The Medicaid Program: The Policy’s Issues

Overview of the Medicaid Program

Eligibility

The eligibility of candidates in the Medicaid program is variable, depending on the requirements of every American State. However, the program is subject to financial and categorical eligibility requirements because only people with low incomes are supposed to be beneficiaries of the program (Health Care Financing Administration, 2011). The financial requirements of every population group vary within each state but this does not mean that the program covers everyone under the low-income group. For example, childless couples and adults who do not suffer from any disabilities are not covered (Health Care Financing Administration, 2011, p. 2). However, people with disabilities and members of families with children, or pregnant women (under the low-income group) are eligible for the program.

Program services

The Medicaid program covers a broad range of services for people entitled to it. However, the degree or depth of the services varies from state to state (depending on federal guidelines) (Health Care Financing Administration, 2011, p. 3). Generally, the program covers mandatory services, but it equally provides optional services. Every state may choose from a category of 33 optional services to include in the “optional services” category (Health Care Financing Administration, 2011). There are certain services such as the family planning service which receive a higher federal funding budget as compared to other services covered in the program.

Amount and Duration of Medicaid Services

The amount and duration of Medicaid services is always determined by the state and therefore, the state may vary the number of days a patient is to be treated under the program, or the number of visits a patient can make to hospital. However, this limitation does not extend to children under the age of six, who are admitted in disproportionate share hospitals (Health Care Financing Administration, 2011). Eligible candidates are allowed to exercise their freedom in choosing the appropriate healthcare agents, participating in the healthcare program. Eligible candidates therefore enjoy the freedom of flexibility.

Program Budget

State and Federal Funding

The Medicaid program budget is financed by the federal and state governments (Health Care Financing Administration, 2011). The federal government’s contribution to the Medicaid program varies with the number of people entitled to benefit from the program, but generally, it covers between 50% and 83% of the total budget of the program, for every state (Centers for Medicare & Medicaid Services, 2011). The variations in federal funding emanates from the determination of a state’s per capita income (the lower the state’s per capita income, the higher the federal funding rate and the higher the state’s per capita income, the lower the federal funding rate).

State Funding Requests

States normally submit CMS-37 estimates to request for federal funding of their state’s Medicaid program. This is to be done each quarter of a financial year, during the months of November, February, May, and August. These estimates are used to determine a state’s requirements for federal funding and for estimating future state Medicaid requirements, through determining historical costs.

Programs and Historical Formats

There are two types of programs under the Medicaid program budget: total computable (total cost of the program) and the administration program (which determines the total administrative cost of running the program). These programs are subject to reports categorized under the same names: total computable costs of the program, federal government cost report and the state cost report.

References

Centers for Medicare & Medicaid Services. (2011). Medicaid Program Budget Report (CMS-37). Web.

Health Care Financing Administration. (2011). Overview of the Medicaid Program. Web.