Medicaid & Medicare Debate

History and Debate of Medicaid & Medicare

Individuals and families with low incomes are eligible for Medicaid, a United States health program jointly funded through federal and state initiatives. States often provide up to half the funding with some counties also contributing funds depending on the state. Medicaid is managed by each state and serves certain categories of United States citizens as well as resident aliens. Categories include low income adults and their families, such as pregnant women, the elderly and people with specific disabilities. Poverty is not the only eligibility qualifier for the program.

Medicaid is the largest funded medical and health program for people with a limited income in the United States. The fastest growing area of the program is nursing home coverage, which is expected to grow exponentially as the Baby Boomer generation reaches nursing home age between the years 2020 and 2040. This projected growth is a large concern for both state and federal budgets as the increase is expected to be quite large.

The Medicaid program was created in 1965 as a result of the Social Security Act. Each state monitors its own program, but the Centers for Medicare and Medicaid Services are responsible for establishing requirements related to funding, eligibility, quality and service delivery. Some states call Medicaid by another name. For example, Massachusetts calls it MassHealth and Oregon calls it the Oregon Health Plan. States may also bundle the administration of the program with other services like children's health insurance programs. States are not required to participate in Medicare but all of them have since 1982. The administration of the program is run differently from state to state with some subcontracting it to private health insurance companies while others pay providers directly for the services. Private companies are also used by some states to administer benefits and enroll eligible participants at a fixed price.

Under the Social Security program, dental services are included. They are optional for adults over 21 but required for those under 21 who are eligible for Medicaid services. Dental services include dental health maintenance, teeth restoration and pain relief. Screening and preventative measures are incorporated for children to focus on the early diagnosis and treatment of any conditions.

In 1990, the Omnibus Reconciliation Act created the Medicaid Drug Rebate Program. This program was effective on January 1 of the following year. It was formed due to the costs of outpatient drugs at discounted prices. Due to the recent recession in 2008 through 2009, Medicaid enrollment saw a large increase. In nine states, the enrollment was 15 percent or higher, which was a drain on their budgets.

Even though Medicaid is a well-known program with numerous federal and state agencies monitoring its usage, in 2010, the FBI discovered fraud from an organized crime group that billed the system over $100 million.

Medicaid vs. Medicare

Medicaid is often confused with Medicare, a social insurance program that is entirely funded at the federal level. Medicare is only available for adults 65 and older, people under 65 with specific disabilities and people of any age who have end stage renal disease. There are three parts to Medicare; Part A covers hospital bills, Part B covers medical insurance and Part D covers prescription drugs. Some people are eligible for both Medicare and Medicaid due to their dual eligibility. Approximately 6.5 million Americans were enrolled in both programs in 2001.

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