Day 51 — Medicaid at 50: What Medicaid Covers and Why

Over the coming weeks this blog will highlight a key feature of Medicaid and the individual states that administer Medicaid and CHIP leading up the the program’s 50th anniversary (July 30th). Hopefully, you’ll learn some interesting facts about Medicaid and each of the 51 state programs.

 

 

“Even people who have spent years working in Medicaid do not always understand its many provisions.” U.S. Department of Health and Human Services, 2000

 

One of the many reasons I love Medicaid is how complex it is. On top of that, it is 51 different unique programs that have a rich political and social history. At times that can get confusing and frustrating. You think you fully understand a policy and then you learn how another state does things.  In order to alleviate that frustration and truly understand the Medicaid program, you must return to the basics of the program. What does it have to cover and why?

Medicaid is a social health insurance program providing financial protection to millions of eligible low-income adults, children, pregnant women, seniors, and people with disabilities most in need of health care services. What does Medicaid actually cover? On a basic level states have two broad catagories of services that they cover- mandatory services and optional services: For a complete list of what these are see this link.  Basically, hospital services, nursing facilities, and a host of other programs for example EPSDT (more on that later) are mandatory and things like eyeglasses, home care services and other auxiliary or social services are optional. For a fun exercise in reading more in depth regulation, read the regulation!

In short, and to be described in more detail later, Medicaid benefits are robust. So much so that a recent study found that Medicaid enrollees are less likely to be underinsured than their privately insured counterparts. One of the least discussed aspects of Medicaid is it’s importance in protecting enrollees from the financial burden of high cost medical and long-term care. In essence, that is the purpose of insurance. In this study, underinsurance is defined as out-of-pocket expenditures exceeding 5% of income. When additional cost-sharing is introduced into the Medicaid program underinsurance increases. Low-income individuals are sensitive to additional cost sharing, so that is among many reasons why the service Medicaid provides to millions of Americans is so important.

More tomorrow!

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