Wednesday, August 19, 2009

A Health Care (Plan) Dilemma :: Part III

Barriers to Enrollment in Medicaid

Medicaid is a jointly state and federal governments funded insurance program for the "poor" created in 1965 through Title 19 of the Social Security Act. Managed by the states, this program reimburses for health care services provided by hospitals and physicians to those who are unable to pay for their own medical expenses. It covers about 40% of the costs of childbirths and 60% of the costs of elderly individual health care. Since 1995, there has been a reduction in the number of elderly Hispanics and Blacks covered by Medicaid (from 40.5 to 23.4 million in 2006). However, as a result of an increase of unemployment and job displacement, in recent years, the number of Medicaid members has been increased tremendously. In 2005, 33.2 million people under 65 years of age were covered by Medicaid nationwide and 36.2 million in 2006; for those who are 65 years of age (and over), 3.2 million were covered in 2005 while 3.3 in 2006 (CDC, 2007). According to the US Department of Health and Human Services, Medicaid spending for outpatient prescription drugs has increased as well by 20% per year on an average from 1997 to 2002, jumping from $11.6 billion to $23.7 billion during that period (USDHHS, 2006). Nevertheless, in urban settings, certain enrollment barriers such as eligibility, language and cultural issues and the public knowledge about Medicaid have kept many uninsured from participating in this program.

Eligibility to Medicaid prevents uninsured from enrolling to this insurance program. Because of the Medicaid funding status, eligibility criteria to the program vary from state-to-state (or even from city-to-city) . In New York State, for example, not all public assistance recipients are eligible to Medicaid. Only those who are under the age of 21, living with deprived families or pregnant women _ ineligible under the LIF category _ with no other children are eligible. Additionally, Medicaid coverage is available to pregnant women or those who require treatment for an emergency medical condition regardless of their legal status. However, for the rest of the population, the minimum salary level required to be eligible for Medicaid varies and/or is uncertain. A family of 4 earning a gross annual salary of about $ 24,000.00 may not be qualified for Medicaid because they would be considered being above the national poverty level. Additionally, the Medicaid form has been reported to be very ambiguous. One must provide Proof of income from sources such as Social Security, Supplemental Security Income (SSI), Veteran's Benefits (VA), retirement, discloses any bank books and current insurance policies enrollment, etc. All those details complicate the process of qualification for uninsured Americans, particularly those living in urban areas. The Kaiser Commission on Medicaid and the Uninsured suggests that being enrolled in Medicaid has more to do with chance than official outreach efforts (KCMU, 2000).

Language and other cultural barriers also influence Medicaid enrollment. In many immigrant communities, English is not very much spoken and understood. Most of the times, parents rely on their children to either translate (for them) or take them to the doctor's office were SCHIP and Medicaid representatives could be easily found. Feinberg et al (2000) suggest that respondents speaking foreign languages are more than twice as likely as others to ignore how to sign up for Medicaid and to even identify barriers related to the application form. Consequently, ethnicity-nationali ty-language concordance mitigates disparities and prevents many from enrolling to Medicaid.

The public knowledge about Medicaid is very limited. Feinberg et al (2002) assert that most commonly, not knowing if a child is eligible for Medicaid and believing that Medicaid is only for people on welfare deter uninsured from enrolling to the program and generating negative perception about Medicaid. There is a lack of outreach that keeps uninsured from learning about Medicaid's eligibility and the types of medical care that are covered. Although in many cities in United States there are a lot of public health activities that are taken place within low income neighborhoods to encourage uninsured parents and their children to enrolling to Medicaid and SCHIP, but many of them are still not getting the message.

Targeted outreach in areas such as employment centers, schools, (churches, public buildings) and other public settings increase children's enrollment in public health insurance programs (Kaiser Family Foundation 2008: 12). Grassroots community has been very successful in helping uninsured understand the eligibility criteria, the kind of health services covered by Medicaid and guiding them through the application process. Dubay et al (2003) suggest that simplifying the application form, lengthening time between renewals, adopting continuous eligibility and eliminating requirements for families to document things that can be verified in different ways are likely to increase Medicaid enrollment. A better understanding of the Medicaid-Medicare system is likely to help Americans (or those who are living in United States) understand why a universal public health plan is important and what is needed to make it work.


The Kaiser Commission on Medicaid and the Uninsured: http://www.kff/. org/about/

kcmu.cfmFeinberg E, Gardner J, Walker DK, Swartz K, Zaslavsky A; Academy for Health Services Research and Health Policy. Meeting. Barriers to Medicaid Enrollment: Lessons from a State Initiative. Abstr Acad Health Serv Res Health Policy Meet. 2000; 17

Dubay Lisa, Guyer Jocelyn, Mann Cindy, Odeh Michael. Medicaid at the Ten-Year Anniversary of SCHIP: Looking Back and Moving Forward. Insurance Design. Project HOPE. The-people-to- people Health Foundation, Inc. 2007

By: Macceau Medozile

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