Internship Research, (cont.)

 

Chapter Three: Medicaid Expansion

 

This week I was reminded of why Medicaid expansion is necessary for our country. I saw something that made me remember why we need expanded Medicaid services. Certain populations of individuals in our country are more vulnerable in regards to health. This vulnerability means that they require extra health services. I realized that the largest users of Medicaid services fall under the category of a vulnerable population. Those populations are the elderly, disabled individuals, children, and pregnant women.

When you break down the benefits of Medicaid for each population, you realize that Medicaid may be the only way they can receive any healthcare treatment. Let’s use elderly individuals as an example. For elderly individuals who cannot afford to retire or retirees who do not have a lot of income, medicare provides them with routine and specialized care. For individuals who are already covered under Medicare, Medicaid provides additional coverage for various services. According to Medicaid.gov, “Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid (e.g. MSPs, QMBs, SLBs, and QIs). Medicaid also covers additional services beyond those provided under Medicare, including nursing facility care beyond the 100-day limit or skilled nursing facility care that Medicare covers, prescription drugs, eyeglasses, and hearing aids. Services covered by both programs are first paid by Medicare with Medicaid filling in the difference up to the state's payment limit,”(2020).  Many individuals with disabilities rely on the services provided through Medicare. “Medicaid is the primary payer for essential long-term services and supports.  In addition to nursing home care, Medicaid supports home- and community-based services, such as personal and attendant care services that help people with disabilities live in their homes and communities.  Medicaid also covers wheelchairs, lifts, and supportive housing services.  This care is typically unavailable through private insurance and is too costly for all but the wealthiest people to fund out of pocket,”(2017).

For the disabled, Medicaid provides employment opportunities. For disabled children, provides services for the child while they are attending school. Ultimately, the major beneficiaries of Medicaid services are women and children. For women, Medicaid provides access to a variety of health services. Routine checkups, reproductive care,  and long-term care services are covered under Medicaid. Many of the women who use Medicaid services are balancing work and family life. “Over half of nonelderly women on Medicaid work outside the home (56%). Many others are not employed for pay but are caring for family members (19%), have a serious illness or disability (13%), or attend school (6%). Approximately six in ten mothers on Medicaid (62%) are working and another quarter are caring for family members. Among women without children, half (53%) are working and another 19% have an illness or disability,”(Medicaid's role for women, 2019). On average,  women live longer than men and develop chronic conditions that require long-term services (Medicaid's role for women, 2019).  Under the Children’s Health Insurance Program  (CHIP), are provided a variety of services, including well visits, dental care, and vaccines. Extra coverage varies from state to state.

According to the Kaiser Family Foundation, “A large body of research shows that Medicaid beneficiaries have far better access to care than the uninsured and are less likely to postpone or go without needed care due to cost. Moreover, rates of access to care and satisfaction with care among Medicaid enrollees are comparable to rates for people with private insurance. Medicaid coverage of low-income pregnant women and children has contributed to dramatic declines in infant and child mortality in the U.S,”(Garfield & Rudowitz, 2020).  Knowing the benefits that Medicaid can provide, some states have still opted out of expanding services. In our state of South Carolina, we have 27.5%  of the population enrolled in Medicaid but refuse to expand coverage. The question is why?

Many South Carolina officials cite the high cost of expansion as the reason for opting out, but the cost of expanding services is not high at all. According to the Center on Budget and Policy Properties, “South Carolina will spend $372 million more on Medicaid to cover additional enrollment of currently eligible children and parents through 2022 with or without the expansion. The expansion would increase state spending by $1.2 billion. Altogether, this additional spending is just 7.0 percent more than what South Carolina would have spent on Medicaid in the absence of the ACA,”(How Would the Medicaid Expansion Affect South Carolina, 2013).  After opting out of Medicaid expansion, the state of South Carolina imposed work requirements to qualify for Medicaid. The issue with this requirement is that many low-income individuals who are unable to work no longer qualify for Medicaid. “In December 2019, when CMS approved South Carolina’s Medicaid work requirement (“community engagement”) proposal, it was the first such approval for a state that hasn’t expanded Medicaid. Because South Carolina hasn’t expanded Medicaid, the state’s Medicaid population consists of low-income people who are children, elderly, disabled, pregnant, or parents of minor children. Adults who don’t fit into one of these categories are not eligible for coverage, no matter how low their income is,”(Norris, 2020). Many of the individuals who are a part of the vulnerable population I mentioned earlier, no longer qualify for Medicaid. So, what happened to these individuals? They are now included in the number of uninsured individuals in South Carolina. The number of uninsured individuals in South Carolina is currently 514,772, but that number continues to grow every day.

Now, that we have identified the issue, what is the solution? Where do we go from here? Healthcare is a right that should be provided to all individuals, despite their ability to pay. How do we incite change in this country? We do it by fighting back. We must challenge our senate and house representatives to make the decisions that we move our country forward and not backward. Having numerous advocates for a particular cause can incite change. Medicaid expansion isn’t a simple task that can be done overnight.  Making this happen will take dedicated coordination and cooperation from state officials.

 

Medicaid Expansion Summary: Medicaid services offer a variety of individuals access to healthcare services. Women, children, the disabled, and the elderly all benefit from Medicaid services. The services provided under Medicare allow these individuals to seek routine and specialized care. According to the Kaiser Family Foundation, “A large body of research shows that Medicaid beneficiaries have far better access to care than the uninsured and are less likely to postpone or go without needed care due to cost. Moreover, rates of access to care and satisfaction with care among Medicaid enrollees are comparable to rates for people with private insurance. Medicaid coverage of low-income pregnant women and children has contributed to dramatic declines in infant and child mortality in the U.S,”(Garfield & Rudowitz, 2020). In states that have expanded Medicaid services, their citizens are receiving extra coverage for healthcare services. Unfortunately, South Carolina opted out of expanding its Medicaid services. South Carolina officials cited high costs as the reason for denying expansion, but expanding Medicaid services would not be a costly expenditure. “South Carolina will spend $372 million more on Medicaid to cover additional enrollment of currently eligible children and parents through 2022 with or without the expansion. The expansion would increase state spending by $1.2 billion. Altogether, this additional spending is just 7.0 percent more than what South Carolina would have spent on Medicaid in the absence of the ACA,”(How Would the Medicaid Expansion Affect South Carolina, 2013) (How Would the Medicaid Expansion Affect South Carolina, 2013). After refusing to expand Medicaid services, South Carolina officials then imposed work requirements to qualify for Medicaid. This addition disqualified thousands of South Carolinians from receiving Medicaid.

Special Note:  A distinction should be made between individuals on Medicaid due to poverty and individuals on Medicaid due to disability. Individuals who are impoverished and may also be disabled, would be considered dual eligibles. Individuals with dual eligibility qualify for both Medicaid and Medicare. My research focuses mainly on impoverished individuals facing maternal health with or without Medicaid coverage.

Click here to continue to Chapter Four - Maternal and Child Mortality