Health Care Systems - Medicaid






While the health care system in the United States is considered among the best in the world, the number of people who do not have health care is still a major problem facing the country. One in every six people under the age of sixty-five, including many children, is uninsured. Medicaid is the joint state-federal health care program for low-income people. Medicaid also covers people who are chronically sick or disabled. Over thirty-six million people rely on Medicaid for health care.

Many states are adopting managed care, instead of fee-for-service, for Medicaid recipients. Roughly one in three people on Medicaid are in a managed care program. Medicaid is different in every state and the District of Columbia. The federal government dictates the rules by which states must run their Medicaid programs.

SPEAK UP!

Sometimes the rules for a managed care plan are difficult for people receiving Medicaid. For example, one plan required all appointments to be made by phone. This would be a problem if a person didn't have a phone, or if a person spoke a different language and could not communicate over the phone. If people have problems with Medicaid or the managed care plan, they can and should make the complaints known to both the plan's members services department and the local or state social services department. Unless people speak up, those who are making the decisions may not even be aware that there's a problem.

Some states are now extending Medicaid benefits to low-income people who work and are not eligible for welfare. Many of these efforts are aimed at insuring children whose parents work but still cannot afford private insurance. Medicaid managed care is an option being offered to families around the country.

Having health care coverage under Medicaid does not automatically mean easy access to health care. Many low-income Medicaid recipients have had difficulty in finding local providers, because low-income neighborhoods are often underserved by the medical community. Because Medicaid also limits the amount it will pay for services and often pays below market rates, many doctors won't accept Medicaid patients. Medicaid patients traditionally are forced to rely on emergency rooms for primary care treatment.

Managed care can correct some of these problems for Medicaid beneficiaries. Once a person is enrolled in a managed care program through Medicaid, the act of searching for a provider is unnecessary. The managed care plan will provide a list of approved providers. Access to preventive care is increased through the use of a primary care physician. Managed care has also improved the range of benefits for Medicaid recipients in some states. Despite these benefits, Medicaid managed care is not without problems. Sometimes people get very little time to choose a managed care plan, and/or sometimes the state does not send out a list of providers when it is time to pick a managed care plan. If a person does not choose right away, he or she will be automatically enrolled in a plan. As a result, the providers could be far away and not accessible by public transportation. Also, if a person already has a relationship with a doctor, and the doctor is not a part of the managed care plan network, the continuity of care is interrupted. The transition to managed care for many Medicaid recipients has been less than smooth.

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