Policy Analysis Model for Medicaid
Final Paper/Research Paper:
We will be looking at advocacy as practice this semester with a particular emphasis on social welfare policy and programs in the United States. Using policy analysis model discussed in class and in your readings, you will provide an analysis of a current U.S. Policy or Program. Your paper must include the following:
The history of the particular social problem that is the target of the policy or program that you are considering, what led the social problem to be defined as a social problem, what values and ideologies guided the development of the policy or program? What was the context in which this problem and policy became an issue?
Your paper must include the ways that social workers have been involved in the social problem/policy issue. This must include the advocacy efforts undertaken throughout history and the effects of these efforts on the formation of policy and/or programs to speak to the social problem. This section must also include a discussion of how this policy affects clients and how the role of collaborative efforts between clients, colleagues and practitioners can and must minimize the negative and promote the positive effects of the social problem/policy issue.
Your paper must also include the theory or theories that inform an understanding of why such an approach, intervention or change in policy will be effective.
Papers will provide an analysis of the policy or program being studied including the key elements of the analysis model (to be discussed in class). You should not stop at a description of the policy or program. You will be graded on your ability to evaluate the policy or program based on the evaluation criteria studied in class as well as any values (yours or others) that affect the policy or program.
Your analysis should also include the ways that issues such as inequality, racism, discrimination, oppression, and injustice affect and or influence the policy or program and its development/implementation? How do your own values come into play when evaluating this policy? How do the NASW Code of Ethics inform your understanding of this issue? This should not just be an add-on to the end of your paper but you should consider the issues listed above seriously. Do these things really influence policy decisions and how? Do your own values influence how you evaluate this policy and is there another side?
Although you may find a lot of information regarding the policy or program you choose, it is your job to summarize the material and report the most important pieces of the information. I expect at least 8 sources in your bibliography. You must use at least 4 up-to-date peer reviewed journal articles; other sources can include any or all of the following: government or nonprofit websites, interviews, newspapers, and books. Non-governmental website sources should not exceed two (2) and should include the ways in which these websites may be biased toward a certain perspective.
Students should observe standard rules for college level paper writing. Papers should be approximately 10-12 pages in length. All papers must be typed, double spaced with no less than 11-point font and 1 inch margins. Papers must be written in APA style with a title page, running head, APA format for in-text citations and reference page.
Policy Analysis Model for Medicaid
Welfare programs are a way for the government to assist the needy in society. Some of the programs shaped for these programs focus on health, housing, or food alongside other services. Since the Great Depression, America saw the need for welfare policy to balance out its economy by taking from the tax pool and giving to those who were disadvantaged in a socioeconomic manner. The federal government collaborates with state governments to provide for women and children, war veterans, and Native Americans alike. This is done through the provision of amenities alongside the support of already existing infrastructure. Medicaid is a welfare program much similar to Medicare that focuses on public healthcare programs. Medicare is is a policy that covers hospital costs for Americans or legal aliens above the age of 65 despite their financial status. The program is ranked second as the most extensive welfare program in the U.S. after the social security program. However, this paper focuses on Medicaid, which is a grant given by the federal government to each state to facilitate healthcare.
Policy Analysis is a way to get a comprehensive understanding of how policies are developed for advocacy. This paper will evaluate Medicaid as a product, its performance, and processes alongside collaborations for social workers. A value critical approach is used to determine the effectiveness and relevance of Medicare in today’s society. As there are problems in all communities, not all of them can be defined as social problems. Thus, to grasp the relevance of Medicare, the social problem behind it will be evaluated to determine whether it serves the need to cater to the status of the affected. Unlike in Medicare, this specific program focuses on the socioeconomic disadvantage of applicants. Through this study, the six policy elements of Medicaid as a welfare program will be examined and taken through the relevant policy analysis evaluation criterion.
To better understand Medicaid, it is best to first learn of its history since the program was enacted in 1965. President Truman and President Johnson signed into law the Social Security Act of 1965, which was aimed at helping the poor in society. Under the Act were plans designed to aid those who had low-income or were unable to afford reasonable healthcare. Title XIX of the Security Act was referred to as Medicaid, and up to today, it acts as a federal-state collaboration to improve health services for the citizens of America. During the Budget Reconciliation Agreement of 1990, parents who earned less than 100% of the Federal Poverty Line were allowed to apply for Medicaid for their children between the ages of 6 – 18 (Luebke, 2019). In 1993, President Bill Clinton signed OBRA into law to bar people from rearranging their assets so that they qualify for Medicaid. Initially, the legislation was motivated by the Democratic Party to increase its involvement in states by caring for the needy who were considered as the elderly and low-income families.
This means-tested program allows states to flexibly dictate their administration as approved by the Deficit Reduction Act of 2005 (DRA). Under this new law, families earning up to 300 percent of the federal poverty level were allowed to apply for cover for their disabled children under the age of 19 (Luebke, 2019). In 2014, President Barrack Obama enacted the Affordable Care Act, which allowed individuals under 65 years to qualify for benefits if their income levels were below the Federal Poverty level of 133%. However, some states challenged ACA in NFIB v Sebelius and the Supreme Court removed the penalty for not expanding Medicaid (Luebke, 2019). Today, it is optional for states to expand Medicaid. Still, if they do, the federal government agrees to cover all costs of newly enrolled applicants exhibiting less than 138% of FPL within the first few years.
Mission, Goal, and Objectives
The core mission of Medicaid involves providing coverage for health to those who cannot afford it so that they can access the needed health services. The program mostly has long term goals such as rebalancing spending, increasing access to services, managing costs, increasing budget predictability, reducing waivers waiting for listing, improving health outcomes, and improving member experience (Dobson et al., 2017). Among their short-term goals, it only applies to states that have accepted the Affordable Healthcare Act, whereby member families are allowed to choose insurance packages based on a fee to receive coverage for a particular duration. Objectives of Medicaid as per Section 115 involve: to promote the long-term sustainability of Medicaid to beneficiaries; to align commercial insurers of health and Medicaid for promotion of smooth transition; to address specific health determinants for increased nationwide morbidity; improved quality of life and dependence; to promote positive health outcomes by improving access to high-quality services and to drive Medicaid value to greatness through payment and delivery systems that align with innovation as per the selected provider.
Medicaid has the potential to alleviate social problems related to health in the general community. Their mission, goals, and objectives are a clear indicator that their purpose aligns with the said social problem. A study was conducted on the Medicaid managed long-term services and supports (MLTSS) program to determine the value of the program. The study took place over twelve states whereby data was collected regarding the implementation and performance of the program. Eight states succeeded in rebalancing spending, all states exhibited positive outcomes in attaining the goals, but only seven out of the twelve states presented documentation for financial records (Dobson et al., 2017). As a result, it is fair to claim that Medicaid satisfies adequacy, equity, and efficiency across relevant states. The program is adequately provided in all States with similar services for people in need. The high attainment of set objectives and goals shows that Medicaid attains high-performance standards for the particular program in its States, which makes the welfare program worthy.
Benefits and services
There are several benefits under Medicaid, ranging from mandatory to optional services as determined by each state. Necessary services include inpatient, outpatient, home health, EPSDT, physician, lab, rural health clinic, family planning, transportation services, and pregnant women counseling on tobacco cessation. Other medical services such as prescriptions, therapy, or expert services are optional for states to implement. Medicaid is used by the federal government to give grants to state governments who then distribute the services to the affected (Rudowitz et al., 2019). An electronic benefit transfer (EBT) card is issued to eligible families, giving them a way to access the services they need. When it comes to delivery of services for welfare programs, states have to write reports in case vouchers are given to beneficiaries.
There are also interrelated benefits since beneficiaries with Medicaid can apply for CHIP (Children health insurance program) to cover their children. Since those who qualify for these Medicaid and its interrelated benefits are not able to wholly pay from their pockets, the federal government imposes rules against states charging premiums for those below 150% FPL (Rudowitz et al., 2019). Cost-sharing is also discouraged, while families are not allowed to pay more than 5% of their income. However, there were reports of discrimination since ACA was implemented across various beneficiaries.
Medicaid upholds consumer sovereignty as the needs of the social problem are governed by rules that protect beneficiaries from being taken advantage of by the state. This can be seen through the prohibition of premiums that would cut off the same people the federal government is trying to aid. Hence, target efficiency is achieved as the people below the set FPL can access proper healthcare. A tradeoff is made for states that want to charge premiums by considering those below 150% FPL to be exempted from charges above 5% of their income. These conditions served for the ability of the policy to satisfy adequacy, equity, and efficiency. The benefits are also a fit as they cover a vast scope in meeting the needs of low-income individuals.
The issue of stigmatization is often present during provider-patient interaction based on a study conducted across 574 adults who are within the low-income group (Allen et al., 2014). This group of people was either under Medicaid or uninsured. They described a feeling of fear or discrimination based on how providers treated them. The qualitative research on stigma was used in a quantitative analysis against sociodemographic factors to determine the association of the stigma. Unfortunately, the study was unable to find influencing sociodemographic features, thus concluding that the provider-patient interaction was discriminatory (Allen et al., 2014). This is because people with Medicaid were faced with unmet needs, worse health, and negative perceptions of public healthcare. This stigmatization may undermine the desired high-quality delivery of Medicaid services.
To qualify for Medicaid, the requirements revolve around pregnancy, income level, age, household size, disability, and applicant’s household role. There are over 72 million citizens who are currently covered by Medicaid all over America. Eligibility based on income is tested under the modified adjusted gross income (MAGI), which includes taxed income and deductions or, in other words, adjusted taxable income. Each state determines the significant programs for beneficiaries who qualify. There is also eligibility for private contracts outside of the program if physicians and beneficiaries wish to do so. These private contracts allow for patients to see physicians who have opted out of Medicaid, but the recipient has to agree to pay the physician without consideration to limits. This provides for overutilization of the program, which increases the adequacy of services for beneficiaries.
Most people registered under Medicaid are of the working class, but to some extent, the program acts as a disincentive to beneficiaries. Some of the adults enrolled on Medicaid have high education levels hence able to attain employment. However, a large number of these beneficiaries are also unable to sustain a job due to health issues or have difficulty in finding a full-time job. This may lead to an inability to meet work reporting requirements hence losing their Medicaid. Ethically, the National Association of Social workers (NASW) Code of Ethics requires welfare programs to adhere to conduct that evaluates the conditions of various individuals. Once these individuals lose their Medicaid, they are likely to sink deeper into poverty, whereas those with health conditions may fail to show up for any job. Medicaid fails to consider itself as a disincentive to work hence defying the NASW ethical codes of conduct.
Administration and service delivery
When dealing with administration and organizational structures for service delivery, Medicaid has an articulate program design that exhibits streamlined integration, integration, and accountability. Medicaid is a centralized program as the federal government oversees all activities and takes liability. The federal government ensures that the healthcare system is managed to attain the objectives as defined. The National Academy for State Health Policy conducted a study on the structures adopted by states to ensure that managed healthcare met the needs of children and youths with special needs (Honsberger et al., 2018). The federal government gives states the authority to determine its organizational structure for the delivery of services. Virginia, Colorado, Texas, Minnesota, Arizona, and Ohio were among the six states under study to determine how they implement their structures. Among their strategies were ensuring care continued even if a child was transitioning from one provider to another, implementation of standardized tools for assessment of goals, and maintaining clarity on contracts. These three strategies satisfied the criteria for continuity, integration, and accountability.
For a long time coming, Medicaid organizational strategies have been blamed for inequalities, discrimination, and racism. The African American group is one to complain since such minorities have suffered the consequences of inequality for decades. During the smallpox pandemic, African-Americans were neglected, and they perished in large numbers. Even though the federal government pretended to care by sending a few doctors to the South, they rejected their pleas for more equipment and medication (Interlandi, 2019). Today it is no different. The ACA saw more African-Americans qualify for Medicaid as opposed to prior times. America remains to be a superpower country where equality is not guaranteed to each citizen. Some states are still not willing to expand their Medicaid to provide coverage for the needy. African Americans in such states constituted a large percentage of the people who would qualify to attain Medicaid if it is expanded (Interlandi, 2019). These claims of discrimination are evident when the Medicaid disparity between African-Americans and whites is taken into account.
Medicaid has a financing structure that is based on the Federal Medical Assistance Percentage (FMAP). It is through FMAP that the government caters for eligible spending as long as they are within the fixed percentage. This percentage ranges from 50% to 74% for higher income and lower-income states, respectively (Chartejee and Sommers, 2017). Since the ACA in 2014, some States were granted 100% payments for adults who had newly joined the program. However, this percentage was reduced to 90% by the start of 2020 (Chartejee and Sommers, 2017). Since Medicaid is the third-largest program in America, it also contributes immensely to revenues. As much as it is considered as a spending item, it is also a significant source of income for the federal government that enables continuity in funding. According to studies, states that have embraced Medicaid expansion have been able to realize effects that are positive towards their economies. Non-expansion states have portrayed challenges in beating the conditions of education and healthcare exhibited by expansion states.
There recently has been a strategy known as the Ryan plan that aims at reducing funding for Medicare to combat general inflation. During the House Republican budget proposal in 2016, there were proposed reforms that suggested a budget cut that would see $180 billion scraped off the block grants each year for a decade (Chartejee and Sommers, 2017). This would result in $913 billion within the decade and a combined $1.8 trillion after that. This would result in millions of Americans would lose their coverage and join the uninsured ranks. The Ryan plan claims that general inflation is outstripped by the growth of medical costs, which may worsen over time (Chartejee and Sommers, 2017). The program thus suggests that Medicaid funds should be linked to inflation, while the federal government contributes 100% towards the funding instead of the required state contributions.
The foregoing elements interact with each other to satisfy the theory of redistribution. Medicaid takes up a redistributive approach as it is based on the levels of average incomes and how they are distributed across individuals and their families. According to Luebker (2014), poverty is likely to increase in economies where income levels are held constant. The Federal government uses Medicaid like other welfare programs to create a balance in its economy from the labor incomes taxed from individuals. In case the economy improves, the average income levels will increase too. This should lead to Medicaid being able to provide more hence reducing poverty. However, if there were to be a significant distinction among the rich and the poor, then poverty would increase for the affected. It is much better for economies where average incomes are evenly distributed across the nation since it will encourage favorable income distribution (Luebker, 2014). It is this theory that Medicaid runs on as it depends on the economy of the nation to gain the financing for delivery.
Societies tend to have three concepts when dealing with redistributive theories; preferences, public opinions, and attitudes (Steele and Breznau, 2019). These concepts are essential for researchers who want to understand inequality in welfare. Preference is closely related to the desired conditions or benefits of a program that may make an individual side with a plan. Attitudes, on the other hand, are an individual’s own positive or negative perceptions, while public opinions are the general thoughts of society towards welfare. According to Steele and Breznau (2019), redistributive theories have a “Robin Hood” approach. In other words, it is balancing the economy by stealing from the rich and giving to the poor. Medicaid takes up the same description since the federal government takes from the tax pool to cater for the needs of the poor.
NASW also expects Medicaid elements to uphold the privacy of individuals who qualify for the program by protecting their information, as stated by HIPAA. As the program adheres to delivering services for beneficiaries, the information of people should be retained as discrete to avoid revealing their eligibility details or undertaken services. Cyber-crimes are gradually on the rise, and if Medicaid intends to maintain a high quality of healthcare, the policy should incorporate practices that make it involves participants feel safe.
In conclusion, Medicaid seems to fit the social problem of concern with regard to the efficiency, equity, and adequacy for participants. A large portion of American citizens is registered under Medicaid, which portrays the social need for medical coverage. The expansion of Medicaid has also made it the third-largest federal welfare program. Since its enactment in 1965, it has continued to fit the need for improved health services. Furthermore, interrelated benefits such as CHIP have expanded coverage to youths and children. It is, therefore, fair to say that Medicaid fits the purpose of alleviating poverty by focusing on low-income individuals.
The welfare policy also exhibits unintended and intended outcomes as it serves people with socioeconomic disadvantages. Some of the expected results revolve around the set objectives that have been achieved through implementation across various states. The policy is adequately available to all States with the option of expansion to those who prefer to widen their coverage. Furthermore, the set benefits are similar across all participants depending on the structure a State prefers. The efficiency of the program is thus seen through the ability to deliver services to improve the quality of life. However, there are unintended consequences where minorities claim to be neglected by the provision of the welfare policy due to their race.
Taking a holistic look at Medicaid, the various elements fit together to form a consolidated and effective policy. Through the value-critical approach, one is able to determine that Medicaid is a relevant program whose policies address the social problem. Even though there is conflict and divergence in some of the elements, the policy strives to offer new and better services every decade. Programs such as Medicaid have deep organizational foundations in reliable systems.
Allen, H., Wright, B. J., Harding, K., & Broffman, L. (2014). The role of stigma in access to health care for the poor. The Milbank Quarterly, 92(2), 289-318. doi: 10.1111/1468-0009.12059.
Chatterjee, P., & Sommers, B. D. (2017). The economics of Medicaid reform and block grants. Jama, 317(10), 1007-1008.
Dobson, C., Gibbs, S., Mosey, A., and Smith, L. (2017). Demostrating the Value of Medicaid Managed Longter Services and Support Programs. National Association of States United for Aging and Disabilities.
Honsberger, K., Normile, B., Schwalberg, R., & VanLandeghem, K. (2018). How States Structure Medicaid Managed Care to Meet the Unique Needs of Children and Youth with Special Health Care Needs.
Interlandi, J. (2019). Why doesn’t the United States have Universal Healthcare? The answer has everthing to do with race. Retrieved from https://www.nytimes.com/interactive/2019/08/14/magazine/universal-health-care-racism.html
Luebke, B. (2019). Medicaid Expansion: Learning from History. Civitas Institute. Retrieved from https://www.nccivitas.org/2019/medicaid-expansion-learning-history/
Luebker, M. (2014). Income inequality, redistribution, and poverty: Contrasting rational choice and behavioral perspectives. Review of Income and Wealth, 60(1), 133-154.
Rudowitz, R., Garfield, R., and Hinton, E. (2019). 10 things to know about Medicaid. Setting the facts traight. Retrieved from https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight/
Shahidi, F. V., Ramraj, C., Sod-Erdene, O., Hildebrand, V., & Siddiqi, A. (2019). The impact of social assistance programs on population health: a systematic review of research in high-income countries. BMC public health, 19(1), 2.
Steele, L. G., & Breznau, N. (2019). Attitudes toward Redistributive Policy: An Introduction. 9, 50; doi: 10.3390/soc9030050