health Care (Medicare and Medicaid). This was second to Defense, which amounted to 24% of the budget. Of the 23% awarded to the Health care systems, 8% was for Medicaid and the remainder to Medicare. Presently, there are over 65 million Americans on Medicaid. Total expenditures are in excess of $250 billion. Of the persons enrolled, 50% are children, 27% adults, 15% disabled, and 8% elderly.
Significantly the largest part of the Medicaid funding is spent on the disabled even though they only amount for 15% of the persons enrolled. This is quite understandable because where as children and adults and even the elder are sick for a while, the disabled are in need of constant care. It is quite difficult to say that Medicaid has a negative impact on the economy. Many may argue that human life is priceless and that the government and society should do everything to sustain it. What we can argue is that with technological advancement health care would become more expensive.
Yes, it might be more affordable to individuals but logically the government would be paying the difference. And where would the government get this money? It would be from the members of society through increased taxes. Truly it is a never ending cycle. Universal Healthcare in Britain versus Medicaid in the U. S Unlike the in United States, in Britain one does not have to be poor to get free medical coverage. In Britain there is a National Health Service, abbreviated as NHS. The NHS began in 1948 and has become the world’s largest universal healthcare program.
It was designed so that everyone would get medical help no matter his or her financial situation. The NHS is free for UK residents, approximately 62 million people. The NHS covers virtually every form of treatment except for cosmetic surgery. The NHS is financed mainly from national taxation. The NHS employs approximately 1. 7m people. The NHS employs 1. 4 million people in England, 155,312 people in Scotland, 85,252 people in Wales and 65,016 people in Northern Ireland. This entails 39,409 general practitioners, 410,615 nurses, 18,450 ambulance staff and 103,912 hospital and community health service, medical, and dental staff.
The NHS is the largest employer in Britain and the forth-largest employer in the world. In England the NHS treats approximately 3 million people weekly. The NHS is run by the Department of Health. The Department of Health regulates England’s 10 Strategic Health Authorities, which supervises all NHS actions in England as each SHA oversees the NHS trusts in its own areas. In 1948, when the NHS began it had a budget of ? 437 million; this is approximately ? 9 billion today.
There is a vast increase in the budget today, as the budget for 2011-2012 is approximately ? 06 billion pounds. The government pays for this publicly funded via taxes imposed on working citizens. Health care is allocated 18% of a citizen’s income tax, which is approximately 4. 5% of a typical citizen’s income. The NHS was established out of the belief that decent healthcare must be obtainable by all citizens, irrespective of wealth. When the NHS began in 1948 the current minister of health said it was founded on three basic values; it meets the needs of everyone, it is free at the point of delivery and it be based on need, not capability to pay.
The NHS has an obligation to every patient it aids and must respect their human rights. It runs a wide-ranging service and is offered to all regardless of sex, race, disability, age, sexual orientation, creed or belief. All NHS services are free, except in rare instances authorized by parliament. Commonwealth Study Ranking the Health Care Systems Of 7 Major Countries A report of seven developed countries by commonwealth classified the UK’s health care system as one of the most effective on earth.
The study assessed quality, efficiency, access to care, equity, and healthy lives. Britain ranked second overall while the U. S ranked seventh. Britain did well in the quality of care and access to care aspects. The access to care aspect of the reported claimed: “The UK has relatively short waiting times for basic medical care and non-emergency access to services after hours, but has longer waiting times for specialist care and elective, non-emergency surgery. ” This is a great feat for a health care system that is free at point of delivery as free services usually experience mass use. Britain placed first in efficiency, which is calculated by stetting total national spending on healthcare as a percentage of GDP.
Despite having income restrictions on its free health care services the US spends the most on healthcare in the world. The U. S allocates 16. 02 % of its GDP to healthcare every year, which is approximately $2. 403 trillion dollars. The government uses around $1 trillion for free medical purposes. The U. S. ’s public healthcare covers approximately 83 million (around 28% of the US population). However, the UK only spends around 9. 3% of its GDP on healthcare for its whole population. Which is $267 billion dollars. Surprisingly, we see that it healthcare is cheaper when totally funded by the government as opposed to the U. S who only provides free health care based on need.
Future of Medicaid The Affordable Care Act of 2010, signed by President Obama generates a national Medicaid minimum eligibility level of 133% federal poverty level for nearly all Americans under age 65. This Medicaid expansion goes into effect on January 1st, 2013 but states can choose to expand coverage with Federal support any time before this date. Commencing in 2014, most adults under age 65 with individual incomes up to about $15,000 per year will qualify for Medicaid in every state due to the Affordable Care Act.
This Act is a more community-based program geared towards helping the disable without removing them from their homes and placing them in nursing homes. The expansion helps low-income adults who have disabilities and do not meet the disability requirements of the Supplemental Security Income program. The expansion also helps those whose income is above their state’s current disability levels. ‘Buy-ins’ In a few states individuals with disabilities but whose income is higher than appointed Medicaid limits are allowed to enroll in the Medicaid program.