LaGuardia Community College
City University of New York
Department of Natural & Applied Science
Practical Nursing Program.
Maternal Child Health Nursing
Edeneth Flores
Stacy Moyston-Duckie
Janell Trotman
Petra Ramnarine
Anaise Ikama
Na Pang
Yvonne Prempha
Majorie Johnson
Marie Jimenez
Paola
SCL 115
Fall I 2007
Prof. Griffiths.
Edeneth Flores
What is Medicaid?
Medicaid is a program was created for those who can't afford to pay for medical care. It is
a needs-based program that covers insurance for aged and disabled persons, families who are
receiving aid, families with dependent children, pregnant women and infants. ( Rosdahl, 2003, P.
33). Medicaid is the largest source of funding for medical and health-related services for people
with limited income. he Medicaid program is part of Title XIX of the Social Security Act that
became a law in 1965 by President Lyndon Johnson. The Medicaid program was signed into law
on July 30, 1965. President Lyndon Johnson is pictured at the signing ceremony in
Independence, Missouri at the Truman Library. Former President Truman is seated beside him.
President Lyndon Johnson held the ceremony there to honor President Truman's leadership on
health insurance, which he first proposed in 1945( http://www.cms.hhs.gov/History/. Its main
goal is to serve low-income family, aged and disabled person, so, they could have an affordable
health insurance. In addition, the program is funded jointly by the state and federal governments
and administered by the states (www.wikipedia.com).
Medicaid offers federal matching funds to states for costs incurred in paying health care
providers for serving covered individuals. State participation is voluntary, but since 1982, all 50
states have chosen to participate in Medicaid (www. Answers.com). Accordingly, Medicaid is
very complex. Over the years, Medicaid has gone through many changes such as the eligibility,
what it covers, income requirements etc. These changes that occurred over the years varies from
state to state. Each individual state has it's own criteria on how a person or a family will be
eligible in this insurance. In other words, Medicaid is a public health insurance program for
which people must qualify (Rosdahl, 2003, P.33).
Petra Ramnarine
Who is eligible for Medicaid
Ethnic group
All ethnic groups qualify for Medicaid in New York State, once criteria for the income levels are
meet.
Age group
All age groups qualify for Medicaid especially children, and people over the age of 65 years old
Population that qualifies for Medicaid is pregnant women, children, disabled persons, mentally
challenge, blind, and people over 65 yrs meets these criteria. Anyone receiving public assistance
or supplemental security income (SSI) also qualifies for Medicaid.
(www.newyorkhealth.gov.2007)
Eligibility
The financial eligibility requirements for Medicaid depend on income and resource levels also
on the number of people in your family and this is subjected to yearly adjustments. People
owning personal property such as cars, homes and other personal properties and still be eligible
for Medicaid .(www.newyorkhealth.gov.2007)
Number in family
Monthly net income
Resource
1
$700
$4200
2
$900
$5400
3
$1100
$6600
4
$1109
$6650
5
$1117
$6700
6
$1134
$6800
7
$1275
$7650
8
$1417
$8500
For additional person, add:
$142
$850
. Income and Resource Levels are subject to yearly adjustments. (www.newyourhealth.gov.2007)
Anaise Ikama
How do you apply Medicaid?
Being healthy or having a feeling of well-being free from microorganism is important
and plays a big role mentally, psychologically and socially. With this in mind, we ought to
emphasize that good health, which is important to everyone, is a part of our daily lives’ needs
and communication. But, are we all in good health? And how many of us here in the City of New
York can afford to pay for their medical care? Therefore, we must not be surprise to learn that so
many, among us, don’t have health insurance to make possible for them to get the care is need to
stay healthy.
There are different types of medical insurance to apply for such as Aetna, Metroplus etc,
but the most common and affordable or sometimes “free” for charge, depending on the states’
rule, is Medicaid. According to the centers for Medicare & Medicaid Services, “Medicaid is
available only to certain low-income individuals and families who fit into an eligibility group
that is recognized by federal and state law” (www.cms.com. 2006). Although there is no fee to
become edible there are special requirements to consider. To apply or request an application, the
following requirements must be met: your age, income and resources (any items that can be sold
for cash) and be either a U.S citizen or a lawfully admitted immigrant.
Now that you have met or match one of the descriptions of eligibility, an application
should be filed to find out if you are eligible. But where, when and what do we need to apply for
Medicaid? You can apply for Medicaid online, by phone or to any of the nearest local
department of social services near you. Any residents of New York City can call the toll free
number at 877-472-8411. Children including pregnant women can apply at any prenatal care,
hospitals or clinics. For those who have family member who live in nursing homes or have
disabled children, there are special rules for them. An application for Medicaid has to be filed
first in order for the Medicaid caseworker to determine your family’s eligibility.
After contacting a qualified caseworker, you will be giving a day to start your application
and interview process. The day of your application interview, you would need “Proof of age, like
a certificate; proof of citizenship or alien status; recent pay check (if…working); any bank books
and insurance policies that you have; proof of [address] like a rent receipt or landlord statement
and the insurance benefit card or the policy (if you have any other health insurance)”
(www.health.state.ny.us. 2007). Then, an eligibility worker will interview by a series of
questions that was answered on the application to see if it correspond with what was put on the
application. If you have been approved for Medicaid, you will need to wait 60 to 90 days to start
your coverage.
Basically, any U.S citizen or lawfully proved immigrant with a low income can apply for
Medicaid and have a qualified caseworker in your state evaluate your situation.
Janell Trotman
What does Medicaid Cover?
Title XIX of the Social Security Act which is also known as Medicaid is very flexible when it
comes to coverage. Medicaid covers most services that falls under the umbrella of healthcare but
there are some restrictions. Some Federal conditions are required if the Federal government
matching funds are to be received. “A State's Medicaid program must offer medical assistance
for certain basic services to most categorically needy populations,” (Websites). These services
generally include the following:

Inpatient hospital services.

Outpatient hospital services.

Prenatal care.

Vaccines for children.

Physician services.

Nursing facility services for persons aged 21 or older.

Family planning services and supplies.

Rural health clinic services.

Home health care for persons eligible for skilled-nursing services.

Laboratory and x-ray services.

Pediatric and family nurse practitioner services.

Nurse-midwife services.

Federally qualified health-center (FQHC) services, and ambulatory services of an FQHC
that would be available in other settings.

Early and periodic screening, diagnostic, and treatment (EPSDT) services for children
under age 21.
(http://www.cms.hhs.gov/MedicaidGenInfo/03_TechnicalSummary.asp)
They are some limitation to some of those services that was previously mentioned. It depends on
which type of HMO the person has and which state they reside in. Some states receive money to
provide other services that other states might not offer. The following is the most common
approve optional Medicaid services:

Diagnostic services.

Clinic services.

Intermediate care facilities for the mentally retarded (ICFs/MR).

Prescribed drugs and prosthetic devices.

Optometrist services and eyeglasses.

Nursing facility services for children under age 21.

Transportation services.

Rehabilitation and physical therapy services.

Home and community-based care to certain persons with chronic impairments
Medicaid also have special services for the elderly population. “Programs of All-inclusive Care
for the Elderly or PACE provides alternative to institutional care for persons aged 55 or older
who require a nursing facility level
care,”(http://www.cms.hhs.gov/MedicaidGenInfo/03_TechnicalSummary.asp). PACE offers all
health care services to elderly people who need help. Some of the services include but limited
preventative, rehabilitative, curative and supportive care. Those type of care can take place in
health centers, client’s home, hospitals and nursing homes. The federal government and State
determines the amount and duration of each service that is given under the Medicaid program.
“States may limit, for example, the number of days of hospital care or the number of physician
visits covered. Two restrictions apply: (1) limits must result in a sufficient level of services to
reasonably achieve the purpose of the benefits; and (2) limits on benefits may not discriminate
among beneficiaries based on medical diagnosis or condition,
(http://www.cms.hhs.gov/MedicaidGenInfo/03_TechnicalSummary.asp)”. In other words some
services must be done to benefit the client’s health.
Medicaid pays for most services but some may not be covered because of age, financial
circumstances, living arrangements and family problems. Some of the services that are offered
require a small copayment.
Medicaid does not provide service to all poor people. “Medicaid program does not
provide health care services, even for very poor persons, unless they are in one of the designated
eligibility groups.” () One has to be within a certain income range and certain resources to
become eligible for Medicaid.
Stacy Moyston-Duckie
What is Medicaid Managed Care Programs?
From the beginning, managed care has implemented a way of improving services being
offer to vulnerable low-income families; while containing program expenditures. Managed care
has given many Americans the opportunity to enroll in their medical coverage program through
other organizations working in conjunction with them such as, Health Maintenance Organization
(HMO), clinic, hospital-based plan : HealthFirst, Fidelis, Metroplus, as well as physician group
that is available at any local departments of social services. Managed care has given their
beneficiaries the primary option of choosing their personal doctor who will be responsible for
making sure all their health needs met. If these physicians are not capable of handling such
conditions these patients are refer to other specialist.
As the article posted on the website, health.state.ny.us/health_care/Medicaid stated that,
“When you join a managed care program, you will choose a personal doctor who will be
responsible for making sure all your health care needs are met” (p. 5).
Under managed care, however, each beneficiary is entitled to a regular primary care provider, a
twenty-four hour telephone access to the physician, along with flexible office appointments. It
was mandatory that clients with special conditions and needs such as the mentally ill, substance
abusers, persons with AIDS fall under the umbrella of managed care. There are several other
services that fall under managed care, “most of the benefits recipients will use, including all
preventive and primary care, … people in managed care plans use their Medicaid benefits card to
get those services that the plan does not cover” (p. 5).
Managed care is offered in other countries and an option for membership is offered. One
can join this health policy singly of jointly with their family. However, special considerations are
given to the disabled person. If these people meet the standard requirement where by they are
included in the Social Security Act, they might be eligible for Medicaid. Proper medical
documentation of the client’s illness must be provided to the local department of social services.
Based on this evidence the department can either request more medical proof through varies test.
The specific medical test and consultant evaluation will incur a fee that the local social services
agency would settle. Today managed care Medicaid program is encouraging community health
centers and hospitals themselves to become apart of the managed care team. Today Medicaid
manage care program has widen and strengthen its boundaries of medical coverage to the poor,
and needy.
Na Pang
Medicaid: Prescription Drugs
Medicaid is currently the largest public payor for prescription drugs, and it is an important source
of drug coverage for the low-income elderly, including nearly 6 million Medicare beneficiaries,
and people with disabilities. While constituting roughly a quarter of Medicaid enrollment, these
two populations account for approximately 80% of the program’s drug spending. Prescription
drugs have been an important driver of Medicaid spending growth for the last several years,
prompting heightened state efforts to control drug utilization and costs.
All state Medicaid programs provide coverage for prescription drugs; although there are sizable
differences in state policies with regard to copays, types of drugs that are covered, and the
number of prescriptions that can be filled. Similar to the private sector, prescription drug costs
under Medicaid have also grown rapidly in recent years. To date, Medicaid has imposed minimal
cost-sharing for its beneficiaries; however, as states struggle to meet expenses within their
Medicaid programs, more have turned to policies to help control drug expenditures, including
creating preferred drug lists (PDLs), using utilization restrictions on certain medications, such as
prior authorization, and negotiating rebates with pharmaceutical manufacturers. In addition, with
the recent enactment of the Deficit Reduction Act (DRA), states can also use enforceable, higher
co-payments for prescription drugs than they previously were allowed. As part of the Medicare
drug benefit, those receiving Medicare and Medicaid, called dual eligibles, had their drug
coverage switched from Medicaid to Medicare at the beginning of 2006. Dual eligibles now
receive subsidized drug coverage through one of the Medicare prescription drug plans provided
by private insurers. Medicaid continues to wrap around Medicare's benefits for the dual eligibles.
While they are no longer providing prescription drug coverage to the dual eligibles, the states are
responsible for payments to the federal government to provide for the dual eligibles' drug
coverage, called the "clawback."
The New York State Medicaid Preferred Drug List is as following.( see attached.)
Yvonne Prempha
MEDICAID-AVAILABILITY AND ELIGIBILITY
Medicaid is a state administered program and each state sets its own guidelines regarding
eligibility and services. Medicaid is available only to certain low-income individuals and
families who fit into an eligibility group that is recognized by federal and state law. It makes
possible for those who can not afford medical care get the care they need.
Whiles Congress and the Centers for Medicare and Medicaid Services set out the main rules
under which Medicaid operates, each state runs its own program .As a result, the eligibility rules
differ significantly from state to state, although all states must follow the same basic framework.
States are required to include certain types of individuals or eligibility groups under their
Medicaid plans. The key states eligibility groups are:
1. Categorically Needy

Families who meet states’ Aid to Families with Dependent Children (AFDC) eligibility
requirements effective July 16, 1996.




Pregnant women and children under the age of 6 whose family’s income is at or below
133% of the Federal poverty level. Refer to the table.
Children ages 6 to 19 with family income up to 100 of the Federal poverty level.
Caretakers (relatives or legal guardians) who take care of children under the age of 18 or
19 if still in high school.
Supplemental Social Security Income (SSI) recipients .In certain states, aged, blind, and
disabled people who meet requirements that are more restrictive than those of the SSI
program are also given Medicaid.
2. Medically Needy
People who fall under this category have too much money to be considered categorically needy.
States that have this program must cover pregnant women through to a 60-day postpartum
period, children under 18, certain newborns and certain blind persons. At the states’ options,
Medicaid may be provided to:





Full time students under the age 21, 20, 19, or under 19.
Aged persons i.e. age 65 and older.
Caretaker relatives (relatives or legal guardians who live with and take care of children).
Blind persons, blinderness being determined under the SSI program standard or states’
standard.
Disable persons, disability is determined under the SSI program standard or states’
standard.
States that have medically needy programs are:
Arkansas,Hawaii,Maine,Nebraska,Pennsylvania,VermontCalifornia, Illinois, Maryland, New
Hampshire, Virginia, Connecticut, Iowa, Massachusetts, New Jersey, Rhode Island, Washington
Dist. of Columbia, Kansas, Michigan, New York, Tennessee, West Virginia Florida, Kentucky,
Minnesota, North Carolina, Wisconsin, Georgia, Louisiana, Montana, North Dakota, Utah.
3. Special Groups
 Medicare Beneficiaries—Medicaid pays Medicare premiums, de-tuctibles and
coinsurance for Qualified Medicare Beneficiaries (QMB)
 Qualified Working Disabled Individuals - Medicaid can pay Medicare Part A premiums
for certain disabled individuals who lose Medicare coverage because of work. These
individuals have income below 200% of the Federal poverty level and resources that are
no more than twice the standard allowed under SSI.
 Eligibility can be extended to working disabled people between ages 16 and 65 who have
income and resources greater than that allowed under the SSI program.
 A time-limited eligibility for women who have breast or cervical cancer and are
uninsured. Women with breast or cervical cancer receive all plan services. States
including women with breast or cervical cancer: Alabama, Florida, Louisiana, Nebraska,


Ohio, Texas, Alaska, Georgia, Maine, Nevada, Oklahoma ,Utah ,Arizona, Hawaii
Maryland ,New Hampshire, Oregon ,Vermont, Arkansas ,Idaho Massachusetts, New
Jersey ,Pennsylvania, Virginia, California, Illinois, Michigan ,New Mexico, Rhode
Island, Washington, Colorado Indiana ,Minnesota ,New York, South Carolina, West
Virginia ,Connecticut ,Iowa ,Mississippi, North Carolina, South Dakota ,Wisconsin,
Delaware, Kansas ,Missouri ,North Dakota, Tennessee Wyoming, Dist. of Columbia
,Kentucky, Montana.
A time-limited eligibility for people with tuberculosis (TB) who are uninsured .TB
patients receive only services related to the treatment of TB. States that include these
groups under their Medicaid: California Minnesota, Oklahoma ,Rhode Island ,Wisconsin
Dist. of Columbia ,New York ,Puerto Rico, Utah, Wyoming, Louisiana.
Long Term Care-All states provide community Long Term Care services for individuals
who are Medicaid eligible and qualify for institutional care. Most states use eligibility
requirements for such individuals that are more liberal than those normally used in the
community.
4. Qualify Aliens
To be eligible for Medicaid, a non-citizen must be a "qualified alien." The Personal
Responsibility and Work Opportunity and Reconciliation Act of 1996, P.L. 104-193 (PRWORA)
substantially restricted immigrants’ eligibility for means-tested benefits programs, including
Medicaid. Qualified aliens, defined in §431 of PRWORA, as amended, include:
 Aliens lawfully admitted for permanent residence under the Immigration and Nationality
Act (INA), 8 USC 1101 et seq.;
 Refugees, admitted under §207 of the INA;
 Aliens granted asylum under §208 of the INA;
 Cuban and Haitian Entrants, as defined in §501(e) of the Refugee Education Assistance
Act of 1980;
 Aliens granted parole for at least one year under §212(d)(5) of the INA;
 Aliens whose deportation is being withheld under (1) §243(h) of the INA as in effect
prior to April 1, 1997; or (2) §241(b)(3) of the INA, as amended;
 Aliens granted conditional entry under §203(a)(7) of the INA in effect before April 1,
1980;
 Battered aliens, who meet the conditions set forth in §431(c) of PRWORA, as added by
§501 of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, P.L.
104-208 (IIRIRA), and amended by §5571 of the Balanced Budget Act of 1997, P.L.
105-33 (BBA), and §1508 of the Violence against Women Act of 2000, P.L. 106-386.
Section 431(c) of PRWORA, as amended, is codified at 8 USC 1641(c).
 Victims of a severe form of trafficking, in accordance with §107(b) (1) of the Trafficking
Victims Protection Act of 2000, P.L. 106-386.
Marie Jimenez
MEDICARE & MEDICAID
Because of the increasing cost of healthcare in the United States, programs such as
Medicare and Medicaid were designed to assist with these rising healthcare costs. According to
Matthews and Berman, the major difference between Medicare and Medicaid is that Medicare
was “created to deal with the high medical costs that older citizens face…[I]t is an entitlement
program while Medicaid is for low-income, financially needy people”(Matthews & Berman,
2007, p. 233). In addition, Medicare provides financial assistance for people who are over 65
years of age regardless of their financial background.
The establishment of Medicare was not a simple process. There were many failed
attempts to pass a bill in which the government would create a universal healthcare plan. One of
the reasons why attempts to pass this bill failed was due to financing. According to Livingston,
“No one knew how much a health care program would cost”(Livingston, 2002, p.138). This was
a problem for Congress because they were not sure of the “true financial burden of a health care
program on the government” until after passing the bill (Livingston, 2002, p.138).
A second reason why attempts to pass a bill failed was that there was a strong opposition
by the American Medical Association (AMA). The AMA feared that the government would
limit and “restrict the practice of medicine…[by] dictating treatments they could offer and fees
they would charge…and limit the number of patients in a physician’s practice”(Livingston, 2002,
p.139). The AMA felt that the government would take away their autonomy and viewed
programs such as Medicare and Medicaid as a threat.
Eventually as the debate over creating a healthcare plan was at its peak, it was until July
of 1965, according to Livingston, that President Johnson made Medicare effective and “signed
into law”(Livingston, 2002, p.146). Today, according to Matthews & Berman, “Medicare
provides coverage for over 42 million people” in the United States (Matthews & Berman, 2007,
p. 227). While Medicare benefits millions of people in assisting healthcare costs, there are
differences between Medicare and Medicaid in terms administration of program, coverage, and
consumer cost.
In terms of how Medicare is administered, Medicare is a federally funded program in
which the rules and regulations apply throughout the United States. In contrast, Medicaid rules
vary from state to state such in determining the Supplemental Security Income (SSI). According
to Matthews & Berman, “Most states use the same income and asset limits set by the SSI,
program. Other states establish their own Medicaid limits”(Matthews & Berman, 2007, p.422).
Coverage between Medicare and Medicaid also differ in that Medicare is divided into a
three-part coverage plan. According to Matthews & Berman, “Part A is called hospital insurance
and covers most of the costs of a stay in the hospital, as well as some follow-up costs afterward.
Part B, medical insurance, pays some of the costs of doctors and outpatient medical care. And
part D pays some prescription drug”(Matthews & Berman, 2007, p. 235). In contrast, Medicaid,
coverage also includes inpatient coverage “and many services that Medicare does not cover such
as prescription drugs, diagnostic and preventative care, and eyeglasses. The amount of coverage,
however varies from state to state”(Matthews & Berman, 2007, p.234).
In terms of consumer cost, Medicare requires paying a “yearly deductible for both Part A
and Part B…[in addition] to paying hefty co-payments for extended hospital stays”(Matthews &
Berman, 2007, p.234). In contrast, depending upon some states, Medicaid “charges consumers
small amounts for certain services”(Matthews & Berman, 2007, p.234).
Paola
What are the current trends in medicaid?
Currently, Medicaid coverage for parents is limited and many low-income parents are not
eligible. Uninsured low-income parents who are working have very limited access to employer
coverage. These parents face real health consequences when they delay care and the entire
family is affected when those delays cause a parent to remain ill or be unable to participate in
daily activities. Without health insurance for parents, families are more likely to incur debt and
cut back on their basic, everyday needs in order to pay for care. Therefore this negatively
influences not only their own health but their financial concerns and most importantly, the well
being of their families.
It’s no doubt that Medicaid Programs aid in preventing larger increases in the already
high uninsured population. Any cuts in the Medicaid program will obviously then reduce or
eliminate the critical benefits that vulnerable Americans, like low income children, parents, and
people with disabilities require.
Today, more Americans than ever before are uninsured, and the situation is rapidly
worsening. With more than one out of three Americans now uninsured, the problem is now a
great dilemma. Rising health insurance premiums are putting health coverage out of reach for
many employees, leaving more workers without even an offer of coverage. Of the total 89.6
million uninsured people in 2006-2007, 64.2 million were uninsured adults (18 to 64 years old).
More than one-third of the uninsured (34.9 percent) were ages 25 to 44—the age group that
makes up the largest percentage of the uninsured.
Why are the numbers of uninsured increasing? A large factor that influences the
uninsured rate is one’s financial income. Individuals who work in low-wage jobs as well as those
who have part-time, temporary, or seasonal jobs, are less likely to have health insurance than
those who work in higher-wage, full-time jobs. This is why states with a larger population of
low-income workers tend to have a higher uninsured rate.
Another factor that affects the numbers of the uninsured is the availability of public
programs and options. States that have expanded Medicaid coverage beyond federally set
minimums tend to have lower rates of uninsured than states that do not offer such flexibility and
alternatives in coverage.
Together, these factors are crippling our nation’s health care system. As efforts to expand
coverage move forward, assessing the coverage needs of low-income non-citizen adults, who
have a very high uninsured rate due to limited access to both private and public coverage, will be
an important consideration. Largely as a result of their high uninsured rates, low-income noncitizen adults have very poor access to care. Having insurance significantly improves their access
to care, but, even with insurance, it appears they continue to face other access barriers, which
include language and cultural differences. Furthermore, federal rules leave public health
programs, such as Medicaid, unable to provide assistance to the millions of low-income working
people who are uninsured but do not meet eligibility requirements.
With the goal of improving health, access to care and reducing the rate of being
uninsured, plans are emerging at both state and federal levels to expand health insurance
coverage. Most recently, a few states have moved forward with coverage expansion proposals
that would provide greater opportunities for obtaining health insurance. Addressing the health
coverage needs of low-income parents will be an important part of future efforts to expand
coverage and reduce the number of uninsured. Furthermore, in order to receive federal matching
funds, each state must provide a certain core set of services and cover specific groups of
individuals. States have some discretion in setting limits on the amounts of service available to
its recipients. States also have a certain amount of freedom in setting reimbursement rates paid to
most of the providers of Medicaid covered services. Some states also have chosen to extend
eligibility to additional groups of people that are not eligible for federal financial funding.
Therefore, even though the program has extensive federal requirements and restrictions, states
administer the program with many options to tailor their programs to meet individual state’s
medical assistance needs.
A plan of action and turning point must be implemented: Either we make addressing
health care coverage a top priority or we continue moving in the wrong direction. These trends
show the terrible consequences of ineffectiveness of the health care coverage system. We need to
ensure coverage for the uninsured. This crisis will only worsen until there is national or state
leadership that takes decisive and significant actions to ensure that health coverage is easily
accessible and affordable for all.
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