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    Medicaid and the State of Health Care

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    Medicaid is a state-operated program funded in part by federal funds and in part by state funds.

    On the basis of your understanding of the statement, answer the following questions (present your answers in the context of Medicaid payment and reimbursement policies):

    Why was Medicaid but not Medicare designed to be state operated?
    What factors prove that Medicaid program is being operated by the state?
    Conduct an analysis of the Medicaid program of your state and another state from a different region of the country.
    What are the main similarities and differences between the two programs?
    Are there enough differences to prove that the state and not the federal government operate Medicaid? Discuss.
    As a government program, Medicaid has recently been subject to cuts and last minute increases in funding.

    Why is Medicaid subject to seemingly constant cutbacks?
    Are these cutbacks due to the relationships between the state and federal governments and the populations being served, or just the rising cost of healthcare in general? Discuss.
    Medicaid is an entitlement program that provides healthcare coverage to a variety of low income individuals.

    Identify three beneficiary groups receiving care through Medicaid.
    Analyze the federal eligibility requirements for each group.
    Discuss the coverage provisions for each group.
    Evaluate the anticipated impact of the PPACA on each beneficiary group.

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    Solution Preview

    The following is not intended as an assignment completion.

    Medicaid is a state funded and administered program, as opposed to the federally funded and administered Medicare program. Medicaid is a state administered program, with 56 programs across the U.S. and its territories. It is different for each state, as each program has different income limits, reimbursement rates for providers, and different medical expenses eligible for reimbursement. It was developed as a state run program, as each state is somewhat different demographically and states can best determine the types of services and level of need for health care services among its populations. Because the program uses federally matched funds, the more a state spends on its Medicaid program, the more the federal government provides to cover the costs of administration (Center on Budget and Policy Priorities, 2013). The federal government provides guidelines for the operation of Medicaid programs, but those guidelines are expansive and states can choose how to operate their programs.
    While the basic premise of Medicaid programs is the same, to provide health care to low income individuals and families, they vary greatly from one state to another. The Medicaid program in Ohio is slightly different from that in Pennsylvania. Though the federal poverty level is typically used to determine eligibility, the percentage poverty level cut off for eligibility is different in each state. In Ohio, children at or below 206% of the federal poverty level are eligible, while adults at 133% of the federal poverty level are eligible. Pregnant women are eligible at up to 200% of the federal poverty level (Medicaid.gov, 2014). Ohio also has established blanket waiver programs, to pay for preventive community services, such as home health services, even for those elderly adults who are eligible for
    Medicare, but not Medicaid. Most Medicaid enrollees in Ohio are required to choose a managed care plan, though exceptions are made for children living in foster care or some other alternative care arrangement through placement by the state.
    In Pennsylvania, children up to one year of age are eligible for Medicaid at up to 215% of the federal poverty level, while the income level decreases to 133% of federal poverty level for children age 6-18. However, eligibility for the CHIPS program, an alternative Medicaid program focusing on ...