The Q Series: Quality Health Care Answers
The Q Series: A series of informative posts on the blog that explain the fundamentals of quality health care and emerging trends in health care delivery reform – this time on Medicaid.
The Q Series: What is Medicaid?
Medicaid is a joint program of federal and state aid for low-income people of all ages. It helps pay for health care costs for individuals and families with limited income and resources. The federal government sets guidelines and states choose the extent of coverage. Each state creates its own Medicaid program, including additional state benefits mandated by the federal government and optional.
Compulsory benefits include medical care and services received in a hospital, a specialized nursing facility, a rural health clinic or a federal health center. The most important benefit is support and long-term health care services. While Medicare offers limited coverage for long-term care, Medicaid can cover the cost of nursing homes, assisted living facilities and other long-term care alternatives, as long as they are medically necessary. According to Medicaid.gov the mandatory benefits of Medicaid also include:
Early detection and periodic diagnosis, diagnosis and treatment (EPSDT) services for children.
Nursing Institution Services.
Home Health Services.
Certified Pediatric and Family Nursing Services.
In addition to these benefits and others, states may also choose to provide Medicaid coverage for prescription medications, occupational therapy services or physiotherapy; speech and hearing services; or respiratory care services.
The cost of coverage depends on income and state rules, and may include limited bonuses, deductibles, copays, and co-insurance. Some groups are exempt from certain reimbursable expenses.
Shireesha Jevaji is Senior Policy and Communications Specialist at NCQA and has been with the organization since 2012. She supports NCQA's external communications to the consumer public and public and private stakeholders. She also performs data analysis for the production of infographics and publications and measures the impact of awareness. Shireesha is currently working on her MPH in Public Health Communication and Marketing at George Washington University.