Medicaid history of program

There are several programs are designed to provide a method for early diagnosis and treatment of standard medical conditions. An important benefit of Medicaid is the provision that the state is responsible for providing treatment for any disease identified during oral screening. The Omnibus Reconciliation Act of initially created the program.

The purpose of program is to create a mechanism for managing the cost of prescription drugs. The program allows states to manage a master list of the drugs covered, generic substitutes, and alternative treatment options. The focus on maintaining a standard level of care for low income citizens remains consistent throughout the history of Medicaid.

Carol Francois. Tax dollars already paid by North Carolinians are funding Medicaid expansion in other states and we want to bring that money back home to work for us here.

Escalating costs, harmful impacts on the healthcare system and potentially disastrous consequences to state finances are some of the main reasons for Republican opposition. The fears of Republican lawmakers that Cooper would act unilaterally to expand Medicaid without the approval of the legislature helped propel a suit against the governor in federal court.

The case was later dropped in the summer of when Republican leaders learned that Cooper never filed plans to expand Medicaid with the Department of Health and Human Services. Still, the battle lines were drawn and the war over Medicaid expansion will likely resume this spring.

So, what is Medicaid expansion and why is it such a contentious issue? The most important provisions of the Social Security Amendments of created two programs, Medicare and Medicaid. Today 19 percent of the U. In North Carolina Medicaid covers 18 percent of the population.

Medicaid was created as a joint federal and state program and the program was optional for states. North Carolina formally adopted Medicaid in January Arizona was the 50 th and last state to adopt Medicaid in Medicaid is a means-tested program.

Recipients must be U. While states must follow federal guidelines, states have flexibility in administering their programs.

States determine eligibility requirements and the Medicaid services they will provide. Because of the flexibility, there is significant variation among the states in the Medicaid services offered as well as the spending levels. Medicaid costs are shared between the federal government and the states. In Fiscal Year , the Federal government, on average, covered about 62 percent of all Medicaid spending in the states.

States with higher poverty rates receive a higher percentage of federal funding than states with lower levels of poverty. For example, the federal government covers In North Carolina, the federal government covers 67 percent of all Medicaid spending. Since its inception in , the cost of Medicaid and the scope of the populations it serves have expanded significantly.

Today there are approximately 2 million Medicaid recipients in North Carolina. Numerous factors contributed to the growth of Medicaid. Jones, Jr. Schilling and Stephanie A. Nielsen and Philip J. Morgan Healthcare Conference, Boubker and Kyle Y. Carra and Mark N. Griffin and Andrew N. Beezley and Nathaniel J. Naydonov and Patrick J. Janeiro and Hadley M. Segal and Deirdre A. Bryan and Kyle R. Boubker and Sunny J.

Davalla and Clair E. Within broad federal guidelines and certain limitations, states determine the amount and duration of services offered under their Medicaid programs. States may limit, for example, the number of days of hospital care or the number of physician visits covered. Two restrictions apply: 1 limits must result in a sufficient level of services to reasonably achieve the purpose of the benefits, and 2 limits on benefits may not discriminate among beneficiaries on the basis of medical diagnosis or condition.

In general, states are required to provide comparable amounts, duration, and scope of services to all categorically needy and categorically related eligible persons. There are two important exceptions: 1 medically necessary health care services that are identified under the EPSDT program for eligible children, and that are within the scope of mandatory or optional services under federal law, must be covered even if those services are not included as part of the covered services in that state's plan, and 2 states may request "waivers" to pay for otherwise uncovered home and community-based services HCBS for Medicaid-eligible persons who might otherwise be institutionalized.

As long as the services are cost effective, states have few limitations on the services that may be covered under these waivers except that, other than as a part of respite care, states may not provide room and board for the beneficiaries.

With certain exceptions, a state's Medicaid program must allow beneficiaries to have some informed choices among participating providers of health care and to receive quality care that is appropriate and timely. Medicaid operates as a vendor payment program. States may pay health care providers directly on a fee-for-service basis, or states may pay for Medicaid services through various prepayment arrangements, such as health maintenance organizations HMO s.

Within federally imposed upper limits and specific restrictions, each state for the most part has broad discretion in determining the payment methodology and payment rate for services. Generally, payment rates must be sufficient to enlist enough providers so that covered services are available at least to the extent that comparable care and services are available to the general population within that geographic area.

Providers participating in Medicaid must accept Medicaid payment rates as payment in full. From to , excessive and inappropriate use of the DSH adjustment resulted in rapidly increasing federal expenditures for Medicaid. Legislation that was passed in and , and again within the BBA of , capped the federal share of payments to DSH hospitals.

States may impose nominal deductibles, coinsurance, or copayments on some Medicaid beneficiaries for certain services. The following Medicaid beneficiaries, however, must be excluded from cost sharing: pregnant women, children under the age of 18, and hospital or nursing home patients who are expected to contribute most of their income to institutional care.

In addition, all Medicaid beneficiaries must be exempt from copayments for emergency and family planning services. Under the DRA , new cost sharing and benefit rules provide states with the option of imposing new premiums and increased cost sharing on all Medicaid beneficiaries except for those mentioned above and for terminally ill patients in hospice care. The DRA also established special rules for cost sharing for prescription drugs and for nonemergency services furnished in emergency rooms.

The federal government pays a share of the medical assistance expenditures under each state's Medicaid program. That share, known as the Federal Medical Assistance Percentage FMAP , is determined annually by a formula that compares the state's average per capita income level with the national income average.

States with a higher per capita income level are reimbursed a smaller share of their costs. By law, the FMAP cannot be lower than 50 percent or higher than 83 percent. In fiscal year , the FMAP s varied from 50 percent in 12 states to The federal government also reimburses states for percent of the cost of services provided through facilities of the Indian Health Service, for percent of the cost of the Qualifying Individuals QI program described later , and for 90 percent of the cost of family planning services, and shares in each state's expenditures for the administration of the Medicaid program.

Most administrative costs are matched at 50 percent, although higher percentages are paid for certain activities and functions, such as development of mechanized claims processing systems. Rather, the federal government matches at FMAP rates state expenditures for the mandatory services, as well as for the optional services that the individual state decides to cover for eligible beneficiaries, and matches at the appropriate administrative rate all necessary and proper administrative costs.

Medicaid was initially formulated as a medical care extension of federally funded programs providing cash income assistance for the poor, with an emphasis on dependent children and their mothers, the disabled, and the elderly. Over the years, however, Medicaid eligibility has been incrementally expanded beyond its original ties with eligibility for cash programs. Legislation in the late s assured Medicaid coverage to an expanded number of low-income pregnant women and poor children and to some Medicare beneficiaries who are not eligible for any cash assistance program.

Legislative changes also focused on increased access, better quality of care, specific benefits, enhanced outreach programs, and fewer limits on services. In most years since its inception, Medicaid has had very rapid growth in expenditures. This rapid growth has been due primarily to the following factors:. As with all health insurance programs, most Medicaid beneficiaries incur relatively small average expenditures per person each year, and a relatively small proportion incurs very large costs.

Moreover, the average cost varies substantially by type of beneficiary. National data for , for example, indicate that Medicaid payments for services for Similarly, for However, certain other specific groups had much larger per-person expenditures.

Medicaid payments for services for 4.