What is the biggest insurance program in the country? Medicaid. Nearly 1 in 5 Americans participate in Medicaid, and that total is rising. According to some recent estimates about 11 million more people will be added to the programs over the next decade.
Of course Medicaid is often associated with Medicare, but there is much confusion over the basic roles of these programs.
In theory, Medicaid is suppose to help lower income Americans of all ages while Medicare is healthcare for seniors. However, the reality is that a large portion of Medicaid costs are actually spent on senior care as well–most notably long-term stays in nursing homes. That is because Medicare usually only covers limited nursing home stays–often 90 days–and only those directly from the hospital. Long-term care for seniors that have significant disability is usually not covered. That means that a senior who needs that care is either required to pay for it out of pocket, use private long-term care insurance (if they have it), or try to qualify for Medicaid. Medicaid is based on the individual’s assets. That means that many seniors are forced to “spend down” their assets in order to qualify for the program.
It is for this reason that nursing home compliance with federal Medicare and Medicaid laws is so crucial. If facilities are not allowed to participate in the CMS program–and lose residents on Medicaid–then they often are unable to function.
Possible Medicaid Changes
The connection between Illinois nursing homes care and Medicaid also means that it is important for local residents to follow political developments with the program. Political candidates are often talking about different changes to the system–usually offered in order to save costs. That is obvious in the current Presidential campaign as both candidates often mention Medicaid in their long-term plans for the country.
In the midst of the campaigns spin and confusion, it is often difficult to get a clear idea of what each candidate is actually proposing for Medicaid. A recent NPR segment sought to clarify the issue, offering a straight-forward explanation for each candidate’s position.
The story notes that Governor Romney is proposing more far-reaching changes. Right now Medicaid is a joint state-federal program. Romney’s proposal would change that–giving individual states much more control. The federal government would simply give each state a block grant to use for the program as they wish. In addition, that grant would be capped year over year. Critics argue that the cap is lower than the annual inflation rates, meaning that this proposal would be nothing more than a pay cut for Medicaid providers (hospitals and doctors), which forcing states to do more with less.
Alternatively, President Obama’s Medicaid proposal was a part of the Affordable Care Act. Essentially it allows states to expand coverage to more low income families. The idea is that this growth in Medicaid participation will lower expensive emergency costs while improving the overall health of the community. Critics argue that this does nothing to curb the financial stresses of the program and that it is unsustainable in the long-term.
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