As budget season in Washington begins, one thing comes to the top of our ledger: Medicaid.
Members of Congress have proposed a new health insurance overhaul that, among other things, would cap Medicaid payments to states in a misguided effort to cut costs. A similar scenario is playing out in the states that have not yet expanded Medicaid under the Affordable Care Act (ACA). Indiana's recent federally approved proposal allows the state to benefit from an influx of federal dollars for expanding Medicaid, while also imposing burdensome premiums and co-pays on the poor people it is trying to help.
Lest the impact of these proposed changes be lost, we should stop and look at what makes Medicaid "Medicaid" and why it is so important that Medicaid remain "Medicaid."
Fifty years since its enactment, Medicaid has proven over and over again to be successful in achieving what it is designed to do: provide needed health care coverage to the most vulnerable individuals. Medicaid covers people who otherwise would have to do without, with crippling consequences for them and the nation.
Part of what makes Medicaid so successful is its structure, which is tailored to the populations it serves: low-income people, particularly children, persons with disabilities, pregnant women and older adults. Contrary to popular belief, Medicaid covers these groups in the most cost-conscious way, often lower than comparable private insurance plans. And Medicaid is flexible, giving states lots of ways to tailor programs to meet their budgets and enrollees' needs.
Yet, Medicaid is a favorite program to attack. Whether it is from opponents who want to gut federal funding and radically transform the program or states that aim to cut costs by burdening beneficiaries, the attacks keep coming.
Here are four ways to keep Medicaid "Medicaid." Because 68.5 million people are counting on it.
- Mandatory benefits stay mandatory: To put it simply, Medicaid plays a crucial role in our health system through the scope of care it covers and the populations it serves. Low-income children and youth suffer disproportionately from chronic diseases and developmental delays. Medicaid provides them with access to a screening and treatment benefit (known as Early and Periodic, Screening Diagnostic and Treatment), which can catch problems earlier and help improve their long-term health. Similarly, Medicaid ensures that low-income women have guaranteed access to family planning services. Medicaid also targets services to individuals with disabilities and older adults -- serving as the most significant long-term care insurer in the country. This enables people in these groups to receive care in their homes or communities, rather than an institutional setting. Federal law gives states a great deal of flexibility in deciding how to cover services, as long as those services are sufficient in the "amount, duration and scope." This Medicaid standard for care protects those who need it and should never be compromised.
- Keep Medicaid affordable: Because Medicaid covers people who are living near or below poverty, cost-sharing can quickly lock people out of care or force them to make difficult choices between health care, food and rent. States can impose premiums and cost-sharing on some Medicaid beneficiaries. Congress, however, has closely guarded beneficiaries over the years, acting to ensure that coverage is affordable. The only way to keep Medicaid affordable is to limit premiums and other forms of cost-sharing that undermine access to care.
- Uphold due process protections: Medicaid is a legal entitlement and as such, comes with Constitutional and statutory protections. Beneficiaries have the right to receive their Medicaid cards and needed services without unreasonable delays. And states cannot terminate or alter coverage without letting beneficiaries know in advance about the planned action and providing them with the opportunity for a hearing before an impartial hearing officer. Functionally, this means that Medicaid's protections allow people to maintain access to the health care they need while justice is pursued.
- Maintain continuous coverage: Low-income people often face urgent health care problems and have no ability to quickly access care without special enrollment policies. Vulnerable people can also face threats to their health when their coverage status changes and leaves them one emergency away from tragedy. Medicaid includes special protections that avoid cutting off care or leaving a newly eligible person without the ability to enroll. Unlike private coverage, Medicaid enrollment is open year round, and the law requires that assistance be furnished with reasonable promptness. In the context of the ACA, states are implementing new requirements to re-determine enrollee eligibility under the new income counting rules, and must do so in ways that do not burden enrollees or cause them to inadvertently lose coverage. And to ensure that people can quickly get the care they need without delay, Medicaid provides retroactive eligibility, back to the date of application. Together these policies ensure that enrollees can quickly apply, access and keep coverage when they need it and must be protected.