Role of Courts in Health Policymaking

Posted: July 5th, 2021

Introduction

Health insurance and coverage cannot be complete without talking and reviewing the Medicaid program. Medicaid program, a publically funded program by the federal and state governments, provides health coverage to Americans. They include children, adults, elderly, low-income Americans, and PWD. Medicaid program has evolved since its inception and undergone many changes and amendments to align with the changing health issues and market trends (CMS, 2019). The discussion focuses on the history of Medicaid program, changes the program has undergone, the coverage in the USA, and future changes expected.

Legislation that Introduced Medicaid

The Medicaid program as signed into law in 1965 by the then President Lyndon B. Johnson. Initially, the program was referred to as the “Original Medicare,” which included two main parts. They were recorded as A and B, namely Hospital Insurance and Medical Insurance, respectively (CMS, 2019). The primary reason for the passage of the bill was due to the increasing need for health insurance to cover the growing elderly population, to ensure accessibility of affordable healthcare in the growing medical costs.

The Social Security Amendment of 1965 is the legislation that enabled the birth of Medicaid through the added Title XIX (Medical Assistance Program) in the Social Security Act. Through this program, the federal government would fund the states for health services among the ‘needy’ or low-income groups. Some of the groups enlisted and eligible for the Medicaid program included PWDs, elderly population, expectant women, and people that required long-term care. These groups would receive health insurance through affordable prices and coverage. The source of funding would be from the federal government through the state governments (Smith, 2006). The federal payments were authorized through the federal matching funds to states to pay the vendors. The Title XIX became the onset of other legislations such as Kerr-Mills legislation of the Medical Assistance to the Aged (MAA), among others. This new legislation ensured the federal funding to states was maintained and medical costs covered.

Changes in the Medicaid Program 

The Medicaid program has stood the test of time and evolved accordingly to serve the people effectively and to the best levels. More importantly, there have been changes in market trends, as well as the evolution of illnesses and customer needs. Some of the changes in the Medicaid program include an extension to cover wide variations of services, replacement of various legislations, and eligibility expansion. Primarily, there has been the formation of the Supplement Security Income program that replaced the federal-state funding system to a federal cash assistance program for the PWDs (Medicaid, 2019). Secondly, the Children’s Health Insurance Program (CHIP) was created to ensure children acquired adequate health services as well as health insurance. The federal Medicaid law has had many modifications, where mandates have increased, expanding the options to ensure many Americans are covered, and ensuring all states adopt these Medicaid services.

The expansion of services included adding more services and requirements in the program for children as well as mentally challenged patients. Some of the new services included EPSDT (Early and Periodic Screening, Diagnosis, and Treatments) for the children and the (ICFs/MR) for mentally challenged, among others. The development of the Medicaid, as seen above, led to the development, change of existing and new programs to ensure all the Americans are covered and receive adequate health coverage (Medicaid, 2019). Over the years, Medicaid has seen many expansions in the optional and mandatory eligibility to extend and prove a variety of options. This change ensured that many low-income families, children, and other mentioned groups were insured and received health care services easily. For instance, the OBRA-81 enabled states to add the Disproportionate Share Hospital payment methods to capture a large number of Medicaid beneficiaries among low-income Americans. Another instance involves the addition of Section 1915(c), where Home and Community based services programs could be used to expand the services, accessibility, and eligibility among the mentioned groups. The Medicaid program has its limitations, as it cannot meet all the changing needs of customers. Thus, more changes and modifications are expected.

The ACA is another significant change that occurred in 2010 and has become a broader health coverage initiative. The ACA has led to increased coverage with propositions that expand the accessibility, eligibility, and affordability rates. For instance, nonelderly Americans with an income of $17,236 or 138% FPL can easily access Medicaid coverage (Medicaid, 2019). The ACA initiative I an illustration that the federal-state partnership wishes to achieve effective public health among low-income individuals.

Medicaid Coverage and Demographics in the USA

Medicaid program has been in existence for 54 years; thus, the Medicaid program covers over 74 million people, an equivalent of 23% of the total population. The 74 million Americans are enrolled for both the Medicaid and CHIP programs, with 36 million enrolling their children in CHIP or Medicaid (CMS, 2019). In 2019, about 37 states have incorporated the expanded Medicaid version, where a new 12.6 million Americans are eligible. Concisely, when dividing the covered demographics into the elderly and nonelderly, the nonelderly have the majority of Medicaid coverage. The demographics mainly covered by the Medicaid include children and youths under the age of 19 years, the elderly (65 years +), PWDs, institutionalized patients, pregnant and recent mothers, and employees both full and part-time (CMS, 2019). Despite having the broad demographics and participants, children, the elderly, and PWDs are the majority of individuals covered by Medicaid. In addition, these groups are mostly low-income individuals and families.

The numbers vary depending on the states; however, what remains constant in all states is that, most of the individuals covered by the Medicaid are low-income and PWDs. On the other hand, CHIPs are state-run programs for low-income parents that may not qualify for the Medicaid program.

Changes Expected to Occur in Medicaid

As stated above, the Medicaid program has its limitations, as it cannot meet all the changing needs of customers. Thus, more changes and modifications are expected. Primarily, it is expected that Americans covered by the Medicaid program will increase due to the increased choices and alternatives. Secondly, the Trump administration already announced potential changes as well as proposals in the Medicaid program, making it common knowledge that several changes are expected. Some of the expected changes include state expansions of eligibility into the program, especially in the ACA program (Medicaid, 2019). Besides, there has been an ACA replacement bill that is likely to affect many aspects of the Medicaid program. The slowdown in the SDOH I likely to also affect many health outcomes, particularly in health insurance. These challenges will result in changed and an updated Medicaid program under the Trump administration (Daly, 2018). The spillover effects of globalization and advancement in technology have changed most of the traditional forms of conducting businesses and increased payment options. Therefore, payment options are likely to increase, making it an expected change in the program. Finally, there are expected regulatory actions and changes, especially among the approved Medicaid waivers.

Conclusion

The Social Security Amendment of 1965 is the legislation that enabled the birth of Medicaid through the added Title XIX (Medical Assistance Program) in the Social Security Act. It was signed into law in 1965 by the then President Lyndon B. Johnson. Some of the changes in the Medicaid program include an extension to cover wide variations of services, replacement of various legislations, and eligibility expansion. The Medicaid program covers over 74 million people, an equivalent of 23% of the total population. Children, the elderly, and PWDs are the majority of individuals covered by Medicaid.

References

CMS. (2019, May 8). CMS’ program history: Medicare & Medicaid. Retrieved from https://www.cms.gov/About-CMS/Agency-Information/History/index.html

Daly, R. (2018, October 18). What Changes Are Coming to Medicaid in 2019? Retrieved from https://www.hfma.org/topics/news/2018/10/62136.html

Medicaid. (2019). Affordable Care Act Provisions. Retrieved from https://www.medicaid.gov/medicaid/benefits/prevention/affordable-care-act-provisions/index.html

Smith, J. D. (2006). Legislating Medicaid: Considering Medicaid and Its Origins . Health Care Financing Review, Vol 27(2) pp: 46-52.