See Decription

Introduction

The social health care program, Medicaid is aimed at providing health care services to the needy and those with disabilities in the United States. The Act should provide the state with the way forward or criteria to be followed in selecting the people who are to benefit from the social health program. However, over time, it has not been clear to every American citizen as to which criteria should be used in determining the needy in the society. In particular, it has been challenging on selecting the eligible citizens for the program with a focus on the level of income and the level of expenditure. For instance, the issue of “spend down” periods has posed a lot of difficulties in determining the eligibility for Medicaid. A way great issue regarding the funding, expansion, and determination of eligibility for Medicaid includes the requirement by the Supreme Court in the United States for regions such as Massachusetts to contribute the six months’ excess income towards medical expenditure before the Medicaid coverage program begins in such regions. This paper seeks to explain the issue of Medicaid coverage and the eligibility of the different level of community members. It also explores the level of government affected by the issue as well as the analysis of the eligibility of Medicaid.

Economic Issue

The social health program (Medicaid) requires adequate funding in order to cover effectively a large and needy population. While it would be more beneficial to expand the program to the other categories of people in the society such as those with disabilities, there should be constant and enough supply of funds both from the government and the good wishers such as donors to help reach out every needy member of the society. Inadequate funding is an issue since there is a large percentage of people who need medical assistance and cannot afford it unless they get subsidized medical health care or fully assisted by programs such as the Medicaid (Ford, Spicer, & Institute of Medicine (U.S.), 2012).

Coupled with the low income of most of the society members, it is clear and evident enough that the majority of the people in the United States value social programs such as Medicaid. However, failure to adequately fund the program has only led to development and implementation of strict procedures and regulations in determining those who are eligible for the program. In particular, the six-month spend down period has resulted in more complex procedures, some of which are neither clear nor understandable to society members. The methodology used has never been friendly to the low-income people; the approach involving spend down for six months tends to be difficult in determining the rightful members to the benefits of the program (Commerce Clearing House & Blue Cross Association, 2005). For instance, at some point, the income of particular groups may, unfortunately, exceed the categorically needy level. In such a case, needy people are mistakenly excluded from the program. Using same methodology for the State Medical Plans would be advisable in fair and just determination of eligible applications.

Level of Government

The challenges in determining the eligibility for Medicaid is experienced at the state level. The social health program is popular and thus attracts the attention of the citizens, the government, as well as the international organizations. While the government of the United States has the obligations to provide medical care to the citizens, it is compelled to adhere to the requirement of the Social Security Act as well as the legislations from the Supreme Court (Ford, Spicer, & Institute of Medicine (U.S.), 2012). On the other side, the state has the overall responsibility to implement the adjustments or changes that are encouraged and required for the Medicaid. The responsibility has now seen many states come up with health reforms, some of which have resulted in a lot of alterations on particular aspects of the social health program. This has led to challenges in financing and coverage of Medicaid to the needy.

Analysis

The problem of eligibility for the program coupled with the challenges in funds and coverage is accelerated by the lack of clarity in the methodology used; the six-month spend down approach fails to outline clearly all the limitations of the methodology (Commerce Clearing House & Blue Cross Association, 2005). In most of the cases, the provisions of the Social Security Act are watered by plain statutory language while the actions of the authority in charge of the Medicaid program do not fully comply with the legislation of the Supreme Court. The problem has ever existed due to the mere instructions of states to ensure fair and equal treatments of all income components for categorically and medically needy persons. Additionally, there is no clarity on the control of the length or duration of spend down methodology. In particular, the problem of funding and expansion of the Medicaid program, as well as the determination of eligibility arises from the inconsistency of the legislation and the Congressional intent.

Conclusion

The program targets to provide all the necessary assistance to the citizens of the United States fairly as long as they fall into the legal category of the needy people as spelled out in the legislation by the Social Security Act. The challenges in the funding, expansion, and determination of eligibility for the program require consultations and adherence to the provisions of the Social Security Act in order to ensure fairness to every needy person in the United States.

References

Commerce Clearing House., & Blue Cross Association. (2005). Medicare and Medicaid Guide. New York.

Ford, M. A., Spicer, C. M., & Institute of Medicine (U.S.). (2012). Monitoring HIV cares in the United States: A strategy for generating national estimates of HIV care and coverage.