Gerontological Nurse Certification Review, Second Edition by Alison E. Kris RN PhD

Author:Alison E. Kris RN, PhD
Language: eng
Format: epub
Publisher: Springer Publishing Company, Inc.
Published: 2015-06-14T16:00:00+00:00

MEDICAID

Medicaid, a combined federal and state payment system, varies from state to state, but it funds health care, including nursing home care, for low-income older adults.

Medicaid is a governmental program aimed at improving access to health care for indigent individuals.

Medicaid is a state-administered insurance program that provides health care for all ages. In fact, half of Medicaid recipients are children.

To be eligible for Medicaid, older adults must meet specific income and asset guidelines put forth by their state.

Older people who have minimal financial resources and who qualify for income assistance through a federal program called Supplemental Security Income (SSI) also become eligible for Medicaid health care benefits.

Persons age 65 and older may have Medicare benefits and also qualify for Medicaid.

For older adults with limited assets and income, Medicaid may supplement Medicare benefits and pay for health care expenses not covered by Medicare, including medications, additional hospital or nursing home days, and durable medical equipment.

For older adults who have both Medicare and Medicaid coverage for health care, Medicare is the primary payment system and Medicaid is secondary.

The Centers for Medicare & Medicaid Services (2014) reports that Medicaid is currently the largest source of funding for health-related services for the poor in the United States.

Medicaid was enacted by the same legislation as Medicare in 1965, also known as Title XIX of the Social Security Act.

There is wide variability in covered medical expenses throughout the country.

Each state establishes eligibility guidelines, allowable expenses, how much will be paid for these expenses, and how the program will be run within the state. Thus, there are as many different Medicaid programs as there are states. Mandated covered expenses for older adults include:

•Inpatient and outpatient hospital services

•Physician services

•Nursing home services

•Home care services that are delivered to prevent nursing home stays

•Laboratory and x-ray services

Many state Medicaid programs provide extended coverage for home- and community-based services if these services are keeping the older adult out of a covered nursing home stay; these fall within a newer Medicaid program known as All-Inclusive Care for the Elderly.

The Personal Responsibility and Work Opportunity Reconciliation Act of a 1996 welfare reform bill made legal resident aliens and other qualified aliens who entered the United States on or after that period ineligible for Medicaid for 5 years.

If an older adult is a Medicaid recipient, payment for health care expenses is provided directly to the health care provider.

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