Tag Archives: Medicaid

CHIP!

I love that show! No, wait, that’s not it. Not plural.

So crunchy! Dang, that’s not it either.

Children’s Health Insurance Program. In 1997 people decided that children not having health insurance in America, a country that spends 15% of the world’s largest GDP on health care, was a bad thing. Since people can always rally around “the children” they created the State Children’s Health Insurance Program, funding matching grants to the states to provide health insurance to the children who weren’t eligible for Medicaid due to income, but didn’t have health insurance through a parental employer.

Section 2101 of the PPACA expands this program by offering more money to the states (23%!) to increase enrollment. If there isn’t enough money, then those children will be eligible for the Exchanges. The plans offered must meet be comparable to pediatric care available through qualified health plans. If a child is made ineligible for Medicaid because of changes to the eligibility of that program, that child will be eligible for CHIP.

Section 2102 is called Technical Corrections. They are very technical.

Section 2201 discusses how to simplify enrollment in Medicaid and CHIP, and how those programs can be coordinated with the Health Insurance Exchanges. Short answer – the Internet!

Section 2202 gives authority to the hospitals to make presumptive declarations about who is eligible for Medicaid.

The next subpart discusses improvements to Medicaid services.

Section 2301 allows coverage for freestanding birth centers for pregnancy, assuming it is licensed as such.

Section 2302 is really depressing. It says that you can pay for both hospice care and treatment for sick children at once. I told you it was depressing.

Section 2303 provides for family planning services for women who are not pregnant.

Section 2304 is a clarification of the definition of medical assistance. It’s not the world’s most interesting definition, but important, I supposed.

I think I could have come up with more than 4 improvements to Medicaid, but I guess you have to start somewhere.

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Mediwhat?

For those of you who don’t know – Medicaid is joint program between the federal government and the state to assist specific lower income populations pay for medical care. It was established in 1965 along with Medicare (a social insurance program for those over 65, fully funded by the federal government).

During the debate over the details of the PPACA in Congress, there was some suggestion of creating a national, single-payer, health care system by expanding Medicaid coverage to all people in the U.S. This was immediately denounced as “socialism” and therefore anathema. Instead, the PPACA expanded the coverage for some people.

Up until the passage of the Act, Medicaid eligibility was incomes at or below the poverty line. Section 2001 expands this coverage, starting in 2014, to those with incomes up to 133% of the poverty line. Additionally, whereas before childless or non-pregnant adults under 65 were not eligible unless they were disabled, those restrictions will be removed. The Congressional Budget Office estimates that this will be 16 million additional people. This increase is fully funded by the federal government for 3 years, decreasing each year after that until its final funding level of 90% starting in 20201.

You can’t enroll yourself, if you don’t enroll your children, or have them covered in some other way.

The states can’t limit enrollment until they have operating Exchanges.

Medicaid must offer the minimum essential coverage that is required by the PPACA in general.

Mental health services must be offered in the same manner as other medical services – known as mental health parity.

Reports shall be made!

Section 2002 says that adjusted gross income will be used, and you can’t leave out any income, but you can’t have an asset test. This doesn’t apply if you are getting other aid that makes you eligible, you are over 65, you are blind, or disabled. Current enrollees are grandfathered in.

Section 2003 says that if you are eligible for Medicaid, you, and your children, don’t lose that eligibility if you don’t apply for insurance through an employer.

Section 2004 increases the age limit for eligibility for Medicaid for former foster children, who wouldn’t have the opportunity, then, to be on a parent’s insurance.

Section 2005 gives more money to the US territories. Quick! Who can name them?? Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Island and American Samoa.

Section 2006 gives more money, for two years, to areas hit by natural disasters.

Section 2007 rescinds money due to the Medicaid Improvement Fund for years 2014 through 2018, if it isn’t spent. On a fascinating side note, go to this page http://www.ssa.gov/OP_Home/ssact/title19/1941.htm and read the foot notes about all the changes that have taken place in just this one section. Oh Congress.

1 it should be noted that Texas, or rather its governor, among other states, has already stated that it will not enact this portion of the PPACA. While we haven’t gotten to the portion that is the stick to this carrot, the Supreme Court struck down the portion of the PPACA that stated that if a state didn’t increase eligibility, that ALL of its Medicaid funding would be rescinded. Instead, only the portion for the increase will not be given. I leave it to the Legislatures of the various states to explain why they aren’t insuring their citizens.

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