Medicaid Cover Policy

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Historical Background of the Policy

Medicaid cover is a public insurance program in the United States that provides low-income individuals and families with health coverage, including seniors, children, pregnant women, parents, and people with disabilities. States and the federal government jointly fund the program. Medicaid benefits and eligibility tend to vary across states because federal guidelines tend to be broad. The historical problem that led to the creation of Medicaid was the disproportionate access to health services, particularly small-income households. Their low income and economic status could not allow them to afford insurance cover and Medicaid sought to address this problem. Historically, the issue of access to health care for poor populations has been rife. Since its creation, the program has been protecting the well-being and health of millions of American citizens, saving lives, and improving the country’s economic security. Before the creation of Medicaid, poor people were excluded from mainstream medical care. They depended on the charity of hospitals, physicians, and clinics for care. Whenever they attempted to access health services, they were met with discrimination. The hardships associated with health services led to reduced services being given to the poor compared to their rich counterparts. As regards history, the Medicaid Program was signed as a law by President Lyndon B. Johnson on July 30th 1965, as part of the Social Security Act. Originally, Medicaid was meant to give health care insurance coverage to individuals eligible for cash transfers. Over the years, the program has evolved from health coverage to be a social provision program. The policy originated in 1865 in a bid to provide older American citizens with security because at the time, they were not being well served in an insurance market that mainly targeted the employed. The legislative history of the Medicaid Program stretches back to 1965, when the Social Security Act was enacted. In 1965, the program’s eligibility was limited to families with children below 18 years considered deprived of parental support because of unemployment, death, or lack of capacity. 1967, the program expanded to include early and periodic screening, diagnostic, and treatment (EPSDT) benefits for children below 21 years. After four years, states allowed the program to offer services to the mentally retarded and in intermediate care facilities. In 1972, an amendment was made that required reasonable payments for inpatient services. In 1977, the Hyde amendment prohibited payments for abortion services except when the mother’s life is in danger, rape, and incest. In 1981, the Omnibus Budget Reconciliation Act was enacted, which gave states a mandate to pursue mandatory enrollment for specific populations. Between 1982 and 2000, a series of amendments including deficit reduction, tax equity responsibility, omnibus reconciliation, family support, voluntary reconciliation, work incentives, cervical cancer, and breast cancer prevention were enacted (Sommers, Chen, Blendon, Orav, & Epstein, 2020). The latest amendment was the coronavirus Aid, Relief and Economic Security Act of 2020, which among many benefits, allowed medical practitioners to certify Medicaid health services at home.

Description of the Problem that Necessitated Medicaid

The problem that necessitated the creation of Medicaid was the unequal access to health services among poor populations. Initially, they were at the mercy of public hospitals and health practitioners. Because they did not have access to health insurance, they were discriminated against whenever they tried accessing health services. The lack of access to health insurance by Medicaid is rife, as indicated by the numbers. The Centers for Medicare and Medicaid Services (CMS) estimates that in 2019 over 75 million Americans were part of the program (Mann, White, Rogers& Gomez, 2019). The breakdown indicates that the majority are children accounting for 40% of the total population, with other populations being the disabled, the aging people and adults. According to statistics, 47.3% of Medicaid users are whites, 40% are African Americans, 30% Native Americans. Children remain the most affected by the problem which explains why they make up the majority of the population relying on the program.

Policy Description

The Medicaid program works by financing up to a fifth of the personal health care expenditures for the poor population in the United States. It also provides jobs and significant financing for nursing homes, hospitals, physicians, and community health centers. Once a person is deemed eligible for coverage, the individuals pay none or make minimal payments every month. Medicaid covers majority of the health expenses and long-term care provided the service provider is certified. Medicaid limits out-of-pocket spending and provides benefits including dental visits, eye exams, regular checkups, vaccines, prescription drugs, x-rays, lab tests. Additionally, the programs provide access to mental health services and medical specialists. The Medicaid policy covers state residents and must be United States residents or non-citizens who have met certain criteria. To implement the program, individuals are screened for eligibility. They must be from low-income backgrounds or be part of the categories, including people with disability, pregnant women, children below 19 years or adults with dependent children. The kind of resources counted as assets are investments, cash, savings, bonds and credit unions. The short-term goal of Medicaid is to institute an insurance plan instead of managed care in paying for health services. The long-term goal is to have person-driven and long-term support for people with disability and chronic diseases to achieve an independent and improved quality of life. At the federal level, the Center for Medicare and Medicaid (CMS) is tasked with overseeing the administration of the Medicaid program while individual states establish and manage policies to run the program on a day-to-day basis. The Medicaid program relates to the values of social justice, competence and services. This is because it seeks to address underlying inequalities that prevent poor people from accessing healthcare. It levels the playing field and gives the poorest people in society an opportunity to get quality healthcare. While social workers were not directly involved in the development of the Medicaid program, they continue to be a crucial part of the process by providing community-based care coordination.

References

Mann, E. S., White, A. L., Rogers, P. L., & Gomez, A. M. (2019). Patients’ experiences with South Carolina’s immediate postpartum Long-acting reversible contraception Medicaid policy. Contraception, 100(2), 165-171.

Sommers, B. D., Chen, L., Blendon, R. J., Orav, E. J., & Epstein, A. M. (2020). Medicaid Work Requirements In Arkansas: Two-Year Impacts On Coverage, Employment, And Affordability Of Care: Study examines the impact of the Arkansas Medicaid work requirement before and after a federal judge put the policy on hold. Health Affairs, 39(9), 1522-1530.