Medicaid Myths and Truths

Medicaid is a program by the Federal and State government to provide access to health care for families and individuals belonging to the low-income, limited-resources bracket.  Each state has established their own eligibility guidelines, the services and benefits made available to those who qualify and the rates of payment. Such a large health program is not without complexities and this has led to widely-believed myths that have caused confusion to many.

This article does not serve as legal advice. Remember, it is always best to consult with a professional advisor who specializes in Medicaid requirements and long-term care issues in your state of residence.

MEDICAID MYTH #1: Medicaid is an outdated program.

FACT: Medicaid keeps up with the American health care system as it has developed over time. Individual states have been experimenting with new ideas for benefit design, eligibility requirements and delivery systems as allowed by the waiver process. Several states are presently exploring with moving long-term care services from a nursing home to home and community-based care.

MEDICAID MYTH #2: Medicaid is inflexible.

FACT: Although Medicaid has minimum federal standards requiring states to cover certain groups of people, each state has the flexibility to modify and execute their programs beyond the established minimum standards.

MEDICAID MYTH #3: Medicaid spending is uncontrollable.

FACT: Due to the recent economic turmoil, a distinct rise in enrollment of low-income families to Medicaid has been observed resulting in an increase in Medicaid spending. However, the cost growth per one enrollee for Medicaid is still lower than coverage under Medicare, private health insurance providers and employee-sponsored insurance coverage. Additionally the rise in health care costs encompasses the whole American health care system, not just Medicaid.

MEDICAID MYTH #4: Medicaid provides insurance coverage that is more than a person really needs.

FACT: The primary role of Medicaid is to provide low-income families, with health insurance. Most of the time, it is also the only option available for disabled, low-income seniors requiring long-term care. The medical attention these people need are not readily accessible to them through other means, giving Medicaid the function of safety net to catch those who are falling through the cracks in the health care system.

MEDICAID MYTH #5: Medicaid covers a disproportionately large number of people, displacing private health insurance.

FACT: In truth, the people covered by Medicaid do not have access to any other type of medical insurance. They are uninsured due to loss of employer-sponsored insurance, cannot afford to pay for private health insurance themselves or are uninsurable by private health insurance standards due to illnesses or disabilities.

MEDICAID MYTH #6: Medicaid is health insurance for people who don’t work.

FACT: Medicaid was detached from the welfare system in 1996 although it was intended to grant health insurance to welfare recipients in the beginning. At present, working families make up 65% of Medicaid recipients and those who are out of work include disabled individuals. For these, Medicaid provides cash assistance and much-needed health coverage.

MEDICAID MYTH #7: Medicaid picks up the tab for nursing home bills of rich people.

FACT: Medicaid is intended for people who belong in the low-income, limited-resources population; eligibility also extends to those who have depleted their life savings to pay for large medical expenses. Additionally, the transference of savings and assets to others in order to qualify for Medicaid is now prohibited under the new Medicaid rules. A majority of nursing home residents were not on Medicaid at the time they were admitted into the facilities. Medicaid recipients are still obliged to apply their income towards the costs of their care even after exhaustion of their assets, save for a very minimal amount that go towards a stipend for personal needs.

MEDICAID MYTH #8: Medicaid’s unrestricted federal-funding promotes excessiveness.

FACT: The recent economic downturn has caused an upward surge in the number of people needing Medicaid coverage. However, states employed cost-control measures since they are required to balance their budgets.

MEDICAID MYTH #9: Medicaid is ineffective.

FACT: Compared to private health insurance, Medicaid has lower administrative costs per claims. Furthermore, Medicaid’s per capita growth is half the rate of growth that is found in the private health insurance sector. Medicaid has remained consistently effective despite the exponential growth of the program.

MEDICAID MYTH #10: Medicaid is a poor substitute for private health care.

FACT: Medicaid has made health care accessible to people who otherwise would not have any means to secure coverage for themselves. The coverage provided by Medicaid to its beneficiaries is comparable to the ones provided by private health insurance companies.