Introduction
In the United States, Medicaid was launched to provide social security (social health programs) for individuals and families in the low income group. The main objective of Medicaid was to provide comprehensive healthcare services at low-cost for individuals with limited resources. As per the Health Insurance Association of America, Medicaid is defined as a government funded health insurance program aimed to provide healthcare services for individuals of all age groups irrespective of caste/creed/ethnicity and those with low income and limited resources. It is the largest source of funding in the US with respect to medical and health-based services. It is jointly funded by the federal and state government that is a means-tested program. However, each state has the power to include the eligibility for Medicaid and the implementation of the entire program. It is not compulsory for a state to include Medicaid, however, all states in the US have Medicaid facilities. Lastly, Medicaid is provided to only legal permanent and US residents (De Lew, N. 2005).
Why was Medicaid but not Medicare designed to be state operated?
The Medicaid program is a dual funded scheme by the state and federal government. Medicare is available to only senior citizens *age 65 and above). Medicaid would help low income individuals to bear costs associated with long-term custodial care. Around 50% of the funding is made by the federal government for Medicaid. Since a large portion of funds are drawn towards Medicaid for low-income families in each state, it is not advisable for Medicare to be operated state-wise. Furthermore, the federal government funds more than 50% for every state in the US including the affluent states. Due to this reason, there are more than 50 Medicaid programs in the US and thus, Medicare for senior citizens and the elderly is not state-owned (De Lew, N. 2005 and Ridic, G., Gleason, S., & Ridic, O. 2012).
What factors prove that Medicaid program is being operated by the state?
The eligibility of Medicaid is stringent compared to Medicare, especially considering the income and resources of individuals. The rules of Medicaid vary depending on each state which indirectly proves that Medicaid is operated by the state and not the federal government directly. However, the scheme is aimed to provide healthcare services to the poor and marginalized. The state-based Medicaid programs are aimed to provide assistance to individuals having little or no resources for medical and health issues. Medicaid program is also based on varying income slabs that are based on each state which conclusively indicates the program to be operational by the state itself (Ridic, G., Gleason, S., & Ridic, O. 2012).
Conduct an analysis of the Medicaid program of your state and another state from a different region of the country: The eligibility requirement for Medicaid is based on income which varies from state to state in the US. In order to understand the difference, the Medicaid program in Ohio is different than that observed in Pennsylvania. The eligibility of individuals are based on federal poverty but there is a state-based poverty in Ohio and other states. For example, children below 200% of the federal poverty and adults at 130% of the federal poverty in Ohio are eligible for Medicaid. The eligibility is different if compared to that of Pennsylvania. Furthermore, pregnant women at federal poverty of 200% are eligible for Medicaid in Ohio (Medicaid.gov, 2014). Ohio in comparison to Pennsylvania offers blanket waiver programs and Medicare services to the elderly. However, in Pennsylvania, elderly individuals are only allowed for Medicare services and Medicaid is based on a different scheme and stringent income eligibility. All individuals under the Medicaid program can enrol for home health services and managed care plans. The difference in Pennsylvania for children-based Medicaid services is that children in foster care could also enrol for managed care plans which is not permitted in Ohio (De Lew, N. 2005).
What are the main similarities and differences between the two programs?: The most common similarity between Medicaid and Medicare is that both offer healthcare services to the society. However, the major difference is that Medicaid caters to low-income groups while Medicare caters to elderly and senior citizens. Medicare is mainly offered to disabled individuals as well unlike those eligible in Medicaid. Medicare is primarily based for elderly individuals with sustainable income resources while Medicaid is aimed to provide cost-efficient services to individuals with low income and limited resources. It is also considered as the last resort for individuals with limited or no resources absolutely. The services provided by Medicaid and Medicare also differ while Medicaid provides comprehensive services under its alliances since individuals would require monetary support for such services. However, Medicare only provides hospitalization, medical, and prescription coverage (Ridic, G., Gleason, S., & Ridic, O. 2012).
Are there enough differences to prove that the state and not the federal government operate Medicaid? Based on current evidence and the assessment of varying data and requirements for Medicaid in each state, it can easily be confirmed that Medicaid is operated by the state and not federal government. Some of the key factors that support this include: (a) Eligibility requirements (b) Policy amendments and changes (c) State-based regulatory norms (d) Pregnant women, children, and elderly group differences (e) state-wise service eligibility (f) state-based acceptance of Medicaid services and (g) state-based regulations (different from those of the actual federal regulations). There are over 50 states that have Medicaid services while each have their own regulations and eligibility thus confirming that it is state operated and not a federal operated scheme (De Lew, N. 2005).
Why is Medicaid subject to seemingly constant cutbacks?: The cost associated in funding all the low-income individuals in the state is often high and is known to consume most of the state-driven healthcare funds. The impact of Medicaid is directly observed on the governing bodies involved in the state-operated services. These have a direct impact on the federal funding for each state (Ridic, G., Gleason, S., & Ridic, O. 2012).
Are these cutbacks due to the relationships between the state and federal governments and the populations being served, or just the rising cost of healthcare in general?
Since more than 50% of funds for Medicaid is provided by the federal, the rising cost of healthcare and the rising number of eligible population has a direct impact on the governance. These cutbacks may often lead to a halt or complete shutdown of Medicaid in the future owing to discrepancies in the funds raised for Medicaid. All three factors, i.e. population, rising healthcare cost, and low management of resources have a direct impact on the inefficiency of Medicaid in each state (Ridic, G., Gleason, S., & Ridic, O. 2012).
Identify three beneficiary groups receiving care through Medicaid. Analyse the federal eligibility requirements for each group: The Medicaid program is aimed to provide health and medical services to low income individuals, disable individuals, and special populations such as pregnant women and children. These three groups however are required to fulfil the eligibility criteria for the program. Low income is basically categorized as an individual with limited or no resources to opt for basic healthcare services On the other hand, children with no financial background or support are eligible for Medicaid services. Essential pregnant women with no family or financial support are eligible for the services. It should be noted that only US citizens and legal permanent residents are eligible for Medicaid.
Discuss the coverage provisions for each group: Medicaid covers four major services which are as follows: (a) Hospitalization coverage (b) medical insurance (c) private-based insurance applicable to claim Medicaid and (d) prescription drug expenses (De Lew, N. 2005 and Ridic, G., Gleason, S., & Ridic, O. 2012).
Evaluate the anticipated impact of the PPACA on each beneficiary group: The Patient Protection and Affordable Care Act (PPACA) would have a direct impact on low income individuals, pregnant women and children, and disable groups. Since Medicaid helps in serving people with low income and other difficulties to basic healthcare services, it would reduce the burden of diseases and also protect patients from rising healthcare costs. The PPACA has an impact if Medicaid aims to serve all groups that require resources and financial support for health and medical requirements. It is important for the state and federal regulations to assess the impact of Medicaid services in each state and its impact on PPACA. Based on current evidence, Medicaid is known to reduce healthcare costs, disease burden, improve quality of care and health services, and reduce social discrimination with respect to healthcare services (Rosenbaum, S. 2011).
References
De Lew, N. (2005). Overview: 40th Anniversary of Medicare and Medicaid. Health Care Financing Review, 27(2), 5–10.
Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. Public Health Reports, 126(1), 130–135.
Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of Health Care Systems in the United States, Germany and Canada. Materia Socio-Medica, 24(2), 112–120. http://doi.org/10.5455/msm.2012.24.112-120
