Social Welfare: Medicaid Program - Research Paper Example

? Social Welfare Introduction The Medicaid program was created in 1965 and it was designed to hospital and healthcare bills such as prescription drugs maternity dialysis and other services for parents, children, frail senior citizens and people with disabilities or earning little or no income (Jansson, 2012). The program is a joint venture that is funded by both the states and federal governments (New York Times, 2010) and aimed at proving health care services for those deemed eligible under its requirements. Medicaid does not provide the patients with money for treatment but simply reimburses the health care providers and the amounts vary based on the regulation of different states. Medicaid is often confused with Medicare which is a social insurance program sponsored purely from a centralized level and which mainly emphases on the older population which is just a part of what Medicaid does. Medicare targets individuals over 65 years of age or those below but suffering certain disabilities and anyone with end stage renal conditions irrespective of age. Another major difference is that medic aid’s eligibility is solely based on low income while in Medicare people from all income groups are eligible. Social Significance The significance of Medicaid’s role in the American social scene cannot be overstated; owing to the high unemployment and corresponding poverty rates, many American would be locked out of health insurance but for the program. It is not tailored to solve any single social problem although from a critical examination one can deduce the main objectives. These include, in no particular order; promoting social equality and access to healthcare, ensuring economic stability of societies by availing affordable care and protecting millions of venerable Americans from the social economic and health risk that arises when one lack medical cover. Medicaid plays a decidedly significant role in promoting social equality by ensuring that irrespective of one’s financial position, they have access to good health care and people do not end up ailing at home or getting poor quality care based on their economic situation. As the main public health insurance program for low income earners, it provides health cover for over 39 million children and families, and long term care for people with disabilities and other health issues, in addition it caters for over 6 million low income elderly people (Moss, n.d). This is a critical social health role since without it, it is estimated that over a quarter of Americas children would have no access to health insurance and many of the groups mentioned above would also be forced to pay for treatment from their own pockets which could easily translate to no treatment at all owing to their financial incapability. Before it was launched, the low-income earners could not access the services offered in the private sector but after its institution, it purchases services for the poor in these healthcare facilities, which would otherwise be beyond their means. Furthermore, when children are unable to afford healthcare owing to lack of health insurance, they will be likely to miss school for long periods owing to their ill health that can potentially result in academic decline. Consequently, they will be unlikely to achieve the academic success necessary for them to get a better life for themselves and the cycle of poverty may persist as they are forced to drop out of school. In addition, the program plays a crucial role in economic stabilization especially during time of recession or after losing their jobs since many Americans are often unable to continue with their health plans either because they were provided by the employer or they can no longer afford the premiums. Without Medicaid, such individuals would be forced to foot their medical bills not to mention the care of their; children, aged parents and/or disabled dependents. Medicaid thus acts as a cushion for families and individual in hard financial time protecting them from the effects of financial crisis, which would potentially translate into a social one. Target population and eligibility Typically, Medicaid primarily targets the low-income members of the community although these are not necessarily the only qualification one must meet to qualify for enrollment into the program since family and disability factors are also considered. The Deficit reduction act of 2005, is categorical that anyone seeking Medicaid must produce documents to prove that that are a citizen of the united states or a resident alien, however, in case of emergencies or situations involving disability or pregnancy, Medicaid makes exceptions (Alonso-Zaldivar, 2006). Special rules also apply in respect to children even if their parents are not eligible, furthermore a child may be independently eligible when they are not leaving with their biological or legal parents. The eligibility is highly complex and categorical and for one to qualify they must fall into one of the several categories that are recognized by the state to qualify one as medically needy. Majority of low income individuals are covered under temporarily assistance to needy families (TANF) which mandates the concerned state to determine if one is eligible based on a variety of “eligibility pathways” (Medicaid Facts, 2003). Despite the fact that states have the autonomy to determine eligibility, the federal government that must be covered by all states under mandatory populations universally dictates some factors. These include; pregnant women and children who are below the age of 6 years living with families which make less than 133% of the federal poverty level which translates to twenty thousand dollars per family of three persons. Also covered are children aged between 6 to 18 whose families makes a collective income that is below 100% of the poverty level which translates to fifteen thousand per three persons in a family (Medicaid Facts, 2003). Parents and individuals aged 18 with incomes that do not exceed the welfare standards set in June 1996 as well as elderly and disable people eligible for the SSI programs. Notwithstanding these, states are required to make allowances so as to cover populations without insurance such as children at above the federal minimum levels disabled working individuals or people whose medical bills are very high especially those undergoing costly medical procedures that may put them at risk of financial vulnerability irrespective of their income status. Service provision and funding In order to qualify for medic aid one need to fill out an application either through mail on online proving their personal and registration details such as age name passport numbers etc, after which the Medicaid staff will carry out an income assessment to determine ones financial eligibility (Medicaid Facts, 2003). When one qualifies and is duly enrolled the state must provide all beneficiaries with a set of basic care packages covering , doctors’ visits, inpatient and outpatient care, lab and x-ray as well as family planning and children health screening. The responsibility of paying for nursing facilities and home based services also falls on Medicaid, which pays for at least 50% of the national cost of nursing care (Mitchell et al., 2006). Furthermore, long-term and expensive treatments that Medicare and majority of other health insurance plans do not cover are supposed to be handled albeit not entirely by Medicare, other services such as dental eye and speech therapy may be provided by states based on their own independent rules on the scope of Medicaid. Owing to the fact that most of those enrolled are unable to pay high premium, the federal government maintains a ceiling limiting the premiums charged. The state and federal governments jointly fund Medicaid although on the ground the state government is the primary control it estimated that as much as 30% of majority state budgets go into funding the program (Medicaid, n.d). The federal government makes payment through the FMAP, which is determined in each state by the per-capita income and averages at 57% per state; however, in some of the wealthy states it is as low as 50% and goes as high as 75 percent in the states with low per capita income (Medicaid, n.d). The FMAP rates are revised and adjusted after every three years in order to make allowances and remedy any shortfalls and imbalances because of economic fluctuations and inflation. States have the option of reimbursing service provides on a basis of fee for service or any if the any available managed care plans that are available to them, their payment levels for providers are markedly lower than those from other insurance firms. The disparities in these numbers is however not universally explicable since each state dictates payment levels based in it financial condition. The role of social workers Home and Community Services (HCS) consists a key part of the Ageing and disability services administration is part of the Aging, which is part of the department of social, and health services, these are the departments that primarily concern themselves with among other elements of social work Medicaid. Consequently, social workers play a crucial role in the process of information sharing mobilization, educating assessing eligibility and ultimately enrolling individuals to Medicaid. Social workers under HCS department are the people who assist potential clients to understand the options open to them and match their needs and preferences to the best quality service available in their community for the most convince and efficacy. After one has applied for enrollment to the service, a social worker visits them at home and discusses the matter at length and interviewing them in order to evaluate the goings-on of their everyday life. This is the assessment stage in which the social worker; by using his/her observation and professional skills determines of one is functionally qualified for Medicaid or not. Should they qualify, they will discuss the options with a social worker who will then proceed to review them as well as provide guidance and answer arising question, thereby the client is able to make an informed individualized plan. Afterwards they will coordinate and set up all the services that are required for the implementation of the plan since, after a client has been enrolled, it is the work of social worker to ensure they remain compliant and determine if they qualify for further benefits or upgrades. Success of Medicaid Despite of several challenges that have faced Medicaid as shall be discussed later in this paper, on must acknowledge that in the period it has been in existence it has radically revolutionized access to medical care especially for the low income earners and it had been tremendously successful in improving lives. For one, today a large number of Americans can access decent insurance cover for as little as nothing which significantly improves the health and economic situation of the country. Today, over 67 million individuals from the different categories mentioned earlier depend on Medicaid for their health insurance and many of them would otherwise have been forced to do without it. Secondly, Medicaid is financially convenient for both the government and the patients and despite popular assumption that it has “runaway” costs the truth is that it’s a better way of controlling cost and recuing wastage than the other parts of the healthcare department (Krugman 2012). In-fact it is estimated to reduce the cost of adult care by about 20% less than would be the case if they used private insurance cover, these lower costs can be attributed primarily to the low premiums and significantly less administrative costs. In addition, the government is ironically less bureaucratic than the private sector when it comes to health issues (Krugman 2012). However, the most overt albeit not necessarily significant evidence of Medicaid’s success is the fact that it has reached an extent, which it requires restructuring and expansion so it can reach more people owing to its rapidly increasing enrollment rates. The government’s projection for the expansion includes provision of insurance to all individuals earing below 138% of the federal poverty level form 2014(Graham, 2013). As originally enacted, the Affordable Care Act (ACA) required each state to expand Medicaid eligibility this will considerably increase the number of eligible individual and over 20 states have agreed to the expansion so far (Graham, 2013). Challenges and recommendations Can one claim that Medicaid is a perfects system? Naturally the answer will be no, from an abstract or theoretical viewpoint, the system is almost utopic; it caters for virtually all the health needs of the poor, disable and elderly (Book, 2012). However, it if faced with several major challenges such as the reluctance of private hospitals to treat those it covers owing to the anomaly low fees that government pays. In addition, the rules of eligibility are too flexible especially among different states making it unfair that someone may be qualified for insurance in one state; however, the most notable discrepancy is the apparent disregard the program has so far had for poor people without children. Contrary to conventional assumption that all one needs to qualify for eligibility is to be a low income earner, in some states no matter how poor one is as long as they are not disabled, under18, aged of have children they do not qualify . In respect to such and other issues, these are some of the policies and program whose changing would substantially improve the service delivery and scope of the program ultimately benefiting more of the low income earners and other individuals needing it. One of the changes which is contained in the expansion plan is the changing of policy to extend the cover to low income individuals who are not parents, should this change be instituted millions more will be able to get badly needed cover. In addition, the government should reconsider its payment plans since some hospitals refuse to treat Medicaid patient owing to their low expectation for compensation (Dranove & White, 1998). Therefore, the whole concept of health insurance is negated since the patient still lack access to quality care services. A large number of needy people do not apply for Medicaid although they qualify out of ignorance of the requirements, many working families for example could tend to assume they make too much to qualify. To reduce such situations, Medicaid needs to launch public education campaign especially in low-income areas so that the potential beneficiaries can make informed decisions on whether or not to enroll for the program. Moreover, the assessment procedure could discourage many potential enrollees owing to the administrative barriers such as face-to-face interviews, lengthy and complicated forms that one is required to fill. Therefore the whole process would be more practical and efficient for the course to be modernized and expedited since the social workers would handle more clients in a short time and the candidate will not feel intimidated this reduces their propensity to skip the whole process altogether. Conclusion From the factors examined herein, there is no doubt that Medicaid plays a critical role in providing affordable health care for millions of America’s low-income earners who would otherwise be uninsulated from the problems of ill health. Through the contributions of the state and federal government Medicaid, aid has remained the leading source of cover for low income Americans for years and it is likely to continue to fill this role for many years to come. Nevertheless, one must take cognizant of the fact that the system despite its apparent efficacy it is far from perfect and requires to gradually keep adapting with the times as well as reevaluating its policies to ensure it does not lock out genuinely needy cases. References Moss, B. (n.d). Medicaid and long term care services for adults. Retrieved from http://www.dshs.wa.gov/pdf/Publications/22-619.pdf Medicaid. (n.d). Medicaid Benefits. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Medicaid-Benefits.html Nami. (2003). “Lower-Income Children: The Role of Medicaid and SCHIP”. NaMi; Medicaid Facts. Retrieved from http://www.nami.org/Template.cfm?Section=Issue_Spotlights&template=/ContentManagement/ContentDisplay.cfm&ContentID=8298 Jansson, B.S. (2012). The reluctant welfare state: Engaging history to advance social work practice in contemporary society. 7th Ed. Belmont,CA: Cengage Learning. Mitchell, G.,II, Salmon, J. R., Polivka, L., & Soberon-Ferrer, H. (2006). The relative benefits and cost of medicaid home- and community-based services in florida. The Gerontologist, 46(4), 483-94. Dranove, D., & White, W. D. (1998). Medicaid-dependent hospitals and their patients: How have they fared? Health Services Research, 33(2), 163-185. Book, R. (2012). Benefits and Challenges of Medicaid Managed Care. Forbes. Retrieved from http://www.forbes.com/sites/aroy/2012/10/18/benefits-and-challenges-of-medicaid-managed-care/ Alonso-Zaldivar, R. (2006, Jul 07). Medicaid's new proof-of-citizenship requirements gain some flexibility; federal officials announce exemptions for elderly and disabled recipients of benefits. Los Angeles Times. Retrieved from http://search.proquest.com/docview/422078085?accountid=1331 Benefits and burdens of medicaid. (2010, Sep 22). New York Times. Retrieved from http://www.nytimes.com/2010/09/22/opinion/22wed2.html Krugman, P. (October 28, 2012). Medicaid on the Ballot. New York Times. Retrieved from http://www.nytimes.com/2010/09/22/opinion/22wed2.html http://www.nytimes.com/2012/10/29/opinion/krugman-medicaid-on-the-ballot.html Graham, J. (2013, Mar 26). ObamaCare remedy? arkansas mulls private medicaid. Investor's Business Daily. Retrieved from http://news.investors.com/business/032713-649380-arkansas-private-fix-for-obamacare-medicaid-expansion.htm Read More