C3 Medicaid Eligibility and Financing

Over 72 million Americans are currently covered by Medicaid (along with coverage by the SCHIP programs), which makes Medicaid the single-largest source of health insurance coverage in the United States. Depending on income, children, pregnant women, parents, senior citizens, and individuals with certain disabilities are able to access the health care system for needed services. In this Case assignment, benefits, eligibility, financing, and reimbursement levels will be examined – including how the Patient Protection and Affordable Care Act impacted the program. How do the economics of Medicare reimbursement levels vs. private insurance reimbursement levels affect health care systems and providers?

Using the references below, as well as some additional research in peer-reviewed sources, complete your Case assignment by answering the following:
1. Examine the benefits and eligibility of the Medicaid program. Who can be covered, and what are the specific income restrictions when qualifying via financial status? How did the Patient Protection and Affordable Care Act change the income determination methodology?
2. Describe how the Medicaid program is financed. How much do the individual states (including your home state) contribute?
3. Determine how the average Medicaid reimbursement level specifically compares to the average reimbursement for private insurance. How can these reimbursement levels affect the bottom line at your facility?

References
Dillender, M. (2017). Medicaid, family spending, and the financial implications of crowd-out. Journal of Health Economics. Vol 53, 1-16.

Kaiser Family Foundation (2019). Ten things to know about Medicaid: Setting the facts straight. Available at: https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight/

Perez, K. (2017). The fiscal realities of a single-payer healthcare system. Healthcare Financial Management, 71(11), 108-109.

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