Medicaid: Provided Services and Costs

Subject: Administration and Regulation
Pages: 5
Words: 1276
Reading time:
5 min
Study level: College


Medicaid is a program that is designed to meet the needs of poor individuals and families who have limited resources. It is essentially an entitlement program that is funded through the collaboration of the states and the government. (Agency for health care administration, n.p.) Medicaid which was established on July 30, 1965, through the social security act is a program that works individually in different states; each state has its set requirements and entitlement procedures. Furthermore, each state has its name for the program. For instance, the Medicaid provided in California is registered under the name of Medical and that provided in Massachusetts is mass health.

Individuals who are covered

It is upon the states to set a standard and verify the eligibility status of the individuals. For instance, the eligibility groups of states could come within the domain of three types, namely categorically needy, medically needy, or special groups. To be categorically needy there are several prerequisites. It usually includes pregnant women and children under the age of 6 whose family income is below or exactly the stated average of 133% of the federal poverty level.

Caretakers or guardians who are responsible for children under the age of 18 and supplemental security income recipients as well as individuals and couples living in medical institutions having a monthly income of up to 300% of the federal benefit rate. The medically needy on the other hand are persons who are under the age of 18, specific newborns for one year, specific persons who are blind and pregnant women through a 60-day postpartum period.

In the special group’s category come individuals whose income is at or below 100% of the federal poverty level, qualified working disabled individuals who lost Medicare service due to employment, and also individuals with specific health-related problems or medical conditions. Moreover, to be eligible for Medicaid, individuals must be either US citizens or lawfully admitted immigrants. The requirements and specificities of each state and group are different. (Centers for Medicare and Medicaid Services, n.p.)

Services provided

The services provided also vary. in general Medicaid groups that are classified as categorically needy are entitled to, ambulatory services, x-ray, labs, appointments with certified physicians, treatments, medical supplies, home health aides, nurse-midwife services, and services specifically geared towards the needs of pregnant women. (New York state department of health, n.p.) Another common service provided is that of dental care which is mandatory for individuals under the age of 21 and is a requirement of the diagnostic and treatment benefit however it is an optional service for the adult population depending on the state’s policies.

For instance, some states may not provide dental services to their adult population in their Medicaid program. Whereas most states provide dental care in case of emergencies more than half do not. Other optional services include diagnostic, care for the mentally retarded, rehabilitation, therapy, home, and community-based care so on and so forth. There are a total of 34 optional Medicaid services. (Technical summary, n.p.).

Cost of Medicaid and Driving Factors of Increasing Cost

Medicaid accounts for 22% of state budgets indicating a substantial growth in Medicaid funding leaving little for other sectors such as education or even transportation. As a rule the richer the state the less it gets as a percentage share. De facto Medicaid is the biggest source of federal revenue for states. (Medicaid cost and complexity tax reform efforts, March 7th, 2005) The Bush administration received much criticism when it was decided that 700 million dollars would be eliminated in reimbursements. This cut would save the federal government over 3.6 billion spannings a time frame of 5 years. (Doster, n.p.)

Medicaid cost has doubled since 1999 to a staggering $330 billion. Moreover, Medicaid costs increased from a grand amount of 159 billion in 1997 to 295billion in 2004; an overall increase of 89 %. ( Meyers, n.p.) the critical factor that is responsible for these apparent growing costs can be associated with the fact that over the years the number of people losing their jobs and subsequently turning towards Medicaid has increased, exerting pressure and pushing up costs. Furthermore rising healthcare costs, increase in the price of prescribed drugs and the current demographic scenario are further fuelling costs.

Another accountable factor is the fact that employers are now refusing to pay for their employee’s health insurance thus individuals from poor working backgrounds have no choice but to turn to Medicaid for assistance. (Medicaid cost and complexity tax reform efforts, March 7th, 2005) it is easier now for workers who were never even enrolled in a welfare program to seek the services of free health. surprisingly another agenda that has been adopted and has led to the increase of costs is Medicaid assistance to illegal aliens.

Impeding factors in the way of dealing with state Medicaid programs

Medicaid reimbursements are the main issue facing several states when it comes down to evaluating the hurdles in the way of Medicaid programs. Funds for programs on school-based health services are being reduced and subsequently, it has led to a decline in the services being provided by Medicaid Red tape in particular has slowed down the process of progress towards sustaining various programs. It is required by the health care financing administration that states review their policies for reimbursements. This requirement restricts outreach programs and imposes several barriers in the way of steady advancements. (Cross, n.p.)

Spending on Medicaid consists of a major part of the taxpayer’s money. Overspending in Medicaid is nothing new and the federal government intends to bring spending under control however this paints a dismal picture for Medicaid programs and their efficiency. The fundamental issue that needs to be given light to is the fact that the costs are high, spending is above the designated budget and the quality of service provided is merely up to standard. (Kilmer, n.p.) There are further issues with the distribution of funds by Medicaid; it is not able to distribute funds in a way to ensure that the funds match the capability of different states to foster them. (Ozawa and Yeo, n.p.)

State initiatives and approaches

Florida is one such state that can truly boast about its Medicaid programs and facilities. It has taken the initiative to cover the domain of mental well-being for its enrollees. Eventually, findings suggest that the mental health plan was a success and it resulted in the development and sustenance of a full-fledged mental health delivery system. (Ridgely, n.p.), whereas north Carolina in 1998 took the initiative of implementing a disease management program strategy covering illnesses such as diabetes, asthma, and cardiovascular diseases through the state’s PCCM program.

West Virginia, on the other hand, is promoting services other than the common facilities and is giving individuals other benefits including mental health services, dental services, etc if they comply with signing a member agreement that states that they must take preventative health visits and take medicines as directed.

The Medicaid program in Indiana has taken the initiative of developing a program specifically for beneficiaries with chronic illnesses in collaboration with the state department for health, namely the ICDMP (Indiana chronic disease management program). It is through this program that members receive services such as those of a nurse case manager whose primary job is to build awareness on how to improve one’s lifestyle in such a manner that it does not meddle with one’s health. Illinois has worked towards evaluating and initiating preventive or other health services for infants. Their approach is that of detecting illnesses at an early stage so that it does not affect development at a later stage. For this purpose, Illinois pays pediatricians extra.

Works Cited

Centers for Medicaid and Medicare services (n.d.), technical summary. Web.

Department of health and human and human services centers for Medicaid and Medicare services (n.d.), Medicaid at a glance 2005 a Medicaid information source CMS. Web.

Agency for health care administration AHCA (2007), Florida Medicaid. Web.

New York State (2008), department of health, information for a healthy New York, Medicaid in New York State. Web.

SRA (2008), Medicaid information, understanding Medicaid programs. Web.

Doster Adam (2007), the raw story, Bush administration cuts $700 million in Medicaid funds for schools. Web.

National conference of state legislatures (2008), the forum for America’s ideas, Medicaid funding. Web.

Cross Jordan (2000) the school administrator, a search for fairness in Medicaid reimbursements. Web.

Owcharenko Nina (2005), the heritage foundation, the top reasons for Medicaid reform. Web.

Kilmer Marc (2008) the buckeye institute, more Medicaid problems in Ohio. Web.

Ozawa Martha (2007) SSWR, bridging disciplinary boundaries. Web. (2005) Medicaid cost and complexity tax reform efforts. Web.

Meyers Jim (2005), Medicaid’s costs soaring. Web.

Ridgeley Susan (2006), Springer link, journal article, Florida’s Medicaid mental health carve-out: Lessons from the first years of implementation. Web.

NGA center for best practices, issue brief, creating healthy states: promoting healthy living in the Medicaid program. Web.