Everything Home Care Leaders Need to Know About Medicaid

The national health program managed as a federal-state partnership, known as Medicaid was put in place to ensure that vulnerable residents of the United States. It has provided health coverage to at least one in every five Americans since 1965.

Usually, the Medicaid standards are established at the federal level, giving each state an option to administer the program in a way it deems fit. This brings variability in the program administration all across the country.

What is Medicaid?

Medicaid plays a pivotal role in the United States’ care system, making it possible for low-income households to access affordable and reliable medical care. Medicaid offers long-term coverage for most Americans, and the care program finances roughly 73 million Americans.

Since private home coverage is expensive for Medicaid enrollees, this program provides low-income individuals the care benefit, comparing those with private insurance access.

The contributions to Medicaid home care have brought peace to many professionals, bringing in the cash flow needed for successful operations.

The Centers of Medicare and Medicaid Services oversee this federal program, administering the state’s specific program. It is worth noting that it’s the nation’s most comprehensive partnership.

Does navigating home care Medicaid intricacies seem overwhelming? Here are some essential facts to understand:

• Medicaid is the Nation’s Public Health Insurance for Low-Income People:

  Medicaid is the country’s insurance program for low-income Americans, covering 1 in 5 Americans, especially those with costly and complex care needs. Medicaid is the source of long-term care coverage, including various care services and miscellaneous, unidentified costs.

  Medicaid provides significant finances for community centers, nursing homes, hospitals, and home care sector jobs. Research shows that federal regulations and Title XIX of the Social Security Act govern the Medicaid program, defining the Medicaid requirements and state authorities.

  CMS (Centers for Medicare and Medicaid Services) within the HHS (Department of Health and Human Services) helps implement Medicaid.

• Medicaid is Known as a Federal-state Partnership:

  Concerning federal standards, the states look into Medicaid programs and garner the flexibility for determining covered services, populations, care delivery models, and diverse methods for paying hospitals and physicians.

  The Section 1115 waivers may test and implement approaches different from the federal statute requirements and program objectives. Eyeing this flexibility, state Medicaid programs differ.

  Two guarantees guide the Medicaid entitlement. Americans who meet the Medicaid eligibility requirements are guaranteed coverage. Secondly, states have the guarantee of matching federal dollars for eligible enrollees. A formula in law determines the match rate for enrollees, according to which there is a higher federal match rate for much poorer states.

• The Program Covers 1 in Every 5 Americans:

  The Medicaid program offers long-term care for millions of poor and vulnerable Americans. These people act as a high-risk pool for America’s private insurance market.

  In 2017, Medicaid provided coverage to around 75 million low-income Americans. In February 2019, around 37 states opened doors to Medicaid expansion.

  Medicaid plays a crucial role for specific populations that cover around 50% of births in a state of poor children, children with special needs, and non-elderly adults with disabilities.

  Medicaid provides much-needed assistance to roughly 1 in 5 Medicare beneficiaries with their premiums and cost-sharing policies for long-term care.

• Medicaid Offers Long-term Care & Health Services:

  Medicaid covers various services for addressing the needs of the populations served. It also covers the services needed by federal Medicaid law, instructing states to cover optional services like physical therapy, prescription drugs, dental care, and eyeglasses.

  The expansion coverage contains ACA’s essential Medicaid home care benefits, including preventive services, substance use treatment services, and expanded mental health. It also addresses the opioid epidemic and more that connects the beneficiaries to behavioral services.

  Medicaid benefits include long-term care like home and community-based services & supports and nursing home care. More than 50% of Medicaid spending is now for the services offered in the home care community, enabling elderly with disabilities to lead independent lives.

• Federal Government & States Jointly Fund Medicaid:

  The Medicaid program is jointly funded by the state and the federal government, matching Medicaid spending precisely. There’s a variation in the match rate varies by state based on both the national ranges and formula, from a minimum of 50% to almost 75% in poor states. Since Medicaid plays a notable role in state budgets, states are also interested in cost-cutting & program integrity.

• Medicaid Spending Has More Concentration on Seniors & People with Disabilities:

  Elderly people and people with disabilities tend to be 1 in 4 beneficiaries, accounting for almost two-thirds of spending. This spending accounts for high enrollee costs for long-term and acute care.

  Since the primary payer for community-based and institutional-based long-term services is Medicaid, Medicare has limited coverage and options in the private insurance market. According to analysis, if an adult Medicaid enrollee has a job-based range, the average care costs would rise to 25%.

• Public Holds a Favorable View of Medicaid:

  Public polls encourage Medicaid to have broad support. Almost 7 out of 10 Americans suggest having a connection with Medicaid. Most political parties have a favorable take on Medicaid and state that the program works well.

  Additionally, the poll shows Americans wish to decrease federal Medicaid funding.

Final Words

Medicaid offers comprehensive coverage as well as financial protection for Americans, most people in working families. Irrespective of low income, the enrollees experience access rates to care compared to private coverage.

Medicaid restores access to care, skyrocketing the recipient’s satisfaction rates. It would be just and wise to consider broader care, including Medicaid buy-in and Medicare for All, which can have significant Medicaid implications.

Related blog posts: