How Beneficial is Medicaid To Those With Low Incomes?
Today, we are aware of the importance of maintaining good health and being able to utilize HealthCare programs in the event that medical attention is needed. However, not everyone is able to fully benefit from these programs. We are made to believe that if we are not financially stable then we are automatically guaranteed “free” health care through Medicaid. However, that is not the case.
According to Title XIX of the Social Security Act, Medicaid is a federal/state entitlement program that financially assists certain individuals and families with low incomes and resources. Medicaid became law in 1965 as a cooperative project jointly funded by the federal and state governments (including the District of Columbia and the Territories) to assist states in providing medical assistance to eligible needy persons. Medicaid is the largest source of funding for medical and health-related services for America's poorest people (http://www.cms.hhs.gov/medicaid).
Those individuals with lower income may feel it is beneficial to take advantage of Medicaid. However, under the Medicaid program, there are certain eligibility requirements. For instance, those who qualify for Medicaid in one state may not be eligible for Medicaid in another, due to individual state regulations.
Although Medicaid is designed to cater to the financial needs of the lower class, candidates must meet a specific criterion of eligibility. In order to qualify for Medicaid, there are several factors the government takes into consideration. These factors include age, pregnancy, disability, blindness, income and resources, and citizenship (http://www.cms.hhs.gov/medicaid).
Under federal guidelines, families with children receiving support under the former Aid to Families with Dependent Child (AFDC) program (Hoffman et al. 2001), now called Family Independence (FI), are still eligible for Medicaid. Individuals receiving Supplemental Security Income (SSI), which include the elderly, the blind and the disabled with low incomes are also eligible. Children and pregnant women with a family income that is at or below the minimum Federal Poverty Level, which was $18,400 for a family of four in 2003, are also eligible (Shi & Singh 2004).
Medicaid is known as a “means-tested program”: people must qualify based on their assets and income, which must be below the level determined by each state (Shi & Singh 2004). Due to the variation in state eligibility requirements regarding Medicaid, applicants should research their specific state’s criteria of eligibility. The Medicaid coverage groups in the state of South Carolina are parallel to the national level requirements, with income being one of the main factors in determining who qualifies for benefits. In the year 2002, in the state of South Carolina, those falling under the category of the aged, blind, and disabled who earn a minimum of $749 per month ($8,980 per year) with a household consisting of only one individual are eligible for Medicaid services (http://www.dhhs.state.sc.us?).
Although Medicaid aims to accommodate those in financial need, many are naïve in believing that Medicaid is responsible for full coverage of their medical expenses. The money is not sent to you but is sent directly to your health care provider. In some cases Medicaid will cover all medical expenses, but in other instances you may be asked to make a co-payment. Co-payments are small portions of your total medical bill that you may be asked to pay in order to control overutilization of the services Medicaid provides (http://www.cms.hhs.gov/medicaid/).
It is a right of the Medicaid member to be able to choose his or her own physician, hospital, pharmacy, or other medical provider. In order to receive payments, the medical provider must be listed as a Medicaid provider and be willing to accept Medicaid as payment in full. However, in the state of South Carolina, there are some exceptions. There is a limit of four prescriptions per month per recipient 21 years or older. There is a $3.00 co-payment on each drug unless the recipient is pregnant or a child under 21. Medicaid also has the right to waive coverage of pregnant women at high risk. This is to have a better birth outcome (http://www.dhhs.state.sc.us).'
The last sentence (re 'birth outcome' and its relation to coverage) needs further explanation, Bianca.