Medicaid long term care program: Still Thriving Ahead

Medicaid has been a long-term means-tested program that consistently receives funding support from federal and state governments. The individual state administers the implementation of this program. Medicaid long term care specifically caters to the needs of low-income groups, such as low-income families with children and people supported by the Supplemental Security Income or SSI (e.g., seniors/elders [aged 65 and older], blind, or disabled people). SSI is a monthly stipend provided to qualified recipients who are unable to work, with no properties or assets, and no means of support from extended families.

A wide range of long term care services and assistances is available to beneficiaries of the program. Basic services—such as laboratory and X-ray services, hospital services, doctor's consultations, family planning, qualified nursing and home health services, intermittent health checkups, and analysis and therapy for children—are provided. Assistances on the other hand, extend from personal (e.g., dressing, eating, bathing, toileting) to living support (e.g., managing home, preparing food, using the telephone, managing medications). Nursing home care and community-based support services are also included.

Provision of long term care services and supports may either be on long term basis or lifetime, depending on the individual's age, income, resources, and physical and developmental conditions. Elders with ages from 65 and above would require long-term assistances. Children, teenagers, and adults with physical and/or developmental disabilities require lifetime services and supports, including those with traumatic brain injuries.

Who qualifies?

Medicaid is specifically designed to low-income individuals or families. There are set financial and functional eligibility criteria to be met by potential Medicaid applicants. Basically, individuals or families with limited or exhausted income or resources are determined as eligible. A particular example of this scenario is when an elder had entered a nursing home as a private client and used up all his life savings. Obviously, the run down of all possible available assets is what makes him eligible for Medicaid.

Likewise, people with physical and mental impairments who are unable to work can be qualified. Especially, if there is no any form of support from extended relatives.

Some current concerns

The fact that Medicaid depends solely on financial funding while exclusively financing for support all long term services, it is understandable for Medicare to design and carry out some strategic measures to help reduce increased spending. Below are some of the determined issues being currently resolved by Medicaid.

Limiting Medicaid eligibility

Eligibility has further made exclusive to very poor or those with huge expenses. Medicaid functions only when all possibly available income or resources are exhausted as it is not an insurance program rather means-tested.

This is also to reduce individuals to exploit functionality of the program. Unfortunately, there are those who conspire to transferring their savings and countable resources to family members or others to make them eligible.

Expansion in consumer direction

Although Medicaid had kept ahead in expanding and improving its community long term support systems, ambiguity in the systems is still inevitable. For instance, the quality of services being delivered and misuse of funds on behalf of incapacitated recipient cannot be avoided. The need for a balance in personal independence, consumer protection, and proper use of public funds is clearly recognized.

Increasing demand for long-term care

As Medicaid continues to play its role in financing long term care supports services, the program also carries the burden on whether it can persist to providing coverage to its beneficiaries.

Through the years, Medicaid long term care has thrived to serve its purpose of financing all support systems. However, Medicaid also deals to a number of problems, which is mainly related to the ways it works or how it operates. In some ways, the system is limited to low-income group therefore denying access for people who can afford care on their own. Likewise, issues on abuse of public funds and quality of long term care services being delivered are confronted.

Fortunately, such issues/problems did not hinder nor stop Medicaid to come up with strategic federal policies and measures that eventually led to some significant improvements. For example, there have been marked developments on the quality and access of the nursing home care and in community-based services when expansion of consumer direction has been made. Likewise, limiting of eligibility discourage some individuals to manipulating the system and misuse of funds. And creating more Medicaid services and a new program to serve as its aide can provide further financial security, likewise security to sustained improvements and future for the Medicaid long term care program.