Medicaid is a federal-state program that offers healthcare coverage to low-income individuals, children, pregnant women and the elderly.
State-specific benefits vary, but typically cover hospital and physician services, labs and X-rays, home health care and nursing facility services for adults. Some states also cover additional services like prescription drugs and dental care.
Eligibility
Medicaid eligibility is determined by a person’s income and resources. Certain populations, such as children, pregnant women, and adults under 65, can be determined eligible based on an ACA-specific version of modified adjusted gross income (MAGI).
State and category eligibility rules differ. Furthermore, the Affordable Care Act (ACA) removed the asset test for some groups such as pregnant women and certain childless adults.
In 2013, the Affordable Care Act (ACA) extended Medicaid eligibility to nonelderly adults ages 19-64, up to 133% of the federal poverty level. This fills a void in coverage for those with limited financial means who had previously been excluded from coverage under Medicaid.
Many studies have demonstrated the positive long-term effects of the ACA Medicaid expansions on health and education outcomes. These can include increased insurance coverage, improved health outcomes, and reductions in risk behaviors such as smoking or drinking.
Coverage
Medicaid is a government-run program that offers free health insurance to low-income adults and children. Under the Affordable Care Act, states have the option to expand their Medicaid programs to cover those with slightly higher incomes; in such cases, 90 percent of the cost is covered by the federal government.
State Medicaid programs must cover a set of mandatory services required by federal law, such as hospital and physician care, laboratory/X-ray services, home health services and nursing facility care.
Most states provide additional “optional” benefits which can be critical for health. These could include prescription drugs, dental care, vision services and hearing aids.
Medicaid expansion under the Affordable Care Act has had an immense impact on reducing uninsured rates, offering coverage for a variety of healthcare services while helping to close health disparities between whites, blacks and Hispanics. As such, states with expanded Medicaid have seen dramatic drops in their proportion of uninsured adults.
Taxes
Medicaid is a federally funded social insurance program that provides health coverage to low income Americans. It’s the only form of coverage millions of Americans receive.
The federal government pays most of the cost of medicaid, leaving a significant portion to states. New York has long complained about rising costs and has implemented legislation requiring its counties to contribute towards their share, known as “local share.”
States across the nation have implemented taxes or fees on hospitals, private insurers, and providers to cover these costs. These so-called “provider taxes” aim to boost state appropriations for Medicaid services.
Some states have used these funds to assist politically connected providers. Unfortunately, this type of financing scheme has had detrimental effects on many medical facilities and the Medicaid program’s general payment rates. Because tax rules can be complex for healthcare providers, consulting an expert is recommended in order to guarantee that the correct taxes are remitted back to the state where a provider operates.
Managed Care
Managed care is a type of health insurance that has agreements with healthcare providers and medical facilities to offer you discounted healthcare services. This helps you control costs while improving patient outcomes.
Managed care plans come in many varieties, but three popular ones are HMO, PPO and POS. Each offers a different amount paid for getting care as well as how much of it the plan covers.
An HMO requires you to select a primary care physician who will manage most of your healthcare. They typically need your referral before seeing other specialists. A PPO allows for unlimited visits to any healthcare provider or hospital within its network; however, you will pay more if outside that network you receive care. Furthermore, Point-of-Service plans (POSs) exist which let’s you choose between HMO and PPO options each time you need medical attention.
