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

© 2008 Delmar Cengage Learning. 2 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

© 2008 Delmar Cengage Learning. 3 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

© 2008 Delmar Cengage Learning. 4 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

© 2008 Delmar Cengage Learning. 5 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

© 2008 Delmar Cengage Learning. 6 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

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

© 2008 Delmar Cengage Learning. 8 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

© 2008 Delmar Cengage Learning. 9 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

© 2008 Delmar Cengage Learning. 10 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

© 2008 Delmar Cengage Learning. 11 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

© 2008 Delmar Cengage Learning. 12 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

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

© 2008 Delmar Cengage Learning. 14 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

© 2008 Delmar Cengage Learning. 15 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”

© 2008 Delmar Cengage Learning. 16 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