Medicaid is a government-run health insurance initiative that was established in 1965. It offers medical care to low-income individuals and families, encompassing coverage for newborns, adults, pregnant women, elders, and persons with disabilities. The provinces and the federal government are contributing equally to the cost of funding this program. Within the parameters outlined by the federal government, Medicaid is administered independently within every state. Since the federal standards are so general, every jurisdiction has considerable flexibility in developing and managing its programs. As a direct consequence, Medicaid eligibility requirements and reimbursements may and frequently differ substantially from one state to the next.
Children make up over two-fifths of those enrolled in the Medicaid program, although they only contribute one-fifth of the program’s overall cost. Even though the elderly and individuals with disabilities make up just one-fifth of Medicaid program enrollment, they are responsible for roughly half of all Medicaid expenditures. This is since these populations need more extensive medical treatment (Bitler and Zavodny, 2017). The Medicaid initiative is a counter-cyclical policy. Its membership increases to meet increased demands through economic downturns when individuals are more likely to lose their employment and traditional job-based free healthcare. More than ten million new individuals, about half of whom were children, registered in Medicaid directly because of the Great Recession from 2007-2009 and its repercussions (Couch et., 2018). Additionally, due to the COVID-19 pandemic national health and financial crisis, the number of people enrolled in Medicaid increased and will continue to increase over the next few months. Therefore, the Medicaid initiative will protect millions of individuals who lose their jobs or incomes from being uninsured.
Since Medicaid is known as an “entitlement” initiative, it implies that everyone who satisfies the criteria for enrollment in the program has the legal right to do so. Additionally, it ensures that states would get financial assistance from the federal government to cover a portion of the expenses of their Medicaid beneficiaries. Medicaid is not available to everyone with a low income, even those who qualify. Individuals over the age of 21 who reside in the 15 states in the United States which have not adopted the Expansion of Medicaid provisions of the Affordable Care Act are not eligible for Medicaid regardless of how low their income levels are, except those who are pregnant, older adults, taking care of children, or those who are living with a disability. And in the intermediate state that does not allow Medicaid expansion, parents remain ineligible for benefits if their earnings exceed 42% of the federal poverty threshold (Graves and Swartz, 2017).
Even if they are legally in the country, many persons who are also not native citizens of the United States cannot get Medicaid benefits. Individuals with provisional special protection status, whom the national government allows living within the nation for humanitarian purposes, are not included in this group. Additionally, those who are not eligible for the program are individuals who have been granted provisional permission to the U. S. for several reasons, including work in several disciplines, travel, or learning programs, among many other things. Even though they fulfill all of the conditions for participation in the Medicaid program, legal permanent citizens, also known as green card members, are not permitted to participate during the first 5 years of their residency. The U.S. can waive the five-year waiting period and provide admission to all pregnant women and children who are legally present in the country.
In accordance with federal regulations, state Medicaid initiatives are obligated to provide coverage for a range of “mandatory” services, which include hospital and medical treatment, X-ray services to patients and laboratories services, home base care for older adults, and care provided in nursing facilities. Younger individuals under 21 years old are entitled to an advantage from the program referred to as Early and Periodic Screening, Diagnostic, and Treatment. This benefit requires the state to offer a more extensive range of services. Care home, and other extensive healthcare services and supports are paid for with the remainder of Medicaid’s expenditure on services. Approximately three-quarters of all the Medicaid program’s expenditures go toward acute-care services, including hospitalization, outpatient treatment, and pharmaceuticals. Medicaid covers over sixty percent of care homes patients, and the program pays around fifty percent of the expenditures associated with extended care support and services. Immediate medical treatment is not something that is offered through Medicaid. Many Medicaid recipients are enrolled in private planned care programs for their medical coverage. When it comes to the rest of the population, state Medicaid initiatives are responsible for paying hospitals, physicians, care homes, and many other healthcare professionals for the health coverage that they give to individuals who are eligible for subsidies.
Overall, Medicaid is a very efficient program covering the costs of medical care for low-income individuals. Medicaid has been a driving force in reducing the total number of people without health insurance since the primary widespread implications of the ACA were established in 2014. Assuming that Medicaid was not there, most people who are now enrolled in the Medicaid program would be without health insurance. This is because private medical insurance is typically not an alternative for individuals who receive health coverage from the Medicaid initiative. Many people who earn low wages do not even have significant exposure to insurance coverage for their families and themselves through their employment type. They are unable to afford to buy coverage on the private market. Medicaid is also beneficial in improving healthcare outcomes, access to treatment, and promoting financial stability for families with low incomes.
References
Bitler, M. P., & Zavodny, M. (2017). Medicaid. In The law and economics of federalism (pp. 183-213). Edward Elgar Publishing. https://doi.org/10.4337/9781786433602.00011
Couch, K. A., Reznik, G. L., Iams, H. M., & Tamborini, C. R. (2018). The incidence and consequences of private sector job loss in the Great Recession. Soc. Sec. Bull., 78, 31. https://www.ssa.gov/policy/docs/ssb/v78n1/v78n1p31.pdf
Graves, J. A., & Swartz, K. (2017). Effects of Affordable Care Act marketplaces and Medicaid eligibility expansion on access to cancer care. The Cancer Journal, 23(3), 168-174. https://doi.org/10.1097/ppo.0000000000000260
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