Compare Medicaid Eligibility Requirements And Covered 172831

Compare the Medicaid eligibility requirements and covered services of your state of residence to those of another state

Compare the Medicaid eligibility requirements and covered services of your state of residence (California) to those of another state. Discuss how each state responded to the option of expanding Medicaid benefits proposed by Healthcare Reform.

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Compare the Medicaid eligibility requirements and covered services of your state of residence to those of another state

Compare the Medicaid eligibility requirements and covered services of your state of residence to those of another state

Medicaid, as a joint federal and state program, plays a crucial role in providing healthcare coverage to vulnerable populations, including low-income families, pregnant women, children, and persons with disabilities. As part of the Affordable Care Act (ACA) reforms, states were given the option to expand Medicaid coverage to include more low-income individuals. This paper compares California’s Medicaid program with that of Texas, focusing on eligibility requirements, covered services, and state responses to Medicaid expansion under the Healthcare Reform.

Medicaid in California

California operates its Medicaid program under the name Medi-Cal. Medi-Cal’s eligibility requirements are relatively inclusive, with income thresholds and categorical criteria that accommodate a broad population segment. As of 2023, Medi-Cal covers individuals with incomes up to 138% of the federal poverty level (FPL), including low-income families, pregnant women, children, seniors, and persons with disabilities (California Department of Health Care Services, 2023). Medi-Cal also extends coverage to many immigrant populations regardless of their legal status, which is a notable feature exclusive to California.

Regarding covered services, Medi-Cal provides comprehensive healthcare benefits, including hospital and physician services, preventive care, prescription drugs, mental health services, dental care, and long-term care (California Department of Health Care Services, 2023). The state emphasizes integrated care models, particularly managed care programs, to improve health outcomes and contain costs.

Medicaid in Texas

In contrast, Texas, which opted not to expand Medicaid under the ACA, maintains more restrictive eligibility requirements. Texas Medicaid primarily serves specific low-income groups, including pregnant women, children, elderly individuals, and persons with disabilities. Eligibility is generally limited to those with incomes significantly below the federal poverty level—typically around 138% for children and pregnant women but lower for other categories (Texas Health and Human Services Commission, 2023). Due to the decision not to expand Medicaid, many low-income adults without dependent children fall outside the coverage scope in Texas unless they qualify under limited categories or via other programs.

Covered services in Texas’s Medicaid program mirror federal minimum requirements, including primary and preventive care, hospital services, prescription drugs, mental health services, and dental care for children. However, the scope and extent of services for adults are more limited compared to Medi-Cal, especially regarding long-term care and dental coverage (Texas Health and Human Services Commission, 2023). The emphasis remains on state-funded and federally matched services with more constrained eligibility, impacting access for many low-income adults.

States’ Responses to Medicaid Expansion

The ACA’s Medicaid expansion aimed to extend coverage to individuals with incomes up to 138% of the FPL. California embraced this opportunity, implementing expansion in 2014. The state’s response was proactive, supporting the amendment to the federal Medicaid program to broaden eligibility. California’s expansion substantially increased the number of individuals covered via Medi-Cal, reducing the uninsured rate and improving access to healthcare services (Kaiser Family Foundation, 2022). The proactive approach aligns with California’s broader public health goals and commitment to health equity.

Conversely, Texas rejected the Medicaid expansion, citing concerns over long-term costs, federal mandates, and philosophical opposition to government-mandated healthcare coverage. As a result, over 1 million low-income Texans remain ineligible for Medicaid, leading to significant coverage gaps. The state’s decision has been criticized for exacerbating health disparities and increasing uncompensated care costs for hospitals and providers (Kaiser Family Foundation, 2022). The difference in response illustrates the political and policy divergence between states prioritizing expansion and those opting for limited scope coverage.

Impacts of Medicaid Expansion on Healthcare Access and Outcomes

Research indicates that Medicaid expansion significantly improves healthcare access, increases preventive care utilization, and reduces mortality rates among low-income populations (Baicker et al., 2013). California’s expansion contributed to these positive trends, decreasing emergency room visits for non-urgent issues and improving chronic disease management. Moreover, expanded coverage supports better maternal and child health outcomes, aligning with state public health initiatives (California Department of Health Care Services, 2023).

In states like Texas that have not expanded Medicaid, many low-income adults lack access to regular healthcare, leading to delayed treatment and worse health outcomes. Hospitals face increased financial strain due to uncompensated care, impacting the overall healthcare system's sustainability (Coughlin, 2021). The divergence in outcomes underscores the crucial role of Medicaid expansion in achieving equitable healthcare access.

Conclusion

The comparison between California and Texas highlights the substantial effects of Medicaid policy decisions at the state level. California’s proactive expansion under the ACA broadened coverage, improved health outcomes, and reduced disparities, demonstrating the benefits of embracing healthcare reform initiatives. Conversely, Texas’s decision to reject expansion has contributed to persistent coverage gaps and worsening health outcomes for its low-income residents. Overall, this comparison underscores the importance of state-level policy choices in shaping healthcare access and quality for vulnerable populations.

References

  • Baicker, K., Finkelstein, A., Nabory, D., & Kessler, D. (2013). The Effect of Medicaid on Emergency Department Utilization: Evidence from Oregon’s Affordable Care Act Medicaid Expansion. American Economic Journal: Economic Policy, 5(2), 208-233.
  • California Department of Health Care Services. (2023). Medi-Cal Overview. https://www.dhcs.ca.gov/services/medi-cal/Pages/default.aspx
  • Coughlin, T. (2021). Medicaid Expansion: Benefits and Challenges. Health Affairs, 40(1), 115-122.
  • Kaiser Family Foundation. (2022). Medicaid Coverage and Spending. https://www.kff.org/medicaid/
  • Texas Health and Human Services Commission. (2023). Medicaid in Texas. https://hhs.texas.gov/services/health/medicaid

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