Thursday, December 8, 2011

Medicaid 2011

Medicaid and CHIP (Children's Health Insurance Program) provide health coverage to nearly 60 million Americans.  Medicaid was created in 1965 and provides individuals that qualify with health protection.  It provides long term care for people with disabilities and for older people as well.  Medicaid gives health insurance to low-income families with children and it also gives supplemental coverage for low-income Medicare beneficiaries for those services that Medicare does not cover such as deductibles, premiums and outpatient prescription drugs.

Each state sets its own eligibility standards, benefits package and payment rates, Medicaid is a federal and state program.  According to the NYC department for the aging Medicaid eligibility for those age 65 and older, blind or disabled is as follows: a single individual must have a maximum monthly income of $767 per month and assets of $13,800.  A married couple can have a maximum monthly income of $1,117 per month and assets of $20,100.  Assets can include cash, stocks and bank accounts some assets do not count such as a primary home and your car. To be eligible you have to be a U.S. citizen or qualified alien.

Although Medicaid provides health coverage to the needy studies have found that children with Medicaid have to wait longer for care compared to children with private insurance.  This has shown true even for serious medical problems and according to researchers the lower payments and delays in payment are the main reason why.  The New England Journal of Medicine published the article "Auditing Access to Specialty Care for Children with Public Insurance" which details a study conducted in Cook County, Illinois.  The state of Illinois uses CHIP and Medicaid as a combined program.  The study revealed that out of 546 calls placed to clinics 66% of callers reporting Medicaid-CHIP coverage were denied an appointment for specialty care compared to callers reporting Blue Cross Blue Shield of which 11% were denied an appointment.

States may pay health care providers on a fee-for-service basis or may pay for Medicaid through different prepayment arrangements, such as health maintenance organizations (HMOs).  The providers participating in Medicaid must accept Medicaid payment rates as payment in full.  Most states have "state-only" programs to provide medical assistance to the financially challenged people who do not qualify for Medicaid. 

In 2008 Medicare, Medicaid and CHIP financed $823 billion in health care services according to the Centers for Medicare & Medicaid Services (CMS).  National health expenditures in 2019 are expected to grow to $4.6 trillion.

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