Medicaid Health Plan was initiated in 1965 under the Social Security
Act. CMS (Centers for Medicare and Medicaid Services) is responsible for
overseeing the programs and creating the funding, eligibility standards
and requirements for the service delivery, as each state has to
administer it own program. Certain states have even given their own
names to the Plan. For instance, it is called Medi-Cal in California,
and in Massachusetts, it is called Mass Health. Medicaid is not
mandatory for all states; however all states have participated in the
program, and some states have even integrated the Plan with other health
programs.
Most states use private companies to deliver the
various benefits of the Medicaid Health Pla. Some states also pay
hospitals, clinics, and doctors directly. In states that subcontract to
private companies, the health insurance company is allowed to
participate directly in the Medicaid program; however, the price per
person is fixed. Once the pan has chosen the eligible candidates and
recruited them in the program, the private insurance companies are
responsible for delivering the benefits of Medicaid to these people.
Since, there are many private companies involved, there is some sort of
competition, which ensures superior quality and delivery of health care
services
The Medicaid Health Plan is mainly for providing health coverage to
families, elderly, pregnant women, children, people with low income, and
disabled people. Even though all state run Medicaid programs have to
comply with federal guidelines, these guidelines might vary between
states. The eligibility criteria for the pan also differ between each
state; however, majority of states provide coverage for low-income
families with children, certain seniors, disabled people and pregnant
women. Secondly, the eligibility criteria for Medicaid is expanding to
include more people, and hence if people were disqualified before, they
should check the new rules, as there is a possibility that they might be
eligible for the Plan under the new rules.
Medicaid Health Plan
has helped several states to improve their health delivery systems for
marginalized portion of the population. People who have not enrolled for
the Plan have to rely on expensive emergency room services instead of
primary care providers. Beneficiaries of the Plan on the other hand have
a dedicated health care provider who will coordinate care at low costs.
The Plan facilitates contact and access to community based health care
services, which not only includes medical care, but also services to
meet social welfare and behavioral challenges. It also provides
counseling and prenatal care to expectant mothers.
Medicaid
Health Plan is much superior to fee-for-service program in terms of
savings of cost and quality of measures. Beneficiaries of the Plan can
save as much as 20 percent overall, compared to other programs. Drug
costs for the members are also lower by up to 15 percent compared to
fee-for-service programs. For the states also, the Plan has been a big
boon. States are now able to coordinate health care services in a much
better way for the beneficiaries and at the same time are able to
control the rising costs of health care.