States qualify for federal match if they agree to

Info icon This preview shows pages 5–7. Sign up to view the full content.

States qualify for federal match if they agree to provide coverage for: pregnant women, children, poor elderly, disabled Match rate based on State’s per capita income Pay more to poor states because they have more enrollees and less money Pays for 57% of Medicaid overall ACA expansion, Fed will cover for first 3 years 2/3 of spending on Acute care, 1/3 on Long-term Medicaid pays large chunk to Nursing care Block grants as alternative to Fed matching? Single set amount per patient per year Fed gives dollar amount and State has flexibility to design program Could increase incentives for States to reduce costs, because they receive 100% of benefits of reducing cost Cost $320 billion in 2010 Eligibility Rules Mandatory Eligibility: certain pregnant women, children, foster children, adults with dependent children, elderly and disabled receiving SSI 185% FPL for pregnant women ($18,000-19,000) Children eligible if family has 250% FPL Big spend item people living with HIV/AIDS- 47% Optional Eligibility: Medically needy, persons in nursing homes, people with breast or cervical cancer, disabled not receiving SSI Mandatory Medical Benefits States must provide ceratin service in order to receive Fed matching funds Nursing facility services for those over age 21 Inpatient/outpatient hospital care Physician care Home health care for persons eligible for skilled-nursing facilities Optional Medical Benefits May also receive Fed matching funds for providing certain optional services Optometrist services, Eyeglasses
Image of page 5

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

Diagnostic services Rehab and physical therapy Hearing aids Nursing facility services for children under 21 Prosthetic devices Coverage and Cost Sharing States determine the amount and duration of services offered under their Medicaid programs Two restrictions apply Amount provided must be sufficient to reasonably achieve purpose of the benefits May not discriminate based on medical diagnosis or condition States may impose nominal deductibles, coinsurance, or copays on some recipients for certain services Beneficiaries excluded from cost sharing: Pregnant women; children under 18; hospital or nursing home patients who are expected to contribute most of their income to institutional care All beneficiaries excluded from copays in emergency services and family planning services If below 150% FPL, basically no cost sharing Growth State Medicaid spending growth in negative territory in 2009-’10 because of the federal stimulus Allocation between State and Fed growth changing because stimulus money running out Reasons for rapid growth in expenditures Increase in size of Medicaid covered populations (fed mandates, population growth, economic recession) Expanded coverage and utilizaiton of services Increase in number of very old and disabled people requiring extensive acute and/or long-term health care
Image of page 6
Image of page 7
This is the end of the preview. Sign up to access the rest of the document.
  • Spring '08
  • Harrington
  • Medicare Modernization Act, Cost sharing, Medicare Advantage

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern