What is Medicaid? It might just be the reason why a pregnant woman is able to get medical services during and after childbirth. Medicaid is a way the United States government uses to make good health care accessible to some of its citizens. It’s recorded that over 74 million Americans are benefiting from the Medicare program.

Medicare is a Public health insurance plan that is sponsored by the federal government and individual state governments in order to provide health care coverage to low income earning families and other eligible members of the society.  

Individual states are free to set the standards for receiving this insurance plan but whatever they come up with has to fall in line with the federal government’s regulations. The state governments can decide to make the Medicaid program in their states cover more than it usually does and can also include more types of people.


How did Medicaid Start?  

It all started way back in 1965 as a social security act that allowed the federal government to disburse funds to willing states so as to give children whose parents or guardians earn low incomes access to standard health care services. As years passed the United States government modified the requirements and regulations till it transformed into Medicaid.


In 2019 it is recorded that the Medicaid program paid for the medical services of half of the women that gave birth in the United States. This is by far the largest health care insurance program that provides health care coverage to Americans.


Who is qualified for Medicaid?

  1. Children in low-income families
  2. Low-income pregnant women
  3. Disabled people
  4. People above the age of 60
  5. Low-income parents or caregivers


Who is not eligible for Medicaid

  • Adults from 21 years upwards (till they become elderly) are not eligible for Medicaid no matter how low their income is.
  • Adults who are below 138% of the poverty line are also qualified to benefit from this program. This is due to the Affordable Care Act.


What is the Affordable Care Act (ACA)? 

The Affordable Care Act, formerly known as “The Patient Protection And Affordable Care Act” and is sometimes called “ACA”, “PPACA” or “Obamacare” was enacted by the 111th US congress and signed by President Barack Obama in 2010 to make it a law. 

The Affordable Care Act was designed to provide low-income earners living below 138% poverty line and other eligible people with affordable health insurance policies so they will be able to have access to standard healthcare. The federal government uses premium tax credits to reduce the cost of insurance for an individual and cost-sharing reduction to provide subsidies to reduce the cost of insurance deductibles, co-insurance, co-pays and out-of-pocket maximum therefore, giving the individual a cheap insurance policy. 


How did the ACA improve Medicaid eligibility range?

Due to the fact that the Affordable Care Act expanded the eligibility range for Medicaid to 138 percent below the poverty line, more people have access to price subsidised health care services. Now not just pregnant women, children or senior citizens can benefit from this program but also adults with low incomes.

In 2013, before the Affordable care Act started to work, an estimated 44 million Americans were without health insurance but in 2017 the amount dropped to 27.4 million.


What does Medicaid cover?

Here are the mandatory benefits of Medicaid:

  • Inpatient hospital services
  • Home medical services
  • Outpatient hospital services
  • Early and periodic screening, diagnostics and treatment services
  • Nursing services
  • Physician services
  • Rural health and clinic 
  • The federal government approved health centre services
  • Laboratory and X-ray services 
  • Family planning services
  • Nurse midwife services
  • Certified paediatric and family nurse practitioner services.
  • Birth centre services
  • Ambulatory services

The state government can go ahead to add more benefits to the mandated ones if they like.


What is the difference between Medicaid and Medicare?

Over the years people have been confused about the difference between Medicaid and Medicare. Although both of them help subsidise the price of health care services for people they differ in eligibility format and who controls them. Medicare focuses on senior citizens, that’s older people and disabled people (Young or old) and is managed by the federal government while Medicaid focuses on helping low-income earners and is managed by the state government.


However you look at it, healthcare is such an important aspect of society and the US government has shown that it takes it very seriously by first starting the Medicaid and Medicare programs then enacting the affordable care act into law.

A lot of families today can now have access to good healthcare whenever it’s needed. It is estimated that by 2029 Fourteen million more people will be enrolled on the Medicaid program and granted access to affordable healthcare.


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