Medicaid: Benefits, Eligibility, Financing, and Reimbursement Levels

Medicaid Eligibility and Financing
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Medicaid Eligibility and Financing
1. The Medicaid program benefits and eligibility, the individuals covered, and income restriction to qualify through financial status.
Since Medicaid is the largest insurance company in the U.S.A., it is critical to understand the eligibility and benefits of this program. Medicaid has medical eligibility divided into financial or non-financial eligibility. Financial eligibility is calculated using Modified Adjusted Gross Income (MAGI). MAGI is used in deciding the Medicaid income eligibility for most specific groups, including pregnant women, children, adults, and parents (Brooks et al., 2020). The federal law highlights a person can qualify for Medicaid in case the individual's household income has not yet reached 133% of the federal poverty level (FPL). Even though most of the people are included in MAGI-based income, other groups are exempted. This group includes those eligible based on disability, blindness, or age who are 65 years or older (Colello & Morton, 2019). On the other hand, for non-financial eligibility, the Medicaid beneficiaries must be state residents in the area where they are receiving Medicaid. Moreover, these individuals must be United States or certified, qualified non-citizens. Other eligibility limitation for the group is based on pregnancy, age, or parenting status.
There are also Medicaid benefits that have been designed in such a way that they will address the beneficiaries’ diverse needs. The states usually initiate and regulate the Medicaid programs while deciding the amount, type, duration, and service scope in the broad federal guidelines. The Medicare benefits are divided into mandatory and optional benefits. Mandatory benefits include inpatient hospital services, x-ray services, physician services, outpatient hospital services, rural clinic services, family planning services, nurse midwife services, medication-assisted treatment, and home health services. On the other hand, the optional services include physical therapy, dental services, eyeglasses, dentures, occupational therapy, prosthetics, language disorders, and clinic services.
2. How has the Patient Protection and Affordable Care Act (ACA) changed income determination methodology?
The Patient Protection and ACA transformed the income determination methodology. For instance, it helped in the expansion of Medicaid eligibility to reach 133% of the federal poverty level (FPL). This percen