What Is Medicaid – How It Works?

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Medicaid is a joint federal-state government health care program in United States of America. This is designed to help primarily the people who don’t have enough resource and income to pay for their health care. It is jointly funded by the federal government and the state government, and administered by the state government with federal government norms.  The portion of federal funding depends on the state of the states, i.e. the states with high per capita income get lesser federal fund while those with lower per capita income are eligible for lager fraction. On an average the federal government pays 57 percent of the Medicaid budget.

A broader outlook

This joint federal-state government program provides health coverage and nursing home coverage to certain category peoples.  To be eligible for a Medicaid beneficiary, a person needs to qualify certain criteria’s. Different states have different criteria. However the general criteria include low-assets, person with disabilities, mental disability, pregnant women, children, elderly who needs nursing homes etc. Although Medicaid is for persons having low assets, but merely fulfilling this criteria is not sufficient to get the Medicaid benefits. The CMS says ‘Medicaid does not provide medical assistance for all poor persons, unless they belong to designated eligibility groups. ‘In order to be eligible for Medicaid benefits, one needs clear two broadly requirements, i.e. general and financial requirements.  Also one has to declare that he or she is so disabled to the point that he or she could not work. Apart from regular health care and nursing home care benefits, one may be also eligible for dental service. Once you qualify for Medicaid, you will have to meet additional functional requirements to qualify for long-term health care services.

Whom does it benefit?

Medicaid was created to help low-assets people who need medical service. It pays some or all of their medical fees. This service is provided to only the US citizens with an exception in emergency cases where the Medicaid benefits are extended regardless of the immigration status. A child may be eligible for Medicaid regardless of the eligibility status of his parents or guardians. So even though the parents are not eligible, the child is.  A majority of the Medicaid beneficiary are children.

Medicaid does not pay benefits to individuals directly; instead Medicaid sends benefit payments to health care providers. In some cases Medicaid beneficiaries are required to pay a small fee (along with the Medicaid benefits they are availing) for medical services.  Medicaid is limited by federal law to the coverage of “medically necessary services” only. The payment made by the person depends on different factors. In this way the budget of the government get little light.

Along with other programs like CHIP, Medicaid now provides health care services to more than 60 million Americans.  The benefits are immense. The Medicaid impact is huge. The study carried out by MIT and Harvard school of public health in 2011 showed that due to Medicaid, there has been a 30% increase in hospital use. Persons with Medicaid benefits prefer preventive cares. There has been a high rise of good health in public. There are less depression and diagnosis since Medicaid implemented.

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