The Medicaid program has existed for 56 years and is positioned as a health insurance system for low-income segments of the population. The most recent data shows that Medicaid provides coverage for approximately 77.9 million people, from doctor visits and inpatient and outpatient hospital services to nursing facilities and home health services (Donohue et al., 2022). On the financial side, Medicaid accounts for 16.7% of national health spending, $688 billion, while responsibility for funding is shared between the states 32.4% and the federal government 67.6% (Donohue et al., 2022).
On average, states spend 28.7% of their budget on Medicaid (Donohue et al., 2022). Moreover, this figure varies widely depending on the coverage definition for particular groups of the population, for example, people with dual entitlement or addiction and the economic circumstances in individual states (Mazurenko et al., 2018). Research shows that Medicaid coverage facilitates access to primary health care services equivalent to the privately insured population, although the overall health status of Medicaid participants is slightly lower.
According to the Centers for Medicare and Medicaid Services, people may be eligible for free or low-cost Medicaid services depending on income and family size. In all states, Medicaid provides health insurance to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. The situation is complicated because, in 37 states, the coordination of medical care is delegated to private organizations that are reluctant to share data, which limits the availability of timely clinical, financial, and administrative data for supervisors (Donohue et al., 2022). The availability of continuous Medicaid insurance coverage has reduced the barriers to patient treatment compared to periodic insurance or lack of insurance coverage over the past year. Policies that increase failures in Medicaid coverage can negatively affect access to health care, even among those with access to the social security system.
Getting treatment can be frustrating for people eligible for Medicaid and needing care. The reduction in cost recovery forces doctors to refuse to participate in the program for patients. A nationwide survey of doctors showed that 31% “do not want” to accept new Medicaid patients (Gadboi et al., 2021). Low payment rates to healthcare providers in many states mean it is difficult for Medicaid recipients to find a doctor, forcing many to rely on expensive and overcrowded emergency departments in hospitals for non-emergency care.
Medicaid patients often receive lower medical treatment, are referred to less qualified surgeons, receive poorer postoperative instructions, and often get worse results for identical procedures than similar patients with and without insurance (Gadboi et al., 2021). The simple truth about Medicaid is that the program has become too big to provide good services to people who need government assistance.
The ACA was a turning point in coverage opportunities for low-income Americans. However, eligibility for both Medicaid and the tax subsidies offered in the ACA insurance markets is closely tied to family income. Even with the tremendous efforts to simplify enrollment and renewal, nothing can overcome the income fluctuations leading to cover shifts over time. The risk of a break in insurance coverage persists, especially in states that have decided not to expand eligibility for Medicaid. Insurance premiums are an obstacle to obtaining and maintaining Medicaid coverage (Mazurenko et al., 2018). Even relatively small cost-sharing levels are associated with reduced care, including necessary services, and an increased financial burden on families; government savings from insurance premiums and Medicaid equity are limited.
Reporting systems should become more comprehensive, standardized, and widely available to enhance the quality of medical care. Plans, hospitals, and other service providers should then use the information they provide to conduct meaningful audits and make changes to improve quality. Measures should also be taken to encourage beneficiaries to use the available information when choosing healthcare providers. However, beneficiaries should exercise caution as the data is presented differently depending on the source of information, which sometimes leads to confusion or misinterpretation. Most indicators focus on one specific care detail and should not be used as an indirect indicator to measure overall quality.
References
Donohue, J. M., Cole, E. S., James, C. V., Jarlenski, M., Michener, J. D., & Roberts, E. T. (2022). The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity. JAMA, 328(11), 1085-1099. Web.
Gadbois, E. A., Gordon, S. H., Shield, R. R., Vivier, P. M., & Trivedi, A. N. (2021). Quality management strategies in Medicaid managed care: Perspectives from Medicaid, plans, and providers. Medical Care Research and Review, 78(1), 36-47.
Mazurenko, O., Balio, C. P., Agarwal, R., Carroll, A. E., & Menachemi, N. (2018). The effects of Medicaid expansion under the ACA: a systematic review. Health Affairs, 37(6), 944-950. Web.