Free Essay Sample on Medicaid Policies

Medicaid is an insurance program for the public that offers health coverage to individual and families with low income as well as children, pregnant women, people with disability, parents, and seniors; it is jointly funded by states and the federal government. Each state has its federal guidelines that are used to run the Medicaid program. Medicaid program is appreciated by very few people; many denigrate it while most people do not understand what it is. The program is a combination of three other programs: traditional insurance source, poor children coverage and also some parents to these poor children; a complex range payer for long term and acute care services for people with mental illness, physical disability and the frail elderly; and a wraparound coverage source for elders with low income. Services used, eligibility criteria, and costs do vary across these categories hence challenging those that want to make generalizations concerning Medicaid.

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Medicaid is usually criticized but for contradictory reasons. Some of these reasons include the high cost, difficulty in controlling the budget, and the possibility of the rising Medicaid costs to take the positions of other critical things such as public safety and education. Providers normally get less payment compared to those from other bodies (Rupp & Riley, 2017). Enrollees have learned that it is not easy to find a provider who is willing to accept Medicaid, and there are always concerns about quality, more so in managed care and nursing homes. All these problems can be solved by spending more. Medicaid is also criticized because of its rigidity when it comes to rule- with several application forms, huge requirements for documentation, dozens of eligibility categories that are federally defined, and benefits imposed by courts (Rupp & Riley, 2017). However, eligibility levels are established by states, determination of services covered, setting of pay rates for the providers, and defining licensing, providers' quality of services and health plans hence leading to tremendous variety in people who have Medicaid card as well as what it means to have the card. There is a variation in the percentage of population covered with public programs and the amount of money to spend on them in different states (Burns & Dague, 2017). Waivers- the process federal governments use to grant states flexibility during constraints have minimized the rigidity in the program but on the other hand, have opened a doorway for more criticism on the program for undermining the eligibility population's basic rights as well as contravening congressional intent.

Fiscal pressure Medicaid is now facing more success than failure. It has become the United States workhorse in the health care system (Jewell, 2017). Whenever the nation identifies a new problem, for instance, the need for health care from the population or financial support, they call Medicaid immediately. These decisions are sometimes initiated by the state while at other times they are initiated by the federal government. They have yielded a significant and rapidly growing program that is being witnessed today (Burns & Dague, 2017). The crisis facing the Medicaid program portrays the mismatch the resources people commit and the ambitions they have for the program.

There are numerous benefits that come along with enrolling for Medicaid. The federal government has mandated coverage for a total of thirteen services, including outpatient and inpatient hospital services; x-rays and laboratory testing; physician services; home health care and nursing home; family planning; and Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) for children who are below twenty years (Faul et al, 2017). There are also many optional benefit categories which include prescription for drugs which is universal in all states; intermediate care facility for the mentally retarded (ICF-MR) which is in twenty two states; dental services which is in twenty six states; optometric services which are in twenty eight states and prosthetic devices which are in thirty one states. Medicaid benefits are supposed to be offered to pregnant women and children at no cost while adults only need to make "nominal" copayments. According to the federal government, this payment should be less than $3 with about half the costs for the coinsurance rates. There are no premiums charged, and there are also no deductibles required to meet before the coverage begins (Bae, 2016). States have a defined latitude to regulate the "amount, scope and duration" of services provided, but some states opt to limit the prescriptions, the number of therapies available to a given patient every month and the in-hospital days.

In conclusion, Medicaid is a program that deals with the health issues of citizens in a given country but supported by the federal governments. The program has numerous benefits to those who enroll since it seeks to help economically unstable people. However, the program faces many challenges and has been criticized for being inefficient and oppressing those who have enrolled by asking a lot of money. Various policies have been put in practice to ensure the program runs smoothly and serves the target group efficiently.

References

Bae, S. H. (2016). The Centers for Medicare & Medicaid services reimbursement policy and nursing-sensitive adverse patient outcomes. Nursing Economics, 34(4), 161.

Burns, M., & Dague, L. (2017). The effect of expanding Medicaid eligibility on Supplemental Security Income program participation. Journal of Public Economics, 149, 20-34.

Faul, M., Bohm, M., & Alexander, C. (2017). Methadone prescribing and overdose and the association with medicaid preferred drug list policies-United States, 2007-2014. MMWR. Morbidity and mortality weekly report, 66(12), 320.

Jewell, D. V., Shishehbor, M. H., & Walsworth, M. K. (2017). Centers for Medicare and Medicaid Services Policy Regarding Supervised Exercise for Patients With Intermittent Claudication: The Good, the Bad, and the Ugly.

Rupp, K., & Riley, G. F. (2016). State Medicaid Eligibility and Enrollment Policies and Rates of Medicaid Participation among Disabled Supplemental Social Security Income Recipients. Soc. Sec. Bull., 76, 17.