Personal Finance

The information source for Medicaid information

Medicaid is a joint federal and state program that pays for the medical expenses of certain families and individuals with a low income or resources. It came into effect in 1965 through the Social Security Act titled XIX.

The implementation of Medicaid program is the responsibility of the respective state governments and the overall setup or progress is constantly monitored by the Centers for Medicare and Medicaid Services (CMS) – earlier Health Care Financing Administration – under the United States Department of Health and Human Services. The CMS reserves the rights for establishing the requirements for quality, service delivery, eligibility standards, issuing regulations and funding.

Though functioning under the common umbrella of the Centres for Medicare and Medicaid Services, the Medicaid program varies in its implementation from state to state. The Medicaid policies governing the eligibility, payment, and services are complex and differs considerably, even among states of geographical proximity or similar size. Services provided by one state may differ sizeably in terms of amount, scope or duration from that of a neighbouring state. Also the eligibility criterion; one person who is eligible for Medicaid in one state may find himself out in the scheme of things in another state. Besides, the state legislation has the powers to change the Medicaid rules, eligibility and service scope during a given year.

The participation of State in Medicaid is voluntary. But Medicaid had complete participation from the States since 1982. The mode of payment by Medicaid varies from state to state. Some states prefer to pay private health insurance companies that had entered in to a contract with the state Medicaid program. Some other states opt to pay the service providers (doctors, hospitals and clinics) directly to make sure that proper medical care is given to the patients.

In addition, there are other health programs as well in some localities, funded by the government or any political subdivision, for providing health cover for minors and indigents. But it differs from Medicaid in the fact that it lacks federal monitoring. Also, people have confusion regarding the difference between Medicare and Medicaid. The former is a federal health insurance program aimed at people aged over 65 and state has no direct bearing on it. Medicaid covers a much wider range of healthcare services and the program does not involve any premium or deductibles as Medicare.

Half of the funds of Medicaid are used to purchase nursing home and in-patient hospital services. The rest caters to cover physician services, laboratory, drugs, X rays, and other diagnostic and supporting services. Owing to the large customer base Medicaid has, it has sometimes assumed the proportion of a major budgetary issue in many states. For many, the Medicaid fund amounts to about a quarter of the state budget. Hence, an enactment regarding the cutting of Medicaid funds over a period of time is widely debated among state law makers.

The apparent weakness Medicaid has its inconsistency regarding its implementation in various states. Also, as Medicaid has been designed to have the recipients buy their medical care from the private health sector, it failed to exert any control over the cost factor and whatever cost the private facilities charged added the burden of the state funds.

Despite such glitches, Medicaid continues to epitomize the federal government’s good will in making the healthcare facilities affordable and available to the poor. Statistics show that Medicaid covers over 43 million Americans as of now. It pays for over 60% of all nursing home inmates and accounts for about 37% births in the country. Also, it funds various HIV related programs across United States.