Medicare Eligibility and Financing

Medicaid Eligibility and Financing
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Medicaid Eligibility and Financing
Introduction
Medicaid is a health insurance program for the American population. Those eligible to be covered by the program include both the young and old across different gender and races, but special attention is given to the low-income, disadvantaged, marginalized, and vulnerable individuals. The program is usually funded through mutual collaboration between the federal and state government in an established financial framework where each pay for a specified percentage of the Medicaid expenditures. The national government funds the Medicaid program by catering for a share referred to as FMAP (Federal Medical Assistance Percentage). The state government funds the remaining percentage, known as the non-federal share of the Medicaid program. States can establish their independent provider payment rates for the Medicaid plan and change how they fund the payment. However, to ensure that they cater for the share of the Medicaid expenditures for the services and care offered in each state, the states are required to submit a SPA (State Plan Amendment) for review and approval by the Centers for Medicare and Medicaid Services.
Examine the benefits and eligibility of the Medicaid program. Who can be covered, and what are the specific income restrictions when qualifying via financial status? How did the Patient Protection and Affordable Care Act change the income determination methodology?
Medicaid is a joint state and federal program, which, together with CHIP (Children’s Health Insurance Program), primarily provides the benefits of health coverage to more than 72 million Americans. The program covers children, pregnant women, parents, senior citizens, and individuals with disabilities, making Medicaid serve as the single largest health insurance coverage in the U.S. For participation in the Medicaid program, states are required by federal law to mandatorily cover certain individuals. These mandatory eligibility groups include the aged, disabled, people from low-income families, qualified children and pregnant women, and individuals receiving SSI (Supplemental Security Income). However, additional options are accorded to states to cover other groups, such as children in foster care and individuals receiving HCBS (Home and Community-Based Services) (Rudowit et al., 2019). The 2010 PPACA (Patient Protection and Affordable Care Act) created a significant opportunity for states to promote the expansion of the Medicaid program to cover nearly all low-income Americans aged 65 years and below. As informed by Rudowit et al. (2019), the eligibility for the children was also extended to at least 133% of the FPL (Federal Poverty Level) in every state. The states were further given the optional opportunity of extending the eligibility of adults with income below or at 133% of the federal poverty level.
When qualifying for Medicaid via financial status, there are specific income restrictions that apply. Individuals aged 65 years and above must have an income level of less than $2,523 per month, which specifically applies to assisted living services, nursing home Medicaid, and in-home care in states providing the Medicaid program through the home and community-based services. The income limits for home and community-based services and nursing home Medicaid are more complicated for the married applicants. When only one spouse is a Medicaid applicant, only the income of this spouse is considered. The situation infers that the income of the non-applicant spouse is not taken into account when determining the Medicaid income eligibility of the specific applicant spouse, which is set at the limit of $2,523 per month (Rudowit et al., 2019). However, the non-applicant spouse is accorded the opportunity of enjoying the allocation of some of the monthly income of the applicant spouse. The situation is referred to as spousal protection, termed as the MMMNA (Minimum Monthly Maintenance Needs Allowance), mainly intended for fostering the prevention of the non-applicant spouse’s impoverishment. In most states, the highest amount of income that is allowed to be allocated to the non-applicant spouse is $3,435, and the combined income with the applicant spouse is also limited, not to exceed this same amount (Rudowit et al., 2019). In most states, as deliberated by Rudowit et al. (2019), the standard income limits for disabled individuals are $841, $1,133 for a single parent/applicant, and $1,526 for a married couple per month.
The PPACA established a new methodology whose specific aim was to determine the income eligibility for Medicaid, which is primarily based on the model of MAGI (Modified Adjusted Gross Income). MAGI is explicitly adopted in determining the financial eligibility for Medicaid and CHIP, as well as cost-sharing reductions and premium tax credits available through the marketplace of health insurance (Rudowit et al., 2019). By specifically applying the use of a single application and one set of income counting rules, the PPACA made it much easier and more convenient for the U.S. nationals to make an...