Chapter 21 - Medicaid. In this chapter, you will learn: Describe Medicaid as a program that covers medical expenses for many of this nation’s poor, distinguish Medicaid from Medicare and understand their relationship. | Chapter 21 Medicaid Chapter Outline THE WHAT’S, THE WHO’S AND THE HOW MUCH’S WHY MEDICAID COSTS SO MUCH MEDICAID AND THE ELDERLY The What’s Medicaid covers health care for the poor was established in 1964 was in full force in 1967 part of President Johnson’s Great Society Programs paired with Medicare (which covers health care for those over 65) is a state-administered program with federal matching funds. The Who’s Covers (1994) 18 million children 18 million adults 60% are female (75% of adults are women) 45% white; 24% black; 17% Hispanic (11% “unknown”) Children are eligible if they are under 19 and in households with income less than 133% of the poverty rate. they are under 1 and in households with income less than 185% of the poverty rate Adults are eligible if they qualify for TANF (Temporary Aid to Needy Families) SSI (Supplemental Security Income) Not all poor are covered 50% of those who live in households with income below 150% of the poverty line are not covered. The How Much’s The federal government pays states a matching grant (ranging from 50% to 70%) that depends on the income of the state. The total federal government obligation is $120 billion The total state obligation is $60 billion More Details States establish reimbursement rates for procedures rates must be high enough so that patients have adequate coverage. States may choose to exclude some procedures most states choose not to cover abortions. Doctors and hospitals may choose not to accept Medicaid patients If they accept any patients for any procedure they must accept all patients for all procedures. It is an “all-or-nothing” proposition. Why Medicaid Costs So Much Per patient expenditures per year on Medicaid are substantially higher (about 20%) than non-Medicaid patients. In part, this is a feature of the clientele The poor tend to be less healthy and need more expensive treatments. Medicaid pays for nursing home expenses of the poor. Medicaid’s Impact on Overall Health Care Prices P* Qpoor Qnonpoor Dpoor+nonpoor Dpoor+nonpoor P* Qpoor Qnonpoor P Q/t S Dpoor Dnonpoor Without Medicaid Q/t S P Dpoor Dnonpoor With Medicaid Medicaid and the Elderly Medicare is the program for the elderly. Medicaid is the program for the poor. If a patient is poor and over 65, Medicaid pays for Medicare premiums, deductibles and most of the co-payments. Expenses by Age Group (1996) Medicaid expenses per patient overall $4,250 Children under 5 $1,406 Elderly 75-84 $8,956 Elderly over 85 $12,169 Children make up half the Medicaid population and account for 22% of expenses. Those over 65 make up for 13% of the Medicaid population and account for 35% of expenses. Getting Medicaid to Pay for Nursing Homes People have to show very little income and have very few assets in order for Medicaid to pay for nursing home care. To determine Medicaid eligibility, the government looks at financial records going back 2 years to ensure that the person did not give away their assets so that Medicaid would pay. The Relationship Between Medicare and Medicaid Medicare Part A is mandatory and has premiums, deductibles and co-payments. Part B is voluntary and has premiums, deductibles and co-payments. When the person is eligible for both Medicare and Medicaid, states choose to have their Medicaid programs pay the Medicare premiums, deductibles and most of the co-payments for both Part A and Part B. Cost Saving Measures in Medicaid Medicaid costs were rising 10% per year in the 1990s HMOs Medicaid has increased it use of HMO’s from 5% coverage in 1990 to 50% by 1998. Primary Care Physicians were established to minimize inappropriate emergency room use by Medicaid patients.
