Aid that Really Matters
What is Medicaid?
Medicaid is one of the United States' health care programs that is funded by State and Federal governments, to help pay all or some of the medical expenses of people who cannot afford to do so (1). Medicaid was established as a law in 1965 under title XIX of the Social Security Act. This program extends to all people in all the 50 states governments, the District of Colombia and the territories. This is the largest program in America that provides medical and health related to help America’s eligible, needy poor people (2). National statue, regulations and guidelines that states must follow include:
1)establish its own eligibility standards;
2)determines the type, amount, duration, and scope of activities;
3)sets the rate of payments for services; and
4)administers it’s own program (2)
Each state determines it’s own complex guidelines, which allows each state to have different policies and eligibility. This may cause complications for someone that moves out of a state in which they qualify to a state where they may not meet the eligibility requirements (2).
Who is most likely to qualify for Medicaid?
One of the most standard qualifying test determined by the state is low income(but is not always a determination to receive aid) and at least one other test that allows for eligibility. Some of the common tests the state uses is can include age, if a women is pregnant, income and resources, citizenship or if the person is a legal lawfully immigrant that has maintained citizenship for at least five years, disabilities and other determining factors (3).
Federal Funds are provided for and given to states if they allow a certain coverage for those who receive other financial assistance under the following terms…(2) “-Individuals are generally eligible for Medicaid if they meet the requirements for the Aid to Families with Dependent Children (AFDC) program that were in effect in their State on July 16, 1996.
-Children under age 6 whose family income is at or below 133 percent of the Federal poverty level (FPL).
-Pregnant women whose family income is below 133 percent of the FPL (services to these women are limited to those related to pregnancy, complications of pregnancy, delivery, and postpartum care).
- Supplemental Security Income (SSI) recipients in most States (some States use more restrictive Medicaid eligibility requirements that pre-date SSI).
-Recipients of adoption or foster care assistance under Title IV of the Social Security Act. Special protected groups (typically individuals who lose their cash assistance due to earnings from work or from increased Social Security benefits, but who may keep Medicaid for a period of time).
- All children born after September 30, 1983 who are under age 19, in families with incomes at or below the FPL. Certain Medicare beneficiaries.”(2)
States give their funds to: other individuals that may not fit into the mandatory eligibility groups, but have similarities, can also gain federal funds if…(3) “-Infants up to age 1 and pregnant women not covered under the mandatory rules whose family income is no more than 185 percent of the FPL (the percentage amount is set by each State).
-Children under age 21 who meet criteria more liberal than the AFDC income and resources requirements that were in effect in their State on July 16, 1996.
-Institutionalized individuals eligible under a "special income level" (the amount is set by each State--up to 300 percent of the SSI Federal benefit rate).
-Individuals who would be eligible if institutionalized, but who are receiving care under home and community-based services (HCBS) waivers.
-Certain aged, blind, or disabled adults who have incomes above those requiring mandatory coverage, but below the FPL.
-Recipients of State supplementary income payments. Certain working-and-disabled persons with family income less than 250 percent of the FPL who would qualify for SSI if they did not work.
-TB-infected persons who would be financially eligible for Medicaid at the SSI income level if they were within a Medicaid-covered category (however, coverage is limited to TB-related ambulatory services and TB drugs).
-Certain uninsured or low-income women who are screened for breast or cervical cancer through a program administered by the Centers for Disease Control.
-The Breast and Cervical Cancer Prevention and Treatment Act of 2000 (Public Law 106-354) provides these women with medical assistance and follow-up diagnostic services through Medicaid.
-"Optional targeted low-income children" included within the State Children's Health Insurance Program (SCHIP) established by the Balanced Budget Act (BBA) of 1997 (Public Law 105-33).
-'Medically needy' persons” (3).
What type of services does Medicaid supply?
The following are mandatory if the state wishes to receive matching funds… “-Inpatient hospital services.
-Outpatient hospital services.
-Vaccines for children.
-Nursing facility services for persons aged 21 or older.
-Family planning services and supplies.
-Rural health clinic services.
-Home health care for persons eligible for skilled-nursing services.
-Laboratory and x-ray services.
-Pediatric and family nurse practitioner services.
-Federally qualified health-center (FQHC) services, and ambulatory services of an FQHC that would be available in other settings.
-Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21”(3).
1"Medicaid." MSN Encarta. 5 Apr. 2007 <http://encarta.msn.com/dictionary_/medicaid.html>.
2"Technical Summary." CMS. 5 Apr. 2007 <http://www.cms.hhs.gov/MedicaidGenInfo/03_TechnicalSummary#TopOfPage. asp.>3"Overview." CMS. 5 Apr. 2007 <http://www.cms.hhs.gov/MedicaidGenInfo/01_Overview.asp#TopOfPage>.