By Caren Howard, MHA Advocacy Manager
Fifty-four years ago, on July 30, President Lyndon B. Johnson signed into law the Social Security Amendments Act of 1965 establishing the Medicare and Medicaid public health insurance programs. The bill was the start of a commitment federal government made to its citizens to provide a safety net to the uninsured who did not have a way to pay for health care.
How Would Medicaid Help Me and My Loved Ones?
Over the past five decades, Medicaid has become a bedrock of our nation’s health system. It is the number one payer of behavioral health, paying for nearly one-third of all mental health and substance use services. It also covers nearly half of all births and half of children with special health care needs.
Medicaid offers key benefits that many private insurers won’t cover. For instance, Early Periodic Screening, Diagnosis, and Treatment (EPDST) is a comprehensive benefit for children that may prevent the development or exacerbation of mental health conditions. We know that mental health problems affect one in five young people at any given time, and about two-thirds of them are not getting the help they need. Early identification, accurate diagnosis, and effective treatment can help young people to more quickly recover and benefit from their education, to develop positive relationships, to gain access to employment, and ultimately to lead more meaningful and productive lives.
Medicaid also covers three crucial supports for adults: 1) peer support for personal recovery, 2) vocational rehabilitation for those wishing to return to school or work, and 3) transitional housing services for those leaving institutional care to return to their community. With these kinds of supports in place, a person’s overall health care costs can be reduced, and it may mean the difference between a fulfilling life in recovery and remission in the shadows.
In 2010, the Affordable Care Act (ACA) increased the reach of Medicaid two ways:
- By giving states flexibility to change their Medicaid program design to better meet the needs of their state through the 1115 Medicaid waiver program (which “waives” standard Medicaid rules and allows states to operate the program under special rules, provided this does not increase overall costs).
- By offering additional federal funding to states to cover non-traditional populations that would be otherwise uninsured (i.e., now dependent-less adults making up to 138% of the federal poverty level could qualify for coverage).
When more people have insurance to help them pay for their chronic and acute health needs, they end up living longer, more productive lives. They are more likely to find and keep work that contributes to the community. Thus, Medicaid helps increase access to care and reduce the strain of uncompensated care on health systems. Rather than becoming sicker, and waiting until a crisis or emergency, it has been shown that individuals and families with Medicaid find help and get better sooner.
How Can We Protect our Medicaid Programs?
We must reinforce the original intent of the law— to provide a safety net for people who are uninsured.
We must reject policy changes that arbitrarily cap or cut funding, turn funding into a block grant, or create additional work documentation requirements as an eligibility barrier that dis-enrolls people from their coverage.
If this issue hits home for you, take action to contact your elected officials online, via telephone, or through the press, to tell them to protect Medicaid and not to undercut the families and children it serves.
We would like to see Medicaid continue to be a safety net for people who need it for another fifty-four years. Let’s celebrate the success of Medicaid and all those who live better lives because of it!
Further Reading:
What Is Medicaid?
Medicaid is a voluntary health insurance program for the public that was designed to cover individuals who were otherwise excluded from purchasing private market insurance, such as: persons with disabilities, persons impoverished, pregnant women, or persons without geographical access to traditional private providers. It also covered long term care services that Medicare did not.
Medicaid is an entitlement program. It guarantees it will cover services for those who meets eligibility criteria (generally based on income), and it limits how much beneficiaries must pay out of pocket for their care. It is funded by both the federal government and a state, but it is solely administered by the state.
In some cases, people are dually eligible for both Medicare and Medicaid and use both programs at the same time. For instance, they may be lower-income seniors who qualify for Medicare and also have a long-term disability that requires services covered by Medicaid. In this case, Medicaid covers the Medicare co-pays and other cost-sharing payments, Medicare pays for the acute care hospital, medical, and prescription drug services it covers, and Medicaid pays for the long-term care that Medicare doesn’t cover.
To learn more about Medicaid, and to see if your loved one may qualify, visit: https://www.medicaid.gov/
