Health Insurance Programs

Survey of Public Health Insurance Programs - Health Insurance is a Family Matter

Medicaid is the state health insurance for older and handicapped people - Part A for hospitals, Part B for health insurance. Centers for Medicare and Medicaid Service. This programme was established in 1965 by Title XXIII of the Social Security Act. End-of-cycle kidney failure (ESRD) has been operating since 1973 and affects more than 90 per cent of the people suffering from the condition.

In 1997, the Balanced Budget Act expanded Medicare reporting to cover annually scheduled mammography, Pap smear tests, screening for prostatic and colon cancers, diabetic treatment, and diagnosing bone and colon disease, handicapped and subject to social security contributions or ESRD (permanent renal disease that requires renal transplantation or dialysis). The Medicare program targets 34 million Americans aged 65 and over, 5 million younger Americans with long-term disability, and approximately 250,000 Americans with chronic renal disease.

The majority of recipients (76 percent) are between 65 and 84 years old, but those under 65 who are handicapped (13 percent) and those 85 and over (11 percent) grow faster than the biggest group ( Kaiser Family Foundation, 2001). Eighty-eight per cent of recipients have an annual revenue of less than $25,000, and about one in four has an annual revenue of less than $10,000 (Century Foundation, 2001).

Over half of the handicapped recipients report income of less than $10,000. Features. Medicare consists of two components: Section A (hospital insurance): Matriculation takes place at the automatic rate at the legal retirement age of 65 with no premiums, except for those who have not paid Medicare tax during employment. Section A provides cover for hospital services as in-patient, critically ill and qualified institutions, home health services and some home health services.

Section B (health insurance): Section B includes medical and out-patient benefits, as well as physiotherapist and ergotherapist benefits, and some domestic health benefits. Section A is funded by a 1.45 per cent wage and salary income taxpayer which is shared evenly between workers and their employer (Kaiser Family Foundation, 2001). The Medicare Part A makes up 45 per cent of programme expenditure and the B Part 33 per cent (Kaiser Family Foundation, 2001).

Medicine+Choice is planning to enter into an agreement with Medicare to perform both Part A and Part B Medicare Service to Registered Recipients and to pay an approximately 18% of Medicare expenditure (Kaiser Family Foundation, 2001). Approximately 5 per cent of the Medicare household goes to the ESRD programme, although only about 0.5 per cent of Medicare recipients are ESRD sufferers (Century Foundation, 2001).

In 2001, Medicare service expenditures amounted to $237 billion, representing 12 per cent of the U.S. government and 19 per cent of overall nationwide expenditures on individual health care expenditures (Century Foundation, 2001). Medicare funded 31% of the country's hospitals and 20% of its medical care in 1999, but only 2% of ambulatory prescriptions (Kaiser Family Foundation, 2001).

Medicaid was established in 1965 as Title XIX of the Social Security Act. As a state twinning, it has been conceived to ensure that the health services of low-income adolescents and young people are publicly financed. Medicaid was originally an expansion of health services from state-funded programs for the needy, with a focus on older, handicapped and dependant infants and their parents.

The 1987 and 2000 laws further extended Medicaid reporting to low-income expectant mothers, more impoverished infants, and some Medicare recipients who were not entitled to a programme of payments in kind and were not previously considered for Medicaid. The most important thing was to raise cover for infants. Recent nationwide enumeration figures show that one in five Medicaid students in the county and a fourth of all under-6s were registered with Medicaid in 2000.

School enrolment increased from less than 10 million in 1980 to over 21 million in 1999 (Kaiser, 2002a). Groups eligible to register for Medicaid are: federally mandated requirements: Infants under 6 years of age and pregnant females whose familial incomes are less than 133 per cent of FPL ($19,977 for a three-person familiy in 2002) (DHHS, 2002b); federally mandated requirements:

Childrens aged 6-18 with a maximum FPL of 100 per cent per child ($15,020 for a three-person household in 2002) (DHHS, 2002b); no Federal minimum: states establish earnings levels for adult without a child; in principle, child parent is entitled if they pass earnings and wealth testing. Parental earnings levels for states averages 41 per cent of the FPL ($6,158 for a three-person household in 2002), ranging from a low of 21 per cent ($3,048 for a three-person household) in Alabama to a high of 275 per cent ($40,224 for a three-person household) in Minnesota (Kaiser, and Broaddus et al.

2002 ); Supplementary Security Revenue Receivers (SSI recipients) or elderly, blind and handicapped persons who are eligible in states that meet more restricted entitlement criteria; Receivers of adoptive allowances and long-term resident benefits under Title IV-E of the Social Security Act; eligible Medicare receivers; certain low-income Medicare receivers; and persons with disabilities who were previously eligible for Medicare but have lose their cover due to their returning to work.

Countries also have the possibility to extend Medicaid insurance to other "categorically needy" groups that exceed basic statewide health insurance thresholds. Throughout the years, many states have extended the scope of their programs to include more of their low-income population than the Confederation requires. Since January 2002, state-initiated Medicaid extensions have increased the entitlement for infants in all but nine German states to a level above the German Bundesmindeststandard (Kaiser, 2002b).

Among the most frequent extensions to Medicaid cover provided by federated matched funding are: babies up to 1 year of age, and expectant mothers who are not subject to the compulsory regulations, whose families earn up to 185 per cent of the FPL; beneficiaries of state supplemental earnings benefits; certain elderly, visually impaired or handicapped adult beneficiaries whose earnings are higher than the compulsory cover but lower than the FPL; individuals who receive nursing under domestic and community-based exceptions;

Those affected by TSB who would be considered for Medicaid funding at the SSI revenue levels (eligibility exists only for TB-related outpatient care and for THB drugs); institutionalised groups with incomes and assets below the stated thresholds; legally residing foreigners and other skilled foreigners who arrived in the United States on or after 22 August 1996 and were not considered for Medicaid for five years under the 1996 Social Security Reforms Act.

It is the biggest programme that provides health and health-related care to the American poor. In 2001, Medicaid insured around 44 million Americans (Kaiser, 2002a). The expansion of admission to Swissmedicine and the facilitation of enrolment have resulted in better health care for the low-income populations. Meanwhile, the number of persons included in data collected by MeDiAid has grown from 42 million in 1999 to 42 million (Kaiser, 2002a).

Recent downturns in the economy should put the Medicaid programme under further strain. These enrolment growths and the associated extra cost during a period of recessions come at a period when states are faced with increasing fiscal constraints as fiscal revenue declines and demands for government programmes rise (Kaiser, 2002a). The enrolment of doctors among non-aged adult and child patients decreased after 1995, after a decades of continuous improvement.

Much research suggests that Medicaid enrolment declined as an accidental result of the 1996 state and federation social policy changes that altered entitlement to benefits and "decoupled" the two types of support. Previously, those receiving money were entitled to Medicaid as well. Medicaid's adult and child enrolment rate dropped 1.5 million between 1995 and 1997 as a powerful private sector and attempts to promote government and federally funded social security reduced attendance at bar grants (Bruen and Holahan, 2002; Urban Institute, 2002b).

Some of the greatest decreases in overall Medicaid registration have taken place in states with the highest percentages of decreases in the number of cases of social assistance, such as Idaho, Kansas and Wisconsin (Ku and Bruen, 1999). Medicaid enrolment declined after the social reforms and has now slowed. The States have made considerable effort to improve the enrolment of those who were still entitled but have become uncovered due to confusions on the part of the Medicaid beneficiary or the beneficiary himself.

Moreover, the 1931 Section allows states to expand cover to cover much higher-income families than previously available, providing new possibilities for extending cover from which states have benefited. Medicaid's registration is also growing as the business community shrinks and more individuals now fulfil the existing registration requirements.

The financing and administration of Medicaid is carried out jointly by the Confederation and the Länder. Confederation funds, known as the US Government's Medical assistance Percentage (FMAP), are calculated each year using a methodology that matches the country's per capita earnings to the nation's earnings median. Countries with a higher per capita incomes receive a lower proportion of their expenses refunded.

The FMAP may not legally be below 50 per cent or above 83 per cent. By 2001, FIMAPs ranged from 50 per cent in 10 states to 76, 8 per cent in Mississippi and an average of 57 per cent overall (DHHS, 2002a). Governments may also obtain compensatory benefits to supplement the coverage of groups of persons and to render extra service.

Those facultative groups and services make up 65 per cent of all Medicaid expenditure (DHHS, 2002a). Until 2001, more than 200 billion dollars in national and state funding were allocated to the Medicaid programme every year (Kaiser, 2002a). Expenditure on Medicaid increased quickly between 1999 and 2000 after a relatively sluggish phase of growth.

Expenditure increased by 7.1 per cent in 1999 and by 8.6 per cent in 2000, against an annual mean of 3.6 per cent from 1995 to 1998 (Bruen and Holahan, 2002). Congressional Budget Office forecasts Medicaid expenditure to grow at an annual rate of 9 per cent on avarage until 2012 (CBO, 2002).

Features. As a countermove to the Confederation's involvement, the states undertake to provide coverage for certain groups of persons and to provide a certain level of service. The majority of older people receiving Medicaid-funded residential home health are covered by the state opt. Massachusetts and Vermont have 41 per cent of low-income, non-ageing inhabitants entitled to Medicaid, versus Virginia, which has only 14 per cent coverage (Kaiser, 2002b).

Governments get federated Medicaid payment for a wide range of compulsory and elective benefits. Medicaid requires the provision of the following basic health related activities to persons registered with Medicaid: in-patient and out-patient clinical departments, medical departments, early and preventive medical check-ups, diagnosis and medical attention for persons under 21 years of age, health facilities for persons over 21 years of age, home health facilities for persons qualifying for home health assistance, home health facilities and needs, health clinics in the countryside and in the state, laboratories and x-ray clinics, and midwifery facilities.

Medicaid's specific child benefit was introduced in 1967 with the establishment of the Early and Periodic Screenings, Diagnosis, and Treatment (EPSDT) programme. The EPSDT is a complete suite that provides regular health and developmental assessments as well as visual, auditory and oral examination service. According to Swiss government legislation, bonuses are only permitted in certain restricted circumstances and certain groups of persons and some types of service are exempted from participation in costs in whole or in part.

Co-payments and excess charges are not permitted for childcare care facilities or facilities related to maternity, contingency and childcare. The deductible may not be more than $2 per monthly per member, the co-payments may be between $0.50 and $3.00 based on the costs of the policy, and the co-insurance requirement may not be more than 5 per cent of the policy costs (Kaiser, 2002b).

Programme cost averages differ according to the nature of the recipient. The Medicaid payment for pediatric service averages approximately US$1,150 per registered infant. Grown-ups under the ages of 65, who make up 21 per cent of receivers, pay an estimated $1,775 per registered individual on service (DHHS, 2002a). Means Medicaid service payment for 4 million older people, who make up 11% of all Medicaid receivers, an estimated $9,700 per capita on average; for 7. 2 million people with disabilities, who make up 18% of receivers, an estimated $8,600 on average (DHHS, 2002a).

In 1997, the Balanced Budget Act established the State Children's Health Insurance Program (SCHIP) and provided new funding for states to provide insurance for non-insured orphans. Almost $40 billion in matched funding in the 1998-2008 financial years permitted states to provide insurance benefits to students in non-Medicaid households earning up to 200% of the FPL (GAO, 2000).

It is the biggest individual extension of health insurance for infants in more than 30 years. The new title XXI of the Social Security Act gave states the opportunity to establish their own paediatric health programme, to extend Medicaid cover or to have a combined programme of a stand-alone paediatric health programme and Medicaid extension.

4.6 million infants were registered in 2001 in SCHIP. Out of the overall number of registered infants, 18 per cent were registered in supplemental infant health programs (S-SCHIP), 13 per cent in Medicaid extension programs (M-SCHIP) and 69 per cent in combined programs (CMS, 2002b). During 2001, the number of SIP registrations at national level increased steadily and fell in only six countries.

14 countries have at least twice as many registered infants between 1999 and 2001 (CMS, 2002b). More than 75 per cent of ever registered infants in 2001 were between 6 and 18 years old. Nevertheless, there are still significant obstacles to achieving cover through SIP. Recent research by the Urban Institute has shown that complex registration processes are still at the heart of the difficulty of covering child eligibility.

Of the thirty-eight (38) per cent of low-income households that enquired about Medicaid and SHIP, the majority referred to bureaucratic barriers as the main cause of non-application (Kenney and Haley, 2001). Features. Whereas states with Medicaid extensions to SHIP must offer the same advantages as other Medicaid registered child programs, states with standalone SHIP programs have a variety of ways to design their service packs, to include the advantages available under a state's Medicaid programs.

The standard SHIP system must include standard medical care, stationary and ambulatory care as well as lab and X-ray work. Nonetheless, states have the power to offer discretionary care such as prescribed medication and ear, psychological health, dentistry and visual care on a more restricted base or not at all.

The overall expenses (premiums, co-payments, excesses, excesses, registration fees) for a child insured in a special SHIP program may not be more than 5% of the child's monthly salary (Kaiser, 2002b). Furthermore, for those whose FPL is less than 150 per cent of their household budget, the premium and share of expenses may not be higher than the par value stipulated by the Centers for Medicare and Medicaid Services.

As part of the SHIP programme, states can either fund either those whose parents have an above Medicaid expected household incomes but less than 200 per cent of the FPL or use their SHIP funding to fund those with higher household incomes (Kaiser, 2002b). The majority of countries offer protection for infants in the family up to 200 per cent of the poor.

17 countries have lower incomes or lower ages, which is the main cause that 6 per cent of low-income infants (