Question

The Affordable Care Act (ACA) encouraged states to expand their eligibility for Medicaid by providing government subsidies to those states that participated. The subsidies awarded were for the first few years of Medicaid expansion.

1. Explain this process of Medicaid expansion as a result of the ACA.

2. Identify those states that did not expand their Medicaid programs. Choose one state and provide an explanation of why they did not expand their Medicaid program with your opinion as to whether you agree with the state’s decision. Defend your position.

Justify your answers with research and reasoning.

Answer 1

Medicaid is a government run program, which aims at insuring the lower-income class people. It is a joint run program between the federal and the state government.

Three major programs running under Medicaid are:

• MCOs to facilitate the long term care of elderly (LTSS)
• Health Insurance Premium Payment Program (HIPP)
• Early and Periodic Screening, diagnostic and Treatment (EPSDT)

Medicaid has been the major contributor in the LTSS. The evolution of health care has changed LTSS to more of managed care at home. However it is a facility for the lower income people who cannot afford appropriate health care for themselves. If a rich man is transferring his assets to prove himself poor and eligible for the Medicaid assistance, this should be considered as pure fraud and strict punitive measures can be considered on the defaulter. There can be exceptions for the transfer of assets and must be considered from case to case basis.

The Medicaid funding is proposed to be set on per-capita basis. This means that the federal government would send a fixed amount to the state government for per Medicaid enrollment in the state. Also the per-capita basis would divide the enrollees into several diverse categories. This will be done to estimate the size of payments.

Talking about the Medicare program, it is going to benefit from the Obamacare repeal. This repeal will increase the funds dedicated to Medicare. Premiums, cost sharing and deductibles are likely to be increased as an effect of the repeal.

• Short term implication: Shift in government policy from ACA to Medicaid
• Long term implication: Increased coverage of citizens under the Medicaid

Florida is one country which did not opt for Medicaid expansion. The Senate of the country had approved the proposal for expansion, but it got rejected by the State Government. The State Government proposed that it will be ablr to take better care of the citizens without the expansion of Medicaid.

However this step is not benefitting the citizens of Florida:

• No of uninsured is third highest in Florida
• The mental health of women is deteriorating in the country
• The primary care of the uninsured is getting difficult to manage

https://www.politico.com/states/florida/story/2018/05/22/with-scott-on-defense-reports-show-florida-woes-for-not-expanding-medicaid-433299

https://www.nytimes.com/2015/06/06/us/health-care-expansion-is-rejected-in-florida.html