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Children Health Insurance
Medicaid and the Children Health Insurance Program (CHIP) Health Care Policy
1-What legislation introduced Medicaid, and what are the funding sources for the program?
2-What are some of the changes, including CHIP, that have occurred to the Medicaid program since its inception?
3-What are the demographics of the majority of people covered by Medicaid, and how many people in the United States are covered by Medicaid?
4-Evaluate the changes that have occurred to Medicaid with the inception of the Patient Protection and Affordable Care Act. What are the current changes in Medicaid based on current legislation?
5-Assess social and cultural changes and their impact on developing new health policies to make Medicaid and CHIP more effective.
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Medicaid was established in 1965 in conjunction with Medicare as part of the Social Security Act. Medicare is a health-insurance program for retirees, disabled employees, and their spouses and dependents that is funded and administered by the federal government (United Health, 2021).
Medicaid, on the other hand, is a combined federal-state program in which states and territories receive federal financial assistance in providing health and long-term care to federally designated low-income families and individuals (United Health, 2021).
Prior to the passage of Medicaid, states received limited federal reimbursements for health care services paid on behalf of public assistance beneficiaries. In 1960, Congress approved open-ended federal matching funds to states for impoverished elderly people’s health care. Still, the breadth of the health-care services that states financed for low-income individuals and families varied significantly (United Health, 2021).
The original law provided states the option of obtaining federal funds to assist in providing health care coverage to children from low-income families, their caregiver relatives, the blind, and the handicapped (United Health, 2021). Medicaid was created to give low-income individuals and families more access to mainstream health care. States would receive funds from the federal government to cover half or more of their expenses in providing services to beneficiaries.
At the same time, the program was designed to offer states a lot of flexibility in how they structure their medical aid programs. States that choose to participate in the program were obligated to provide a baseline range of health care to those receiving public assistance (United Health, 2021).
They were also authorized to provide extra services at their discretion, such as serving medically needy people who did not get government aid. The federal government has consistently strengthened the rules and regulations governing state Medicaid programs.
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Children Health Insurance
Many changes in federal Medicaid legislation have occurred during the last four decades, including substantial changes in eligibility, benefits, payment arrangements, and other administrative issues (Smith, Kennedy, Knipper, & O’Brien, 2005). These developments, when paired with state judgments about the scope of their programs, have resulted in Medicaid expanding well beyond its original focus on providing mostly acute care services.
Furthermore, Medicaid has surpassed private insurance as the primary source of funding for long-term care for persons with disabilities (Smith, Kennedy, Knipper, & O’Brien, 2005). Despite several revisions in federal legislation, the essential basis of the federal-state partnership in the program has remained relatively same. The Supplemental Security Income (SSI) program was established in 1972 (Smith, Kennedy, Knipper, & O’Brien, 2005).
This nationally financed income support program for persons with disabilities replaces the previous federal-state cash assistance programs for the elderly, blind, and handicapped. SSI and Medicaid eligibility were intertwined. Many obligatory and voluntary eligibility categories were expanded in the 1980s, with a particular focus on extending Medicaid coverage to low-income pregnant women and children who did not receive public assistance payments (Smith, Kennedy, Knipper, & O’Brien, 2005).
States were obligated to contribute increased Disproportionate Share Hospital payments to hospitals that cater to a significant number of Medicaid recipients and other low-income people under the Omnibus Budget Reconciliation Act of 1981. The Personal Responsibility and Work Opportunity Act of 1996 broke the historical relationship between Medicaid eligibility and the financial assistance program for Aid to Families with Dependent Children.
For low-income households, a new obligatory Medicaid eligibility group was formed; Medicaid eligibility was no longer automatically linked to receipt of public assistance cash payments (Smith, Kennedy, Knipper, & O’Brien, 2005). The Children’s Health Insurance Program (CHIP) was enacted into law in 1997 and provides states with federal matching money to offer health care to children whose families’ earnings are too high to qualify for Medicaid but too low to buy private insurance.
Through their CHIP programs, all states have greatly increased children’s coverage, with virtually every state providing coverage for children up to a minimum of 200 percent of the Federal Poverty Level (Smith, Kennedy, Knipper, & O’Brien, 2005). The federal Medicaid statute has been amended several times since it was enacted. Federal mandates have grown, particularly in the field of low-income children’s programs.
The creation of 51 extremely diverse Medicaid programs has come from the mix of Medicaid mandates and alternatives. These programs function under broad national principles but are influenced by state judgments regarding who is eligible and what they are eligible to receive (Smith, Kennedy, Knipper, & O’Brien, 2005).
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The sources of funding for Medicaid include Federal Medical Assistance Percentage (FMAP), through Enhanced Matching Rates, Disproportionate Share Hospital payments (DSH) and State Financing of the Non-Federal Share (Rudowitz & Snyder, 2015). The federal government guarantees states matching payments for eligible Medicaid expenditures; states are promised at least $1 in federal money for every $1 spent on the program by the state.
As economic conditions change, FMAP, which is an open-ended funding system, permits federal funding to flow to states depending on real costs and requirements (Rudowitz & Snyder, 2015). Medicaid offers a greater matching rate for certain services or populations in some cases, the most famous example being the ACA Medicaid expansion enhanced match rate. The federal government will cover 100 percent of Medicaid expenditures for newly eligible people in states that expand (Rudowitz & Snyder, 2015).
DSH hospital payments are another source of funding for hospitals that treat a lot of Medicaid and low-income uninsured patients. These DSH payments have been critical to the financial viability of safety net hospitals in several states (Rudowitz & Snyder, 2015). Lastly, States have a lot of flexibility when it comes to deciding how to support the non-federal portion of Medicaid spending.
State general fund appropriations are the major source of money for the non-federal portion. The utilization of alternative monies by governments has risen modestly but consistently over the last decade. This is most likely due to states’ growing dependence on provider taxes and fees to fund the state portion of Medicaid (Rudowitz & Snyder, 2015).
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Children Health Insurance
Pregnant women with low income, children from low-income families, children in foster care, individuals with disabilities, seniors with low income, and parents or caregivers with low income are all served by Medicaid programs(Lee & Jarosz, 2017). States can also opt to include additional categories, such as low-income adults who may or may not have children, in their eligibility. In 2015, the ACS recorded about 66.4 million participants nationwide, accounting for 91.7 percent of the 72.4 million reported by the Centers for Medicare and Medicaid Services in mid-2015 (Lee & Jarosz, 2017).
According to the Center for Medicaid and CHIP Services, there were 74 million Medicaid and CHIP members as of March 2017, with almost 36 million of them enrolled in CHIP or children enrolled in Medicaid. Children and teens account for over half of all persons covered by means-tested public health insurance (Lee & Jarosz, 2017). Nearly 11 percent of adults are 65 and older, many of whom are low-income and rely on Medicaid to supplement Medicare.
Adults who are disabled or institutionalized make up another 14%, while women who have given birth in the last year make up just under 2%. More than seven out of ten people in means-tested health insurance plans belong to these vulnerable categories (Lee & Jarosz, 2017). Only 12% of those left work full-time or part-time.
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References
Smith, G., Kennedy, C., Knipper, S., & O’Brien, J. (2005, January 24). ASPE. From USING MEDICAID TO SUPPORT WORKING AGE ADULTS WITH SERIOUS MENTAL ILLNESSES IN THE COMMUNITY: A HANDBOOK. A BRIEF HISTORY OF MEDICAID: https://aspe.hhs.gov/report/using-medicaid-support-working-age-adults-serious-mental-illnesses-community-handbook/brief-history-medicaid#chap1
United Health. (2021, April 05). From What is Medicaid and what does it cover: https://www.uhccommunityplan.com/dual-eligible/benefits/medicaid
Rudowitz, R., & Snyder, L. (2015, May 20). KFF. From Medicaid Financing: How Does it Work and What are the Implications?: https://www.kff.org/medicaid/issue-brief/medicaid-financing-how-does-it-work-and-what-are-the-implications/
Lee, A., & Jarosz, B. (2017, June 29). PRB. From MAJORITY OF PEOPLE COVERED BY MEDICAID ND SIMILAR PROGRAMS ARE CHILDEN,OLDER ADULTS, OR DISABLED: https://www.prb.org/resources/majority-of-people-covered-by-medicaid-and-similar-programs-are-children-older-adults-or-disabled/
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