Medicaid An Assessment of the Program

The Medicaid Health Care Program

Introduction

Medicaid was formed in the year 1965 as a public insurance program to provide health coverage to families and individuals that earned low incomes. The people that the Medicaid insurance program covers include children, parents, pregnant women, the older people and people living with disabilities (Stevens, & Stevens, 2017). The Medicaid program has been founded jointly with the federal government and the state governments. Each state within the U.S. operates its own Medicaid program in accordance with the federal government guidelines. Stimpson and Wilson (2018) point out that in the year 2019, the Medicaid health coverage program helped 97 million families in the United States within that said year. To break it down, the program is said to have helped 32 million children, 28 million adults, 6 million older people, and nine million people with disabilities who essentially had low incomes. The spending of the Medicaid program on children seems to be the largest compared to the other cluster groups. Although the Medicaid program was started in the United States a while ago, it has not sufficiently penetrated all the states and therefore there may be need to establish ways of ensuring its spread.

California State has the highest number of Medicaid enrolments followed by New York. When calculated as a percentage of the population, New Mexico is arguably the state with the highest number of enrollees of the Medicaid program. The purpose of the essay is to evaluate the status of the Medicaid program. The essay will go further into establishing the advantages and disadvantages of the program. Also, the present essay will establish the opportunities that the program provides to the community and the specific challenges that it brings forth. This write-up will further recommend strategies to counter disadvantages and challenges presented by the Medicaid health program.

Discussion

The Medicaid program was not formed to serve all types of people - rather there are certain categories of people who are eligible to benefit from the program. One of the groups eligible for the program are pregnant and uninsured women. However, a woman who enrolls while pregnant may not eligible for the program. According to Stimpson and Wilson (2018) the other eligibility factors that affect pregnant women include their household size, immigration size as well as income. Women who wish to benefit from the program would have to visit their states website on ‘pregnancy related Medicaid’ and establish their coverage limits according to their conditions. Pregnant women who get covered by Medicaid program also get their children covered.

Children and teenagers are also eligible for the program and especially if their families earn a low income. Children and teenagers encompass all boys and girls below 18 years old without any insurance coverage. Teenagers who are also living on their own are also covered. There are states that cover children up to the age of 21.

The third group of people is people who are 65 years and older. Currie and Duque (2019) are of the opinion that despite the economic improvements in the United States over time, there are many elderly Americans who face challenges in relation to meeting their living expenses. The authors further indicate that 41% of the nation’s population of elderly people have low incomes - which is below twice the federal government’s poverty level. In the year 1994, the federal poverty level in the United States was $7,100 p.a. for a single adult and $9,000 for a couple. 12% of the elderly population in that year was below the poverty level (Rowland, & Lyons 1996). As a result, out of these, 5.9 million elderly poor people had an opportunity to benefit from Medicaid. The elderly people resided in nursing homes and received help from the Medicaid program.

The other group of people that benefit from the Medicaid program are people living with disabilities. People living with disabilities may either be born with disabilities or may become disabled at some point of the lives. People with disabilities are prone to many challenges of even acquiring opportunities in the society because they are sidelined. Such individuals may not get an education and meaningful jobs could be an issue. Most, hence, end up living in poverty. For persons diagnosed with developmental and intellectual disabilities, Medicaid acts as a source of the much needed funds. Medicaid services their activities and ensures that they live normal lives. It is important to note that about 12% of adults in the United States have a disability (Hung,Ross, Boockvar, & Siu 2011). The Medicaid program provides both short term and long term care services in an attempt to ensure that the needs of persons with disabilities are met. Some of the services that Medicaid provides to such people include preventive care, nursing home care and medical treatment for various illnesses. The Medicaid program helps people with disabilities in finding and holding jobs.

As earlier suggested, Medicaid is a social insurance program which covers basic healthcare needs for people who earn low income. The program is therefore designed to cover the health costs of low-income earning individuals. Depending on the State that the program is institutionalized, Medicaid may cover different health care services. There are however mandatory Medicaid services in every state including “inpatient hospital services, outpatient hospital services, nursing facility services, home health services, family planning services, physician services, nurse midwife services, transportation to medical care, and tobacco cessation counselling for pregnant women” among other mandatory services (Stimpson and Wilson, 2018, p. 311). The Medicaid health program also covers both optical and dental services to eligible individuals up to a limit given by specific states. This is because each state is required to run is own program, but the government provides half of the funding for the Medicaid services needed.

The optional Medicaid benefits that eligible individual benefit from include the prescription of drugs, physical therapy, clinic services, occupational therapy, respiratory care services, eye glasses, dentures, personal care and practice services. The Medicaid senior program coverage however goes further into providing extra services to individuals in their homes including skilled nursing care, transportation services, home delivered meals, healthy eating and physical therapy.

Although the United States government is at the forefront in ensuring nationwide insurance coverage, many individuals in the United States are ineligible for Medicaid because of their immigration status. Such groups of people are temporary protected by the federal government.

The Medicaid program has played a great role in insuring low-income families in the United States. This has worked out well because of the support of the Healthcare Act in the country. As of April 2020, Medicaid eligibility has expanded immensely. 35 States in America have implemented the Medicaid expansion program in an effort to serve the poor and low-income earning adults. It is suggested that by the year 2029, the Medicaid health program will serve an extra 14 million individuals in efforts to assist them access affordable and comprehensive health coverage. By the year 2021, 39 states in America had implemented the Medicaid program, leaving out only 12 states which have not adopted the Medicaid expansion program. There are, however, states such as Missouri and Oklahoma which have adopted the program but have not implemented the expansion.

Advantages and Disadvantages of Medicaid Program

A study was conducted by Reddy, Finley Posey & Rohack, (2012) to establish whether expanding Medicaid would help manage health care in Texas. The researchers reviewed the Texas Medicaid program and the potential benefits it had on federal healthcare. The research was conducted through online and state review. The study concluded that if the Medicaid program was conducted in a proper manner, it would result in the responsiveness of its recipients. It would also meet the needs of the enrollees’ while at the same time reducing the costs of the state.

Stimpson & Wilson (2018) also conducted a study to establish Medicaid expansion and improved health coverage in the United States. In the study, the authors argue that there have been racial and ethnic disparities when it came to Medicaid health coverage. The study uses data from the year 2010 to 2015 to establish the effectiveness of the Medicaid program. The study establishes that the Medicaid program has resulted to insurance expansion among the US natives. Non-natives have, however, had problems accessing the health program. There have also been disparities when it came to assisting the non-natives.

Insurance is a term that means the pooling of resources to survive a risk. The Medicaid program has pooled resources to reduce health risk in the United States. In Texas, there are Medicaid waivers supported by the Medicaid program. An example of a Medicaid waiver is the 1115 waiver. This type of waiver works to finance and benefit human services. Waivers are one of the advantages of the program because they are funded by the government hence reducing the costs for the Medicaid program. The reduction of costs in the program help reduce inefficiency (Schlenker & Huber 2015). The healthcare sector is expensive to manage and finance. However, Medicaid waivers come in and help improve efficiency while providing health services to citizens.

Quinn, Weimar, Gray & Davies (2016) carried out a research to establish the clinical outcomes of the Medicaid program in the United States. The expansion and levels of influence of the Medicaid program are making it a purchaser of quality care in the present and also in the future. The research conducted views Medicaid as a program that is influential both for obstetric and pediatric care. Some of the positive outcomes of the Medicaid program also include early elective deliveries, reduced mortality rates, patient satisfaction and emergency department visits. The Medicaid program has also helped ensure preventable hospitable admissions for patients suffering from pneumonia, asthma and diabetes.

The other advantage of the Medicaid programs is that it has enabled low incoming earning individuals to afford genetic therapies within the program. Such therapies include those that insert genes and those that alter gene expression (Ballreich, Ezebilo & Sharfstein, 2020). The program has also enabled children at a very young age to receive treatment for diseases that may have long term effects and affect their growth - including sickle cell disease, cystic fibrosis, and infantile onset spiral muscular atrophy type 1.

According to Harma, Tinkler, Mitra, Pal, Susu?Mago & Stano (2018), Medicaid poses a disadvantage to the healthcare system because there are still uninsured patients who are sidelined because of their race and ethnic group. In the United States, black people and the Hispanic population is less likely to receive insurance. The authors reveal that states that charged higher medical fees had higher probabilities of appointments compared to those that charged lower appointment fees. Less privileged and sidelined groups had to face the challenge of not acquiring appointments because they cannot access Medicaid.

The Medicaid program has experienced certain pressures when it comes to expanding as a resulting of poor financing. There may be better opportunities for individuals to receive healthcare but the issue of financing still takes root in many institutions and Medicaid is not an exception (Kocot, Dang-Vu, White & McClellan, 2013). The Medicaid program is partially financed by the federal government, while the rest is financed by the state in which the program is being implemented. The challenge occurs when financing is delayed from both ends and there is a deficit in accounting. Many patients may end up not receiving medical care because of the governments and states’ reluctancy to release Medicaid funds.

Allen, Wright & Baicker (2014) carried out a study on new Medicaid enrollees in Oregon and how the program was of benefit to them. The researchers examined health care interactions and perceptions of the Oregon Medicaid cohort three years ago. Qualitative data was obtained from 120 enrollees through a wide range of interactions in the system. The study establishes that about 40% of the enrollees were confused about the coverage. This means that they did not have enough information abut the coverage and experienced access barriers to the program. On the other hand, 60% of the enrollees argued that their interactions with Medicaid was easy and they understood the guidelines. The individuals also argued that as a result of the Medicaid program, they had experienced improved health. The study further continues to state that for Medicaid program to ensure 100% utility to its users, there may be need for improved communication with beneficiaries. There may also be need for coordinated care across settings and reduced barriers that new enrollees are more likely to face.

Challenges and Opportunities of Medicaid Program

According to Currie & Duque (2019), the Medicaid program has helped to provide insurance and promoted health in the country. Since the year 1965, the program has worked to improve the lives and health of low-income families. The Medicaid program has increased health coverage and reduced medical debt while improving health outcomes in the medical industry. There have however been challenges associated with the program’s ever increasing costs, the quality of care, and ease of access.

The other challenge faced by the Medicaid program is that it offers limited services to its users and hence is unbale to provide a comprehensive cover. Wallace, Carlson, Mosen, Snyder & Wright (2011) indicate that the Medicaid program reduces dental benefits in Oregon’s Medicaid health plan. Oral health is a critical part of the health sector; however, Medicaid program finds it difficult to provide the care in various states. Oral health is connected to physical health in many ways – and one aspect of wellbeing cannot be addressed and the other ignored. The limited health services make it difficult for customers to receive comprehensive health at a go.

Richard, West & Ku (2012) argue that in relation to the ROI of the Medicaid Tobacco Cessation Program in Massachusetts, a significant percentage of individuals who benefit from the Medicaid program smoke. In their study, the authors aim at conducting a cost benefit analysis of having to provide smokers with free healthcare. The study uses a cost benefit analysis to establish the programs return on investment with data from 2002 to 2008. The survey was conducted to establish the costs that was set to treat each smoker. Some of the costs that were revealed from the research include pharmacotherapy, outreach costs, and counselling costs. The cost on each patient was estimated to range from $549 to $583. It is important to note that from the assessment, it is established that investing in tobacco cessation services that are comprehensive would bring about significant savings. From the study, it is evident that the program has an opportunity to add more individuals struggling with tobacco and help improve their health.

According to Frakt, Carroll, Pollack & Reinhardt (2011), the Medicaid program does indeed have some flaws. However, notwithstanding the said flaws, it has proven to be immensely beneficial. One of the flaws happens to be low reimbursement rates which has made the program be fodder for critics. Low reimbursement rates result in poor services being offered to patients and hence low satisfactory rates to patients.

Policy Recommendations for Challenges within the Medicaid Program

One of the challenges is that Medicaid health program has not yet been implemented in all the states of this great nation. This means that there is scarcity in health care coverage. The Medicaid program should therefore expand its insurance coverage for all the individuals below the federal poverty level in all the states.