Thesis statement
The purpose of this paper is to examine how the determination of eligibility for people that have applied for Medicaid affects its expansion at the state level while considering legislation and funding.
Introduction
Medicaid is a social health care program that was formulated by the United States Congress in 1965 in order to achieve the objective of providing health care services to all citizens, this program targets families and individuals that have low income and resources. It is designed to cover the medical expenses of people with no sufficient resources to carter for their own health care, the funding is contributed by both the state and the federal government although the management is left in the hands of the states but they are required to operate within federal guidelines
. Each state has a different plan in place that determines who qualifies to receive Medicaid services although they all have a few factors in common, the program requires that the participants be united states citizens with low incomes. Medicaid is not necessarily provided to the poor but also to families, children and people with certain disabilities, the process of determining who is eligible for the program is rigorous since factors like income, residency, age, social security number, citizenship, immigration status, household composition and pregnancy status of the applicant are examined. This paper seeks to examine why the expansion of the Medicaid program is facing an uphill battle when the eligibility determination process is applied considering factors like legislation and funding of the program.
Literature Review
Health reforms have greatly altered some aspects of Medicaid eligibility, coverage, and financing since states now have the option to expand Medicaid eligibility to poor non-disabled adults without children which was unheard of during the implementation of the program. The Affordable Care Act of 2010 has made it easy for people with disabilities to qualify for Medicaid based solely on their low income status which enables them to enroll in coverage without waiting for a disability determination, people with disabilities with mid-level incomes can also qualify for Medicaid if they also meet disability-related eligibility criteria. The Affordable Care Act of 2010 gives states the overall primary responsibility to implement most of the changes that are required and encouraged for Medicaid, this has proven to be a tough uphill battle since most states are facing financial constraints thus are not able to fully make any successful changes. The expansion of the Medicaid program rides on the funding capabilities of the state and federal government which have been plagued by many funding issues that are related to the Affordable Care Act since states must determine the number of current eligible participants but are not enrolled for the Medicaid cover before they can make estimates the cost of expansion. The Affordable Care Act has proven to be a hindrance towards the set objectives of Medicaid since it does not increase the funding to states during financial and economic slumps, during economic slumps the enrollment number greatly increases but with no adequate funds to carter for the additional numbers then the expansion of the program is not possible. Although the states have the power to effectively choose whether or not to accept the Affordable Care Act’s expansion of Medicaid eligibility since the condition to expand the program is attached to the legislation, this condition demands that the states partake in the expansion of the program in order to receive 100 percent of the funding required to cover new eligible enrollees. The expansion of the program amidst the global financial woes has proven to be a challenge since most of the legislators are still locked in debate on whether to adopt the expansion plan offered by the Affordable Care Act of 2010 or not, while the debate is still going on, numerous families and individuals still find themselves illegible thus have no health care cover.
References
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.Ku, L., Jones, K., Shin, P., Bruen, B., & Hayes, K. (2011). The states' next challenge—securing primary care for expanded Medicaid populations. New England Journal of Medicine, 364(6), 493-495.
Sommers, B. D., & Rosenbaum, S. (2011). Issues in health reform: how changes in eligibility
may move millions back and forth between Medicaid and insurance exchanges. Health Affairs,
30(2), 228-236.
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