Working with Medicaid

Working with Medicaid

Medicaid is a federal government and state programed health insurance, established under the Title XIX of the Social Security Act back in l965. Medicaid is a voluntary state administered program where each state individually, along with federal government, decides their eligibility guidelines the services that the state will provide under their Medicaid program. However, all states have participated since 1982 (Wikipedia, 2011). These programs are set up to aid eligible families and individuals within the state they live. The federal government monitors the state run programs and aids the states by establishing requirements for service delivery, quality, eligibility standards, and funding to help pay for the medical services of those whom qualify. This paper will focus on the general eligibility requirements, the various services covered, when a provider can directly bill a patient, as well as whether or not I believe this program is effective and why or why not.

There are laws (minimum federal requirements), with guidelines, and regulations that vary from state to state for eligibility in each state’s Medicaid program. Some states have their own names for Medicaid, bundling together additional programs that are managed under the same organization that handles Medicaid. In 1997 the Balanced Budget Act by the federal government, offered the State Children’s Health Insurance Program (SCHIP). This program is for families with low-incomes that are not low enough to qualify for Medicaid to cover many preventative services, physician services, and inpatient and outpatient services for uninsured children till the age of 19 (Valerius, Bayes, Newby, Seggern, 2008). “States are required by federal law to inform all Medicaid-eligible people who are under the age of 21 of the availability of Early and Periodic Screening, Diagnosis, and treatment (EPSDT) and immunizations. The ESPDT program emphasizes preventative care, which also covers health care...