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What is Medicaid? Why is Medicaid so important for individuals with disabilities? How do Medicaid services help Shannon and other kids with disabilities? How do block grants and per capita proposals jeopardize critical services? What is the impact of Medicaid funding cuts? Easterseals position on Medicaid reform. Medicaid provides critical, often life-saving, health care, long-term services and community supports to millions of children and adults living with disabilities.
Created in , Medicaid is jointly funded by states and the federal government. States design their Medicaid programs to provide federally mandated services in addition to services or special populations that are a priority in the state.
Federally-mandated services are directed to both children and adults based on specific eligibility criteria and include hospital services, home health care, laboratory and x-ray services, and nursing home care. States must also provide Early, Periodic, Screening, Diagnosis and Treatment services for eligible children. States may also offer optional services, including prescription drugs, dental care, hearing aids, and physical and other therapy services which are particularly important to eligible individuals with disabilities.
Without these two programs, millions of children would go without crucial healthcare services, positioning them for a lower quality of life further down the road. Congress voted on several bills in — all of which failed to pass both chambers — which would have reduced Medicaid eligibility, slashed funding, and imposed caps on state Medicaid programs. Congress also chose to play political football with CHIP , which expired on September 30, , and did not re-authorize the program until January , a full four months after its funding had expired.
The Trump Administration has also opened the door for states to impose work requirements on Medicaid recipients. These proposals have all been aimed at low-income Americans, who are burdened enough already as they work to make ends meets. Figure 2: The basic foundations of Medicaid are related to the entitlement and the federal-state partnership. States could opt to provide coverage at income levels above cash assistance. Over time, Congress expanded federal minimum requirements and provided new coverage options for states especially for children, pregnant women, and people with disabilities.
Following these policy changes, for the first time states conducted outreach campaigns and simplified enrollment procedures to enroll eligible children in both Medicaid and CHIP. Expansions in Medicaid coverage of children marked the beginning of later reforms that recast Medicaid as an income-based health coverage program. Prior to the ACA, individuals had to be categorically eligible and meet income standards to qualify for Medicaid leaving most low-income adults without coverage options as income eligibility for parents was well below the federal poverty level in most states and federal law excluded adults without dependent children from the program no matter how poor.
The ACA changes effectively eliminated categorical eligibility and allowed adults without dependent children to be covered; however, as a result of a Supreme Court ruling, the ACA Medicaid expansion is effectively optional for states. Under the ACA, all states were required to modernize and streamline Medicaid eligibility and enrollment processes. Expansions of Medicaid have resulted in historic reductions in the share of children without coverage and, in the states adopting the ACA Medicaid expansion, sharp declines in the share of adults without coverage.
Many Medicaid adults are working, but few have access to employer coverage and prior to the ACA had no options for affordable coverage. Figure 3: Medicaid has evolved over time to meet changing needs. In FY , Medicaid covered over 75 million low-income Americans. As of February , 37 states have adopted the Medicaid expansion. Data as of FY when fewer states had adopted the expansion show that States can opt to provide Medicaid for children with significant disabilities in higher-income families to fill gaps in private health insurance and limit out-of-pocket financial burden.
Medicaid also assists nearly 1 in 5 Medicare beneficiaries with their Medicare premiums and cost-sharing and provides many of them with benefits not covered by Medicare, especially long-term care Figure 4.
Figure 4: Medicaid plays a key role for selected populations. Medicaid covers a broad range of services to address the diverse needs of the populations it serves Figure 5.
In addition to covering the services required by federal Medicaid law, many states elect to cover optional services such as prescription drugs, physical therapy, eyeglasses, and dental care. Medicaid plays an important role in addressing the opioid epidemic and more broadly in connecting Medicaid beneficiaries to behavioral health services. EPSDT is especially important for children with disabilities because private insurance is often inadequate to meet their needs.
Unlike commercial health insurance and Medicare, Medicaid also covers long-term care including both nursing home care and many home and community-based long-term services and supports.
More than half of all Medicaid spending for long-term care is now for services provided in the home or community that enable seniors and people with disabilities to live independently rather than in institutions. Some states have obtained waivers to charge higher premiums and cost sharing than allowed under federal rules.
Many of these waivers target expansion adults but some also apply to other groups eligible through traditional eligibility pathways. Over two-thirds of Medicaid beneficiaries are enrolled in private managed care plans that contract with states to provide comprehensive services, and others receive their care in the fee-for-service system Figure 6.
Managed care plans are responsible for ensuring access to Medicaid services through their networks of providers and are at financial risk for their costs. In the past, states limited managed care to children and families, but they are increasingly expanding managed care to individuals with complex needs. Close to half the states now cover long-term services and supports through risk-based managed care arrangements. Community health centers are a key source of primary care, and safety-net hospitals, including public hospitals and academic medical centers, provide a lot of emergency and inpatient hospital care for Medicaid enrollees.
Medicaid covers a continuum of long-term services and supports ranging from home and community-based services HCBS that allow persons to live independently in their own homes or in other community settings to institutional care provided in nursing facilities NFs and intermediate care facilities for individuals with intellectual disabilities ICF-IDs.
This is a dramatic shift from two decades earlier when institutional settings accounted for 82 percent of national Medicaid LTSS expenditures.
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