This essay discusses the eligibility requirements of Medicaid. This is done with specific reference to the Kaiser Family Foundation (2010) views on the impact of health reforms. The essay goes ahead to discuss the changes that Medicaid is likely to experience with the about to be implemented health reforms. Medicaid could be described as a health system that was set up by the United States governments in order to cater for health needs of its population specifically the low income earners. The funding of Medicaid comes from both state and the federal government though it is managed at the state level. Its beneficiaries include US citizens or its permanent residents particularly the low income earners , their children and people with disabilities in such a way that they are unable to obtain a stable source of income to pay for their medical expenditure. Medicaid has a number of services such as those under its Social Security program which include dental services. It was created under the Social Security Amendment in 1965. Though state participation in the program is voluntary, all states have been participants in the Medicaid program since 1982. Medicaid’s Insurance Coverage extends to 58.5 million people of various categories including children, adults in poor families, the elderly and the disabled. This coverage experienced some changes in 2009 due to the 2008-2009 economic recession experienced at that time with a significant increase in the number of enrollees. The 2010 health reforms aim to reduce cases of uninsured citizens in the US. These reforms have a direct impact on Medicaid and its operations. Medicaid’s importance is seen in the fact that it is through it that many are able to access many services such as nursing homes, health care in the homes, hospitals and clinics(Alexander, 1996).
The 2010 health reforms aim to increase the number of insured Americans and the number of people under the Medicaid coverage. This has been made possible by widening the eligibility bracket and creating penalties for those found uninsured. They also increase their control over insurance companies preventing them from limiting their insurance coverage leaving out some uninsured. The eligibility criterion for Medicaid could be better discussed by grouping it into two categories; the criteria used before implementation of the reforms and that which is now maintained by law after implementation of the reforms. In general terms, in order to be covered, one has to fall under a various categories to benefit. The said categories included children, parents, and the disabled, the elderly and pregnant women. Adults without children were not covered not unless they obtained waivers i.e. permission for exemption from the federal government.
Medicaid’s eligibility requirements are mainly controlled at the state level though the federal government sets guidelines and limits to which the state governments can legislate on Medicaid’s operation. Due to this, Medicare’s eligibility requirements tend to differ from state to state. Generally one has to fall within the categories stated previously in order to be eligible for Medicare’s coverage. Medicaid’s coverage can be categorized into two broad groups. The first group is ‘Community Coverage’ which basically covers those with little to no health insurance cover. The second group is ‘Nursing Home Coverage’ which covers the costs incurred by those eligible who stay in nursing homes. In the second category, the person however pays for most of these expenses before being admitted to the nursing home (Kevin, 2012).
The health reforms affect these eligibility requirements as they aim to increase the coverage. Eligibility according to the new reforms is based on a Modified Gross Income income definition instead of the previous asset tests. The coverage will also extend to people with gross incomes of up to 133% of poverty. This will start coming to effect from 2014 as this is mainly a long term health care plan. However it is important to note that some states’ Medicaid coverage already met the new criteria set by the new health reforms and that states cannot roll back previously set coverage levels. It is estimated that an additional 16 million people will be enrolled in Medicaid by the time of full implementation of the reforms in 2019 (Sheri, 1985).
In order to cushion states against increased expenditure caused by the expected increase in numbers of those covered by Medicaid, the federal government has offered to cater for about 95% of the costs for the new enrollees. Due to this, states will experience very little increase in their expenditure with the increased coverage in the short run. Numbers of services that are under Medicaid are increasing especially with the health reforms.
Some of the changes that have been made by the reforms to Medicaid’s services are expected to come into effect before the main changes in 2014. These include services such as coverage for smoking cessation, ‘health home’ option for people with chronic conditions and a state incentive to encourage them to explore prevention measures at no cost to those under Medicaid cover. The funding for Medicare and its services has also been changed by health reforms with an expanded scope and setting up of a commission to advise the federal government on payment policies and other financial issues. (Rudowitz, 2012).
In conclusion, it can be noted that Medicaid plays an important role in health care management and this role has been given more weight with the implementation of the new health reforms. The pre-reform eligibility requirements were seen to be restrictive to a few select categories. The health reforms aim to broaden this coverage to benefit more people access proper health care when they need it. Medicaid is expected to change a lot to fit the demands of these health reforms.