1st; One agreement replies Comment for this discussion The Medicaid program is jointly funded through the U.S. federal and state government which creates both opportunities and challenges for increasing access to care and quality of care for those in need. According to one articleLinks to an external site., federal funding sources for the Medicaid program include Disproportionate Share Hospital (DSH) payments, Federal Medical Assistance percentages (FMAP), and Enhanced Federal Medical Assistance percentages (eFMAP). Due to low Medicaid reimbursement rates, hospitals that service more uninsured and/or Medicaid patients are disadvantaged over those that serve mostly individuals with private insurance plans; therefore, the federal governments provides DSH funding to be spready across eligible hospitals. FMAP, on the other hand, supplements state health funding by matching it. For example, the federal government will fund the state $1 for every $1 the state spends on their Medicaid program. Additionally, some states receive a higher matching based on their income average in comparison to the national income average. This ensures fairness across states and prevents those with lower socioeconomic status (SES) from receiving lower reimbursement when they likely have a higher need. eFMAP increases the percentage matched for specific services (i.e. breast/cervical cancer treatments, family planning, home health, preventative services). State funding, according to another sourceLinks to an external site., mostly comes from the State General Fund. On one hand, FMAP incentivizes states to increase Medicaid spending by matching them. While federal funds require that certain stipulations be met, there is some flexibility in how the states spend federal funds and even more flexibility in how their use their own funds. Bottom line, the more they invest, the more they receive. However, that does not always translate to better care (i.e. program allocation, cost containment, management of funds, etc. all play a part in access and quality of care). Interestingly, this model is considered countercyclicalLinks to an external site. which means that when the economy is struggling and unemployment rates are high, state revenues and spending declines, causing federal spending to decline, when the need is actually increasing. On the flip side, when the economy is doing well, unemployment declines (as does the need for services) while state revenues and spending is actually going up. Joint funding can also create challenges, leaving the Medicaid program vulnerable to political shifts and retrenchment. State politics influence the amount of Medicaid funding and which programs receive it. For example, democratic states may be more apt to support increased funding for the Medicaid program than republican states. Additionally, political views can affect the support of certain public health programs that are more controversial (ex. ab ...

1. 1st; One agreement replies Comment for this discussion
The Medicaid program is jointly funded through the U.S.
federal and state government which creates both opportunities
and challenges for increasing access to care and quality of care
for those in need. According to one
articleLinks to an external site., federal funding sources
for the Medicaid program include Disproportionate Share
Hospital (DSH) payments, Federal Medical Assistance
percentages (FMAP), and Enhanced Federal Medical Assistance
percentages (eFMAP). Due to low Medicaid reimbursemen t
rates, hospitals that service more uninsured and/or Medicaid
patients are disadvantaged over those that serve mostly
individuals with private insurance plans; therefore, the federal
governments provides DSH funding to be spready across
eligible hospitals. FMAP, on the other hand, supplements state
health funding by matching it. For example, the federal
government will fund the state $1 for every $1 the state spends
on their Medicaid program. Additionally, some states receive a
higher matching based on their income average in comparison to
the national income average. This ensures fairness across states
and prevents those with lower socioeconomic status (SES) from
receiving lower reimbursement when they likely have a higher
need. eFMAP increases the percentage matched for specific
services (i.e. breast/cervical cancer treatments, family planning,
home health, preventative services). State funding, according to
another sourceLinks to an external site., mostly comes
from the State General Fund. On one hand, FMAP incentivizes
states to increase Medicaid spending by matching them. While
federal funds require that certain stipulations be met, there is
some flexibility in how the states spend federal funds and even
more flexibility in how their use their own funds. Bottom line,
the more they invest, the more they receive. However, that does
not always translate to better care (i.e. program allocation, cost
containment, management of funds, etc. all play a part in access

2. and quality of care). Interestingly, this model is considered
countercyclicalLinks to an external site. which means
that when the economy is struggling and unemployment rates
are high, state revenues and spending declines, causing federal
spending to decline, when the need is actually increasing. On
the flip side, when the economy is doing well, unemployment
declines (as does the need for services) while state revenues and
spending is actually going up. Joint funding can also create
challenges, leaving the Medicaid program vulnerable to
political shifts and retrenchment. State politics influence the
amount of Medicaid funding and which programs receive it. For
example, democratic states may be more apt to support
increased funding for the Medicaid program than republican
states. Additionally, political views can affect the support of
certain public health programs that are more controversial (ex.
abortions, HIV/aids, obesity etc.). Policy also directly affects
the Medicaid program, as demonstrated in how states were
given the option of participating in the Medicaid expansion
efforts under the ACA and some chose not to. I think that in
times of economic stability where funding is at is highest, states
have the most opportunity to drive public health initiatives and
focus on preventative care, increased access to care, and quality
of care. By offering better care we can improve overall health
while reducing future needs and costs associated with poor
health. It is also clear that neither the state or federal
government can afford these costs alone; therefore, perhaps the
two can partner to refine regulatory requirements that drive up
costs as they may no longer be necessary and/or support our
current healthcare objectives.
2nd; One agreement replies Comment for this discussion
I want to start out with discussing all the positive sides to
Medicaid. With ACA starting in 2010 across every U.S. state, it

3. has brought immense benefits to those living in poverty
(individuals/families), disabilities, refugees and immigrants.
Truly helping those who are the most vulnerable in society to
receive access to healthcare. Medicaid has brought the out of
pocket cost to the individual way down for really all medical
needs. I am a huge supporter of Medicaid for healthcare but also
for waivers. I mentioned this in my last discussion post, but I
was a social worker in healthcare for 5 years (inpatient and
outpatient in both rural and urban settings in MN). I have
helped people apply for various waivers like CADI
(disabilities), chemical dependency (rule 25), elderly waivers,
and so on. Again, these waivers are what help the most
vulnerable people in our society.
Now onto the negatives. When it comes to the financial side, the
healthcare organization view is they are not huge fans of
Medicaid. Why? Because less money compared to private
insurance. Same thing for every other organization/agency like
long-term care, physical rehab centers, chemical dependency
treatment, etc. These agencies will take someone who has
private insurance over someone who has Medicaid first. This is
terribly sad and when I start thinking about this topic more
emotionally rather than objectively.
Medicaid Expansion was optional for states as of 2014, most of
the 50 states did expand but left about 14 states who chose not
to expand. The expansions purpose was to extend accessibility
to even more people who have low-income. But each state got to
make their own rules which is exactly where some
modifications should be made. First modification I would
improve is "who is applicable to apply for Medicaid?" Some
states, only adults with at least 1 child can apply (including
adults who are pregnant and/or have a disability). If you are a
single adult with no children and no disability you are not
applicable. I would modify this to any adult (with or without
children) are able to apply if they meet the income guidelines.
Another modification I would make is the income guidelines,
make it a bit more streamlined in each state. I understand

4. incomes in general varies depending on the state BUT when
people are poor... they are poor no matter what the "federal
poverty line" is in their state. The federal poverty line does not
explain true poverty.
Wrapping up everything I said above, when pushing these
modifications with what is politically feasible, it's much easier
said than done. I personally would focus on the elderly
population. When I was working inpatient med/surg, I honestly
thought the nursing home and homecare systems was going to
break at any moment and with Covid-19 it has broken even
more with less elderly workers and more elderly needing care.
Nursing homes are a money driven industry. Lawmakers and
politicians seem to care (I think) about the elderly (and youth)
the most. Funding Medicaid more in each state would assist
elderly waivers so more elderly can receive the care they need
and nursing homes can still profit from the care they are
providing. Vulnerable Adult reports are high, but unfortunately
counties will not do much unless there is a direct threat like
abuse or having rats in your home. I won't get into that side of
things as social services are another underfunded sector of U.S.
society. Would love to hear other's thoughts! Thanks for
reading!
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