Chapter 15 Medicaid Health Health Care for You

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Chapter 15 Medicaid Health: Health Care for You and Me? Colleen M. Grogan ©

Chapter 15 Medicaid Health: Health Care for You and Me? Colleen M. Grogan © 2008 Delmar Cengage Learning.

Medicaid: Another NHI Policy Orphan • Medicaid partly grew out of early efforts to

Medicaid: Another NHI Policy Orphan • Medicaid partly grew out of early efforts to construct a comprehensive system of national health assistance. • In its early years: – Assumed that its “residual” coverage would be rendered superfluous by expansion of social insurance 2 © 2008 Delmar Cengage Learning.

Pre-Medicaid Old Age Assistance Regime • After initial government ambivalence toward nursing homes (viewed

Pre-Medicaid Old Age Assistance Regime • After initial government ambivalence toward nursing homes (viewed by policymakers as little better than the squalid almshouses they replaced) – Government financed elderly long-term nursing home care with medical vendor payments program in 1950 3 © 2008 Delmar Cengage Learning.

Pre-Medicaid Old Age Assistance Regime • Medical vendor payments – Allowed the states (and

Pre-Medicaid Old Age Assistance Regime • Medical vendor payments – Allowed the states (and federal government) to directly finance the health care needs of those receiving public assistance 4 © 2008 Delmar Cengage Learning.

Pre-Medicaid Old Age Assistance Regime • 1960, Kerr-Mills Act – Established the concept of

Pre-Medicaid Old Age Assistance Regime • 1960, Kerr-Mills Act – Established the concept of “medical indigency” – Drawing a distinction between the true poor (welfare recipients), and those who became poorer (or indigent) as a result of high medical bills 5 © 2008 Delmar Cengage Learning.

Pre-Medicaid Old Age Assistance Regime • Kerr-Mills and the medical vendor payment programs –

Pre-Medicaid Old Age Assistance Regime • Kerr-Mills and the medical vendor payment programs – Effectively amalgamated in 1965 to form Medicaid – Sprang into existence alongside the more prominent Medicare program 6 © 2008 Delmar Cengage Learning.

Middle Class Medicaid • As in the case of Medicare – Medicaid costs quickly

Middle Class Medicaid • As in the case of Medicare – Medicaid costs quickly surpassed early projections 7 © 2008 Delmar Cengage Learning.

Middle Class Medicaid • States increased federal spending by setting a generous means-test for

Middle Class Medicaid • States increased federal spending by setting a generous means-test for Medicaid beneficiaries – Some (such as NY) with a view toward expanding the program to cover everyone 8 © 2008 Delmar Cengage Learning.

Middle Class Medicaid • Amendments in 1967 and 1972 reined in the most generous

Middle Class Medicaid • Amendments in 1967 and 1972 reined in the most generous state Medicaid program – Also broadened Medicaid’s role in the care of children 9 © 2008 Delmar Cengage Learning.

Middle Class Medicaid • Basic tension between the minimalist, welfare-linked conception of Medicaid, and

Middle Class Medicaid • Basic tension between the minimalist, welfare-linked conception of Medicaid, and Medicaid as a broad-based stepping stone to national health insurance continued 10 © 2008 Delmar Cengage Learning.

Middle Class Medicaid • Today, Medicaid covers many in the middle class – Including

Middle Class Medicaid • Today, Medicaid covers many in the middle class – Including two-thirds of those receiving nursing home care – One-third of all childbirths – Many children, and patients of certain medical conditions, including HIV-AIDS 11 © 2008 Delmar Cengage Learning.

Middle Class Medicaid • Many of those approaching retirement age move/disguise assets in order

Middle Class Medicaid • Many of those approaching retirement age move/disguise assets in order to become eligible for Medicaid – Thus ensuring that they can pass down some of their estate to younger family members • Rather than drawing down all resources on health care 12 © 2008 Delmar Cengage Learning.

Middle Class Medicaid • This practice is occasionally condemned by policymakers – But little

Middle Class Medicaid • This practice is occasionally condemned by policymakers – But little serious legal action usually results 13 © 2008 Delmar Cengage Learning.

Recent Developments • 1997, a strong economy allowed for an expansion of health coverage

Recent Developments • 1997, a strong economy allowed for an expansion of health coverage – SCHIP – States offered further funds to cover uninsured children • Either under Medicaid, or separate programs – Represented a significant expansion in Medicaid (and similar) programs 14 © 2008 Delmar Cengage Learning.

Chapter 15 Summary • Medicaid another orphan of earlier failed efforts to enact national

Chapter 15 Summary • Medicaid another orphan of earlier failed efforts to enact national health insurance – Part of 1965 package of reforms, drawing little attention at first • Combined prior programs to help the “medically indigent” 15 © 2008 Delmar Cengage Learning.

Chapter 15 Summary • Quickly became the chief financing source of nursing home (long-term)

Chapter 15 Summary • Quickly became the chief financing source of nursing home (long-term) care • Not simply a “poor peoples’ program” – Medicaid continues to provide for many within the middle class • Policymakers remain ambivalent about Medicaid and its consequences 16 © 2008 Delmar Cengage Learning.