Pros and Cons of Medicaid

Allison Martin
Medicaid

The Medicaid program, which is a form of social welfare, provides access to affordable health insurance to those who meet select criteria. While the program may be beneficial, there are also drawbacks you should consider.

What Is Medicaid?

According to Medicaid.gov, the program currently serves 72.5 million individuals who fall into one of the following groups:

  • Low-income adults and children
  • Pregnant women
  • Elderly adults
  • People with disabilities

Funding is provided by both the federal government and states, but the program is managed at the state level. Adminsitration and benefits of the plan may vary from state to state.

Eligibility Criteria

To qualify for coverage:

  • You must meet the financial eligibility criteria mandated by your state of residence.
  • You must meet residency and immigration status requirements.
  • You must have documentation of U.S. citizenship.

Benefits

According to Medicaid.gov, the following benefits are offered under Medicaid plans.

Mandatory Benefits Optional Benefits
  • Inpatient hospital services
  • Outpatient hospital services
  • EPSDT: Early and periodic screening, diagnostic, and treatment services
  • Nursing facility services
  • Home health services
  • Physician services
  • Rural health clinic services
  • Federally qualified health center services
  • Laboratory and x-ray services
  • Family planning services
  • Nurse midwife services
  • Certified pediatric and family nurse practitioner services
  • Freestanding birth center services (when licensed or otherwise recognized by the state)
  • Transportation to medical care
  • Tobacco cessation counseling for pregnant women
  • Prescription drugs
  • Clinic services
  • Physical therapy
  • Occupational therapy
  • Speech, hearing, and language disorder services
  • Respiratory care services
  • Other diagnostic, screening, preventive, and rehabilitative services
  • Podiatry services
  • Optometry services
  • Dental services
  • Dentures
  • Prosthetics
  • Eyeglasses
  • Chiropractic services
  • Other practitioner services
  • Private duty nursing services
  • Personal care
  • Hospice
  • Case management

Contact the Medicaid program in your state of residence to learn more about the amount, duration, and scope of services covered under their plan.

Pros

If you are considering the Medicaid program, there are a few key benefits you should be aware of.

Affordable Healthcare

Individuals on the lower end of the income spectrum who cannot afford costly insurance premiums have access to healthcare, both basic and specialized, through this program. In some instances, coverage is offered free of charge to policyholders.

Mandatory Benefits

As noted in the chart above, each state has to offer certain benefits to all Medicaid recipients. Many of these mandatory benefits, including physician visits and family planning services, play an integral role in the overall health and wellness of both individuals and families.

Cons

Unfortunately, the program also has drawbacks that may weigh heavily on your decision to enroll.

Coverage Limitations

There are many exclusions, with regards to treatment, in Medicaid plans. Even if the medical provider is adamant about providing the procedure or service, Medicaid will not consider it, and the patient will be forced to either forgo the treatment or pay out-of-pocket.

Limited Health Care Provider Options

In select areas, the number of reputable providers who accept Medicaid may be limited. Medicaid reimbursement rates are substantially lower than what many medical providers are accustomed to billing. As a result, they may be deterred from accepting new patients who have Medicaid coverage. Furthermore, reimbursement windows range from 37 and 155 days, notes Forbes. This timeframe can lead to cash flow issues for small scale medical providers.

Unfair Treatment of the Elderly

Discrimination is also common amongst Medicaid recipients in nursing homes. "There have been reports of elderly people being transferred to a different setting (e.g., from a private or semi-private room to a ward) upon switching from private pay to Medicaid," according to MedicaidPatients.com. In some instances, facilities immediately rejected these individuals at the door upon learning the type of coverage they carried on the grounds that the "Medicaid quota" had been met, the article adds.

A Final Thought

Prior to applying for coverage in your state of residence, carefully analyze the benefits offered to confirm they best suit your needs.

Pros and Cons of Medicaid