California vs. Pennsylvania Medicaid Policy

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Table of Contents

Introduction
Comparison with Pennsylvania Medicaid policy
Background of the SCHIP
Services offered
Difference with Medicaid
References

Introduction

Many states in the U.S. are in the process of implementation of various health insurance policies or they have already implemented the policies following the signing of Obamacare. A good example is California, which has established the State Children’s Health Insurance Program (SCHIP) that specifically caters to children. Each state has established its own Medicaid policies based on federal government requirements. This leads to many similarities and differences when the eligibility requirements and services within different states are analyzed (Sommers, 2010).

Comparison with Pennsylvania Medicaid policy

The various policies in existence within California and Pennsylvania share a variety of similarities and differences. There are many services applied by each state. For instance, California offers the SCHIP policy to assist children in need of medical cover. The eligibility to be considered for the SCHIP program in California depends on families with children. Therefore, families without children are not eligible for the program’s support. Eligibility is also restricted to families that have sufficient finances but considered too high to be eligible for Medicaid. The SCHIP plan is still based on Medicaid, which caters to individuals with incomes below the Federal Poverty Level (FPL). This is determined by the use of modified adjusted gross income (MAGI). Individuals are also ranked according to a percentage of the FPL. Moreover, the monthly dollars earned by a family and the family size are also factors that influence eligibility. The federal government is usually involved in the establishment of Medicaid eligibility requirements. Furthermore, each state is allowed to determine its individual coverage policies as, well as determine the financial criteria used to establish eligibility (Mortensen, 2010).

The SCHIP program can be compared to the Temporary Assistance for Needy Families (TANF) program used in Pennsylvania. The Medicaid eligibility program within this state varies greatly in comparison to the program within California. This leads to various differences that arise when it comes to the kind of program applied, although the eligibility requirements can have various similarities. The TANF program in Pennsylvania caters to children less than 21 years old. It is similar to the SCHIP program, although it also depends on the finances a family has. The income that a family receives and the household size are analyzed before a family can have access to aid. In both states, the minimum income that determines whether a family is eligible for assistance is $2000 per year. Household composition is also considered. This is used to determine the relationship between different family members to identify the individual needs of each family member (Kaiser Commission on Medicaid and the Uninsured, 2011).

In Pennsylvania, the state government also offers various services related to Medicaid. One such initiative is the Supplementary Security Income (SSI). This caters to individuals who are over 65 years of age. It is also applicable in a case where the individual is disabled and blind. This service is similar to the SSI program in California. The program also caters to children. Moreover, the individual should apply for all the available cash benefits provided by the state. An individual who receives the SSI is automatically guaranteed to get medical assistance through Medicaid (Mortensen, 2010). In Pennsylvania, the Medicaid eligibility requirements also consider a person with high medical bills. The individual is seen as unable to finance their medical costs, resulting in the need to be covered by Medicaid. This is different from the Medicaid eligibility requirement applied by California’s state government. In this case, it is not a requirement to have high medical bills (Decker, 2009). Moreover, the person must receive SSI for them to be automatically enrolled in the program.

Background of the SCHIP

The State Children’s Health Insurance Program (SCHIP) of California, also known as Healthy Families, is health insurance formulated to cater for children. President Obama signed into law the reauthorization and development of the SCHIP in 2009. Every state covered by the program has a specific payer who is involved in administering the insurance program. In California’s case, the Partnership Health Plan of California does this role. The insurance program has been vital in registering almost 900,000 California children. Moreover, it also provides thousands of children with easier access to health care services (Sommers, 2010).

The SCHIP caters to the child for almost nineteen years, ensuring financial stability for Healthy Families. Funding for the program is received from the federal government. The program receives two-thirds of its funding from the federal government. The government of California has used more than five billion US dollars within the last decade to provide medical care to children from poor families. Many low-income families have been able to gain from this policy (Kaiser Commission on Medicaid and the Uninsured, 2011).

Services offered

The Affordable Care Act has been able to facilitate the process through which individuals can easily access affordable insurance. There are various services offered in this program. Many of these services are created to cater to kids from low-income families. The services range from preventive health care services to the general well-being of the child. Services offered also include dental care. SCHIP also covers pregnant women. Children who do not have full insurance cover from private providers can be covered under the SCHIP program. The regulations governing the Medicaid program are somewhat applicable in the SCHIP program. The SCHIP program widens the coverage of medical cover given to children. The costs of coverage are shared between the respective state that has the SCHIP and the employer. The program has been able to offer services ranging from dental plans, health plans, and vision plans, which depend on where the covered individual lives (Decker, 2009).

Difference with Medicaid

In California, the SCHIP differs from Medicaid based on eligibility requirements. SCHIP is a special form of Medicaid because it considers families with children. In many cases, SCHIP is applicable in situations whereby the family cannot have access to Medicaid. California uses a state-based marketplace where individuals can choose various Medicaid policies placed on the website. This provides an avenue for choosing insurance covers that an individual prefers. The marketplace is structured in the form of a quasi-government. In California, Medicaid is known as Medi-Cal. The state government uses SCHIP funds to encourage improvements and enhance Medi-Cal programs (Decker, 2009). The Secretary in Charge of Health and Human Services (HHS) is tasked with the development of a model application in which people can utilize in the application of coverage through the marketplace, SCHIP, and Medicaid. States can either adopt the Secretary’s model or apply an alternative derived from the secretary’s model. Models from the HHS secretary characterize many states, or they have continued to modify the models (Kaiser Commission on Medicaid and the Uninsured, 2011).

In conclusion, the Medicaid programs in California are similar to those applied in Pennsylvania because they are both based on an established federal policy on medical coverage. Despite this, differences arise based on the eligibility requirements formulated by each state. In California, the SCHIP is a vital health policy that has played an integral role in ensuring that many Californian children have access to medical cover. This policy has been important in ensuring that there is a sustained effort by the government to provide children with health coverage. The program is different from the Medicaid program, but it is basically a modification of Medicaid.

References

Decker, S. (2009). Changes in Medicaid physician fees and patterns of ambulatory care. Inquiry, 46(3), 291-304. Web.

Kaiser Commission on Medicaid and the Uninsured. (2011). Key questions about Medicaid and its role in state/federal budgets and health reform. Web.

Kaiser Family Foundation (2012). Medicaid 101. Web.

Mortensen, K. (2010). Copayments did not reduce Medicaid enrollees’ nonemergency use of emergency departments. Health Affairs, 29(9), 1643-1650. Web.

Sommers, B. (2010). Enrolling eligible children in Medicaid and CHIP: A research update. Health Affairs, 29(7), 1350-1355. Web.

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