is a health insurance plan that is funded jointly by the Federal andthe State Governments primarily to provide health care services toindividuals who have incomes of up to 133 percent of the FederalPoverty Level (FPL). FPL refers to the minimum amount of income thata family needs to acquire the basics like food, education, andshelter. The program supports persons of all ages who cannot affordto pay for quality health services since they have limited resources.Different states have set their standards that they use to evaluatethe qualifications of an individual to benefit from the program. Thispaper will discuss the financing of , the design andoperations of the program, and the impact of ACA on the eligibilityand coverage of the program.
How Is Financed
program is jointly funded by the Federal government and Statesthrough the following arrangements. The first method is known as theFederal Medical Assistance Percentage (FMAP) (In Fichtner &Mercatus Center, 2014). In this arrangement, the federal governmentprovides funds to program in the ratio of 1:1. This impliesthat the federal government deposits 1$ into the fund if a stategovernment spends an equal amount on the program. This is usually anopen-ended financing method that allows funds to flow from thefederal government based on the actual needs. The central governmentpays for the needs as they arise. Disproportionate Share Hospitalpayments (DSH) is also another source of funding for that isoften deposited into the accounts of hospitals that usually treat alarge number of uninsured patients with low incomes (Morgan et al,2011). Disproportionate Share Hospital payments enhance the financialstability of hospitals that offer services to a large number ofbeneficiaries of insurance plan. It is the responsibility ofeach state to determine the amounts of Disproportionate ShareHospital payments that are supposed to be paid to everyDisproportionate Share Hospital. Enhanced match rates is also anothersource of finances for plan (In Fichtner & MercatusCenter, 2014). These rates are like special funds that financespecific services and populations. The special programs that arefinanced by the enhanced match rates include family planning, healthhome services, Clinical preventive services for adults, statebalancing incentive programs, breast and cervical cancer treatment.The federal government pays the enhanced match rates up to 100percent of costs for new members. Moreover, healthinsurance plan gets financed through the administrative match rates.These type funds cater for the expenses that are incurred by during the administration processes however the costs are relativelysmall because they consume around five percent of the total spending.The federal government matches the costs by the half while theindividual states service the remaining half of the totalexpenditures. However, the federal government is sometimes requiredto match the administration costs at a higher rate than fiftypercent. This occurs when the states are upgrading the systems. So, the federal government assists the states with theresources needed to upgrade their systems. In such a case, thecentral government matches up to ninety percent of the total costthat might be required in the upgrading process. The federalgovernment has always made the greatest contribution towards financing that ranges from sixty percent up to a hundred percent insome special cases. However, States and local funds play a major rolein ensuring that the expenses of have been met.
TheRole of the State and Federal Governments on the Design and Operationof Programs
Thefirst function of the federal government is to issue directions inpursuit of providing good health care to populations living inpoverty. It is the responsibility of the central government to ensurethat the beneficiaries of health program get the bestservices. This is attained through consistent review of the policies and implementation of new ones that would improve theservice delivery. Besides, the federal government supports educationand training for professionals who provide care with the insurance plan. On the other hand, the state governments are the onesthat manage and administer the programs locally. Besides, the localgovernments set the minimum standards that every individual must meetto become a beneficiary of . Every state has got itsdifferent criteria that it uses to determine and monitor theeligibility of recipients.
TheImpact of the Patient Protection and Affordable Care Act on theeligibility and Coverage of
ThePatient Protection and Affordable Care Act increased the eligibilityof the American citizens to be recipients of (Hill et al.,2014). The minimum requirement for a person to become a recipient of became more lenient and individuals who had 133 percent ofthe federal poverty level qualified to be beneficiaries of (Segal et al., 2014). Also, the benefits that were being covered bythe program increased to include special cases such as breast andcervical cancer treatments.
Tosum up, is a program that is designed to provide healthinsurance to families with low incomes mostly of up to 133 percent ofFPL. The program is financed jointly by the federal and stategovernments. Both the federal and state governments are involved inthe running of the program.
Hill,S. C., Abdus, S., Hudson, J. L., & Selden, T. M. (2014). Adultsin the income range for the Affordable Care Act’s expansion are healthier than pre-ACA enrollees. HealthAffairs,10-1377.
InFichtner, J. J., & Mercatus Center,. (2014). Theeconomics of : Assessing the costs and consequences.Arlington, VA : Mercatus Center at George Mason University.
Morgan,L. A., Kunkel, S., & Morgan, L. A. (2011). Aging,society, and the life course.New York: Springer Pub.
Segal,M., Rollins, E., Hodges, K., & Roozeboom, M. (2014).Medicare- eligible beneficiaries and potentially avoidablehospitalizations. Medicare& medicaid research review,4(1).