Happy birthday, Medicaid!
The program that President Lyndon B. Johnson signed into law has lasted 50 years. Medicaid has become part of the fabric of American life, a medical safety net that serves the Americans who are least likely to get health care coverage from any other source.
A long list of laws have adjusted Medicaid in ways that form consistent trends, experts say. The most recent additions — currently in their comments period — may offer clues to where the program is headed next.
“In terms of the overall program structure, there are two interesting points. One has to do with a series of steps involving expansion of coverage for children, which took place over a period of years and ultimately provided a source of coverage for all children under the federal poverty limit,” says Penny Thompson, who left her post as deputy director for the Center for Medicaid and Shift Services in Baltimore in September 2014 and is now a consultant in Elliott City, Maryland.
“That’s made a big difference for low-income families,” Thompson continues. “Positive research shows that children in enrolled families are successfully accessing care, especially primary care, though there are pockets of concern — a lack of coverage for dental care, delays in getting appointments, problems accessing specialists — and a lot of local variation.”
In a similar way, Thompson says, Medicaid has incrementally added services for people with disabilities, including home-based options for delivering services.
“In part because of strong and effective advocacy from the disability community, Medicaid has given people with disabilities options in supporting them outside institutions,” she says, adding that today, individuals receiving care are as apt to be getting home care as institutional care. “Dollars are split about 50/50.”
Thompson thinks that program expansion will continue, and that all U.S. states will eventually participate in that expansion, despite the political upheaval that currently surrounds it.
Caroline Pearson, senior vice president at Avalere Health in Washington, D.C., agrees.
“I think there will be full adoption, but it may take a decade to have the vast majority of states on board,” she says. “At the moment, there is so much anti-ACA and anti-Obama sentiment, and that is dominating the decision-making. The further you get away from the passage of the ACA, the more the politics will quiet down.”
Economics, she adds, will prevail.
“The fact is that there is a huge amount of federal money on the table to both insure citizens and grow the states’ health care economies,” Pearson says.
Even the states that are currently not participating in the full Medicaid expansion are finding ways to use federal money to pay for health care, Thompson says.
“Virtually every state, including those that have thus far rejected expansion, are engaged in productive and meaningful steps to promote quality, affect health care costs overall and deliver coordinated care,” she notes.