Health Advocacy Test 2
What is Medicaid referred to as?
"Title XIX"
Medicaid payment percentages in 2008
- 20% of Medicaid funds were paid to manage care organizations, reflecting the increased role of Medicaid managed care. - 19% paid for acute hospital care - 10.5% going to physicians and outpatient clinics - 4.5% to prescription drugs - 34% of all Medicaid funds go to pay for long-term care
Members of low-income families with children
-All children in families with incomes that fall below FPL are eligible to receive Medicaid coverage -Children under the age of 6 who are in families that earn up to 133% of the FPL are eligible for Medicaid. -The parents of low income children are eligible only if the family income is extremely low, typically 40% - 50% of the FPL -Pregnant women in families that earn up to 133% of the FPL, however, are eligible for Medicaid coverage for medical care during pregnancy and immediately after giving birth
Medicaid program basic services
-Hospital care (inpatient and outpatient) -Nursing home care -Physician services -Laboratory and X-ray services -Immunization and other preventive medicine services for children -Family planning services -Services provided at federal approved community health centers -Nurse midwife and nurse practitioner services
What/Who does Medicaid cover?
-It pays for care only for certain subgroups of poor people -Originally structured purely on an insurance model, with no direct service component
Hyde Amendment (1977)
-No federal funds may be spent to provide abortion services except for cases of rape, incest, or when the mother's life is in danger -This restriction also applies to the Medicaid program, although states are permitted to provide abortion services that are "medically necessary" to Medicaid recipients, as long as they do so using only state funds - 17 states provide abortion services under their Medicaid plans
Additional optional services states may receive in Medicaid
-Prescription drugs -Institutional care for individuals with mental retardation -Home- and community-based care for the frail elderly -Personal care and other community based services for individuals with disabilities -Dental care and vision care
How did the federal govt. reimbursement work?
-The share of the program that the federal government pays depends on the economic condition of the state -States with lower capita incomes have a higher share of the program costs paid by the federal government, while states with higher per capita incomes are reimbursed a lower percentage of program costs
4 principle characteristics of Kerr-Mills program
1. It had a combination of federal and state funding 2. It was administered by the states under broad federal guidelines 3. Eligibility tied to income: Eligibility for the program was tied to eligibility for cash welfare grants 4. As long as the basic benefits required by federal government were provided, each state was free to set its own level of additional benefits
3 ways that Medicaid differs from Medicare?
1. Rather than being universally available to all poor people, it covers only certain subgroups 2. Rather than combining a service plan and an insurance plan, it originally was strictly an insurance plan 3. Rather than being administered by the federal government, it is administered by the states under broad federal guidelines
What is the Kerr-Mills program?
A federal program distributed federal funds to each of the states to assist in paying for medical care for the elderly poor.
Why was Medicaid was created? , and thus often referred to as
As an amendment to the existing Social Security Act
Where does funding for Medicaid come from?
Funding for the Medicaid program, rather state or federal, comes straight out of general tax revenues
How much did the federal government pay for the Medicaid program in 2010?
In 2010 the federal government paid 66% of the overall cost of the Medicaid program
How many children and low income adults did Medicaid cover in 2007?
Medicaid covered 29 million low-income children and 15 million low-income adults
How is Medicaid paid for?
Medicaid is administered by the states, with the federal government reimbursing each state for a portion of program costs
What other program is reliant on general tax revenue?
Medicare Part B
3 groups that are eligible for Medicaid
Must be a part of 1 of the 3 to qualify 1. Members of low-income families with children 2. Elderly people who meet certain income requirements 3. Disabled people
Does Medicaid provide coverage for ALL people who fall below the federal poverty line (FPL)?
No, Medicaid was NOT intended as a program for all people who fall below the federal poverty line (FPL)
Did Medicaid start off as a mandatory program?
No, Medicaid was established as a VOLUNTARY program for the states, with each state free to choose whether to participate
Does each state have the same kind of Medicaid program?
No, each state designs its own program for paying for medical care for poor people, using existing hospital and physicians and initially paying for care on a fee-for-service basis; essentially Medicaid has 50 different programs
How much did the federal government pay for the Medicaid program in 2008?
The federal government paid 57% of the overall $338 billion cost of the Medicaid program
What was the purpose of the American Recovery and Reinvestment Act (AARA)?
The federal government's response in 2009 to the impending national financial crisis, federal reimbursement rates were raised for all states
During times of recession, what section of government faces the most strain?
The strain Medicaid places on both federal and state budgets can be a substantial problem during recession
What does this reliance on general tax revenues mean?
This means that at times of rapidly rising health care costs or of shrinking tax revenues a severe strain can be placed on both federal and state budgets
What was a strong incentive that government did to motivate states to choose to do the Medicaid program?
the federal government agreed to reimburse each participating state for a large part of the program's cost
