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MEDICAID

Megan Morrow
CCAC
SOW125 – Social Welfare
Dr. Christopher Robinson
November 22, 2020
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Medicaid was introduced in 1966 with a maximum of four people signed up. However,

this number has greatly increased over the past 54 years. As of July,of this year, there are

approximately 75 million individuals who are experiencing aid through Medicaid. This increase

is astronomical in growth in such a short period of time. This shows that there is a dependence

and need for Medicaid. Unlike the United States, England offers a completely different view on

health care and ways to provide for those who are less fortunate. Cathi Spears, a nurse for over

26 years, opens up about her ideas on Medicaid in the U.S. and the importance it plays in

people’s lives. The development of Medicaid has drastically changed throughout history along

with the several challenges that came with it.

There have always been low-income individuals in our country, but Medicaid was not

always available to them. Before 1965, the federal government gave the states limited payments

to help meet the needs of those who needed access to health care (Smith, Kennedy, Knipper, et

al., 2017). However, there was a wide variation in the funds for the health care in each state.

This led to the creation of Medicaid. In 1965, Medicaid was authorized under the Social

Security Act. The Social Security Act was a law enacted by Franklin D. Roosevelt. The law

created social security and insurance for unemployment and eventually added Medicaid.

Medicaid is a federal-state matching entitlement program and provides medical and health

related services “to low-income individuals and families for institutional and community-based

care provided by participating institutions and practitioners” (Dolgoff and Feldstein, 2013,

p.229). It was created to expand access to “mainstream” health care. States are able to offer

additional services to those who do not receive public assistance. This means that individuals

can receive the federal mandated and the states selected services. There are many requirements

that must be met such as a person’s age, disability, income, resources, and whether they are a
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United States citizen or a legal immigrant. For example, if an individual is pregnant, they could

receive special consideration to be part of this program. A child may be eligible even if their

own parents are not, in some situations. According to Dolgoff and Feldstein (2013), the rules for

counting income varies from state to state and from group to group (p.230). The formation of

Medicaid has vastly changed the lives or the potential lives of many low-income individuals,

families, and children.

Vulnerable populations and diverse groups of people can be greatly impacted by the

affects of Medicaid. Some of the main recipients of Medicaid are those who belong to one of

these groups, and usually not by choice. There is one major impact that has come about this year

with a profound affect in our society. This is the Coronavirus Pandemic. The effect that

COVID-19 is having on Medicaid is reasonably drastic. Due to COVID-19, there are many

millions of more people out of work and experiencing a loss of income, which makes them

incredibly vulnerable. With this susceptibility during an unprecedented public health crisis, there

needs to be a greater look at Medicaid and how it is helping the people right now. “Adaptation

Health, in partnership with Acumen America and the Center for Health Care Strategies” is

offering a three day webinar of companies and panelists to discuss critical health innovations and

“aims to enable these leaders to champion and implement products and services that improve

outcomes for vulnerable patient populations” (Contify Life Science News [CLSN], 2020). These

presentations will focus on possible solutions to the health care needs of Medicaid populations.

Also, there is a chance for partnerships to form in order to provide the best health care possible

in these uncertain times of COVID-19 and the growing number of the Medicaid qualified

population. Another factor that can greatly impact Medicaid and its populations is situations

such as severe weather. With severe weather, the statistic of vulnerable people increases. This is
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due to many businesses being damaged and ruined to do large storms like tornadoes and

hurricanes, wild or forest fires, heavy or gale force winds, etc. As a result of lack of businesses,

people lose their jobs and now have to find a new way to afford health care. This leads them to

Medicaid. Those who are vulnerable after the severe weather that they experienced may need to

go to several doctors or practices to recover safely. For instance, someone might lose their leg if

their house collapses on them during a huge storm. They will then need to take advantage of the

clinic services and prosthetic devices that Medicaid can offer. While their community works to

rebuild and people are looking to find new jobs and new ways of life, they could continue to

benefit from aid from Medicaid. Overall, there are many impacts that effect the vulnerable and

diverse groups that benefit from access to Medicaid.

Over time, multiple other programs have been put into place that coincide with Medicaid.

For example, The Children’s Health Insurance Program, also known as CHIP, is similar but

overall separate from Medicaid. CHIP is a state funded program that targets low-income

children. States have the option to offer this program or not and do so for “low-income children

and families or to enroll recipients in managed care plans” (Dolgoff and Feldstein, 2013). The

way that CHIP is closely related to Medicaid is by providing necessary health care opportunities

to low-income individuals, and pregnant women in some states, at a low cost. For someone who

applies for Medicaid and has children, they can also find out if their child is eligible for CHIP at

the same time. Benefits for CHIP, similar to Medicaid, vary from state to state and are subject to

change. However, “all states provide comprehensive coverage, including: routine check-ups,

immunizations, doctor visits, prescriptions, dental and vision care, inpatient and outpatient

hospital care, laboratory and X-ray services, and emergency services” (Medicaid and Children’s

Health Insurance Plan [CHIP], 2020). Another program that exists with similarities to Medicaid
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is Medicare. While Medicaid is for low-income families and children to have access to

affordable health care, Medicare is for elderly to have access to health care. There can be times

when a person can be enrolled in both programs. This would be if an elderly person is not

bringing in a sustainable amount of money and are considered to be low-income, then they can

receive help from both Medicaid and Medicare. According to Health Services Research, “dual

enrollees are a heterogeneous group: 38 percent have limitations performing 3 or more activities

of daily living” (Roberts, Mellor, McInerney, et al., 2019). This proves that those who are dual

enrolled really do need the help that they are receiving in order to sustain the most basic life. On

the other hand, not all enrollees have to be dual enrolled. There are many people who are simply

enrolled in one or the other. In relation to Medicaid, there are a few programs that have a

widespread outreaching impact like CHIP and Medicare that impact the lives of those who take

advantage of their benefits.

There have been numerous factors that have changed Medicaid since its creation in 1966

and ultimately led to the way the program works today. Some of the main factors that have been

altered includes “significant modifications in eligibility, benefits, payment arrangements, and

other administrative details” (Smith, Kennedy, Knipper, et al., 2017). Between 1965 to 1980,

eligibility for Medicaid was linked to Supplemental Security Income (SSI). Then, came The

Omnibus Budget Reconciliation Act of 1981 (OBRA-81) which required states to make

additional payments to hospitals that aided a large proportion of Medicaid beneficiaries. Next,

there was The Omnibus Budget Reconciliation Act of 1987 that included nurse reform. By the

1990s, The Personal Responsibility and Work Opportunities Act (PRWOA) of 1996, also known

as welfare reform, lead to even more changes. These changes were mostly dealing with

eligibility for legal immigrants. Around this time, spending for Medicaid reached around $200
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billion and “enrollment has increased from 4 million to 33 million’ (Klemm, 2000). Recently,

federal policies are pushing states to encourage community living for people who are living with

disabilities. With this being said, there have been several changes to Medicaid to make it what it

is today.

Like everything in our world, the way the Medicaid is viewed and operated will evolve

and adapt over time to better assist those who need it. Any changes that would be made would

considerably affect those who are low-income and trying to seek health insurance that they can

afford at a decent price to stay healthy. With President Trump’s administration, there has been

some discussion that would change the Medicaid program into “state block grants as part of a

larger Affordable Care Act (ACA) reform” (US Official News, 2017). With the block grants,

there would be fixed federal funding provided to the states in order to provide health insurance to

low-income individuals. The ultimate goal of the block grants would be to have improved

control over costs. Also, there have been discussions on repealing the Affordable Care Act

(ACA). The repeal of ACA would cause drastic changes in coverage for members of Medicaid.

According to the Kaiser Family Foundation’s chart provided by Targeted News Service, “49

states cover children, and 34 states cover pregnant women with incomes at or above two times

the federal poverty level” (2017). The chart also provides information on “states' continued use

of available options to expand access to coverage and further streamline enrollment and renewal

processes” (Targeted News Service, 2017). Another effect of repealing the Affordable Care Act

is eligibility, enrollment, and renewal policies and practices. The ACA has advanced these

processes to be modernized and technologically driven. All 50 states currently have an

application online for Medicaid. Therefore, there would be adjustments in policies and

effectiveness of Medicaid in the possible future. As seen in the past and today, Medicaid is
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consistently and constantly changing under every governmental administration which are

attempting to best suit the needs of the people currently.

Cathi Spears, a licensed nurse, offered her thoughts and opinions about the current policy

concerning Medicaid. She has spent 20 years working with the elderly and the past six years

working with addiction rehabilitation patients ranging in adolescent to adulthood. She works

with various patients daily who use Medicaid as their form of insurance, therefore, having a lot

of experience with this issue. Cathi believes that if there was no Medicaid then thousands, if not

millions, of people would go without receiving the proper health care that they deserve on a

regular basis. This would result in many unnecessary deaths, and a failure to heal and treat

wounds. Also, with no other option to obtain their pharmaceutical drugs, some may be forced to

turn towards illegal or street drugs for assistance. All of these things would deeply hurt our

country. In addition, Cathi believes wholeheartedly in the medical slogan, “do no harm,” and

believes that Medicaid promotes this idea. By doing this, patients are able to live a healthier,

more fulfilling lifestyle and hopefully not need to rely on policies like Medicaid ever. Knowing

that there are positive ways to obtain assistance, citizens are able to feel reassured that they are

not alone and are able to live a rewarding life.

According to the United Nations, there are 193 countries all over the world and each has

their own way of providing health care to its citizens. These efforts differ significantly from

those of The United States of America. One example of these differences comes from England.

Through the National Health Service, funded by taxation, all English residents are provided free

public health care from birth which consists of hospital, physician, and mental health care. Free

healthcare is a similarity among many countries around the world. Countries such as Canada,

Sweden, Mexico, Italy, Germany, Australia, France, Austria, and New Zealand and many more
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all give their citizens access to free healthcare. Within this care, they have access to preventive

services, including screenings, immunizations, and vaccination programs. Some examples

include inpatient and outpatient hospital care, maternity care, physician services, inpatient and

outpatient drugs, clinically necessary dental care, some eye care, mental health care, palliative

care, some long-term care, rehabilitation, home visits by community-based nurses, wheelchairs,

hearing aids, and other assistive devices. Even with access to free public health care,

“approximately 10.5 percent of the United Kingdom’s population carries voluntary supplemental

insurance to gain more rapid access to elective care” (Tikkanen, 2020). Responsibility for the

National Health Service (NHS) is through NHS England which oversees day to day processes.

NHS England is a government-funded body that is run separately from the Department of

Health. However, those that are responsible for health legislation and general policy are

Parliament, the Secretary of State for Health, and the Department of Health. So, England has

some very drastic differences when it comes to providing health care for its citizens compared to

the United States.

In conclusion, the development of Medicaid has dramatically changed throughout history

along with the several challenges that came with it. Medicaid started with four enrollees and has

transformed into providing coverage for millions in only a couple of decades. The huge increase

in covered individuals shows the great importance that Medicaid has on our everyday American

life and the aid that some need in order to fulfill this way of living. In the current day and age,

there have been incredibly strong and severe weather along with a global pandemic that all

heavily effect vulnerable populations. For these vulnerable groups, Medicaid can be the other

thing keeping them alive. Along with Medicaid, there are several other options provided for

those who are in need such as the Children’s Health Insurance Program, which provides low-
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income children with low-cost health care. When Medicaid and other health care options are

compared to other countries, it can be seen that there are many different ways to provide services

and assistance to people, but we can all agree that some may need more assistance in achieving

their basic human life. After speaking with a local advocate for Medicaid, it became extremely

clear just how important this policy is to millions of Americans.

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Work Cited

Dolgoff, R., & Feldstein, D. (2013). Understanding social welfare: A search for social justice.
Boston, MA: Pearson.

Klemm, J. (2000). Medicaid Spending: A Brief History. Retrieved November 18, 2020, from
https://eds-a-ebscohost-com.ezproxy.ccac.edu/eds/detail/detail?vid=6&sid=8c9e7c2b-
2ebc45b88116553f02533220%40sessionmgr4008&bdata=JnNpdGU9ZWRzLWxpdmU
%3d#AN=4978490&db=bth

Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Final Rule – CMS-
2408-F. (2020, November 9). States News Service, NA.
https://link.gale.com/apps/doc/A641014115/AONE?
u=pitt92539&sid=AONE&xid=3382bfad

Medicaid Demo Day Series Addresses Impacts of COVID-19 on Vulnerable Populations. (2020,
June 8).  Contify Life Science News, NA.
https://link.gale.com/apps/doc/A626138172/STND?
u=pitt92539&sid=STND&xid=6d0ee3a7

New research will help gauge future changes to Medicaid. (2017, February 1). US Official
News. https://link.gale.com/apps/doc/A485551844/STND?
u=pitt92539&sid=STND&xid=2228b20b

Roberts, E., Mellor, J., McInerney, M., & Sabik, L. (2019, October 01). State variation in the
characteristics of Medicare‐Medicaid dual enrollees: Implications for risk adjustment.
Retrieved November 09, 2020, from
https://onlinelibrary-wiley-com.ezproxy.ccac.edu/doi/abs/10.1111/1475-6773.13205

Smith, G., Kennedy, C., Knipper, S., & O'Brien, J. (2017, February 21). A Brief History of
Medicaid. Retrieved November 08, 2020, from https://aspe.hhs.gov/report/using-
medicaid-support-working-age-adults-serious-mental-illnesses-community-handbook/
brief-history-medicaid

Tikkanen, R. (2020, June 05). England. Retrieved November 10, 2020, from
https://www.commonwealthfund.org/international-health-policy-center/countries/england

50-State Survey of Medicaid Eligibility, Enrollment Policies in 2017: A Baseline for Measuring
Future Changes; For Editor Struck. (2017, January 13). Targeted News Service.
https://link.gale.com/apps/doc/A477353359/STND?
u=pitt92539&sid=STND&xid=123db844