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California
The Medicaid program in California State is known as Medi-Cal. While Medi-Cal is funded jointly by the state and federal government, the administration of the fund is looked after by the State. Being one of the states where there is a large number of uninsured, Medi-Cal provides healthcare services to those people who are needy and are the least able to get their health insured. There are certain eligibility requirements prescribed by the state for claiming Medicaid benefits.
In the case of children, the age of the children and the federal poverty level (FPL) is the major criteria for determining the eligibility. Medi-Cal prescribes that Infants up to 1 year with household incomes up to 200% FPL, children 1 to 5 years up to 133% FPL, and children ages 6 to 19 up to 100% FPL are eligible. Uninsured children having income levels above those prescribed by Medi-Cal for eligibility but below 250% FPL would be able to claim the benefits under State’s Children’s Health Insurance Program known as ‘Healthy Families’ program. For adults, health coverage is provided for pregnant women up to 200% FPL.
The extension of this benefit depends on certain work and resource requirements. In the case of the elderly and persons with disabilities, there is the need to meet the requirements of the federal Supplemental Security Income (SSI) program for aged and disabled persons. The benefits are provided up to 100% FPL more than the minimum requirements. There are provisions to assist the individuals who cross the income eligibility requirements but are otherwise in need of medical services. Medi-Cal’s “medically needy” pathway provides for assistance to individuals that “spend down” into medical eligibility. The services here are provided with incomes up to 83% FPL and couples up to 97% FPL after they incur high medical expenses which wipe off their income (Kaiser Commission).
Florida
The eligibility criteria for the state of Florida are different from those of California. In the case of children the coverage of Medicaid is limited to 200% FPL for infants up to 1year of age, 133% FPL for children for the ages 1 to 5, 100% FPL for children from age 6 to 21. Pregnant women are provided Medicaid benefits up to 185% FPL and parents are granted benefits up to 22% FPL. In the case of non-elderly disabled persons under the federal Supplemental Security Income (SSI) program, benefits are extended up to 75% FPL.
The scheme does not cover the elderly people under the SSI program. There are no programs covering people who have spent the larger part of their income on getting medical services as is the case with California State. Florida has initiated a Cover Florida Health Access Act in the year 2008, which provides for the enrolment of children into the ‘Kidcare’ program irrespective of income levels. This can be considered as equivalent to the ‘Happy Families’ program of California. The state has also made a complete reform to its Medicaid services in the form of Florida Medicaid Reform which was made applicable to at least three counties.
Through this reform, the Medicaid program was changed from a defined benefit to a defined contribution program. Under the revised plans, the state has made provision for a risk-adjusted payment to managed care plans instead of spending on individual-based medical assistance programs. The State has also provided for an option to the beneficiaries to move out of the Medicaid programs and can direct the payment of Medicaid premiums to employer-sponsored insurance (State Coverage Initiatives, 2009). These reforms are absent in the state of California which mostly follows the traditional Medicaid plans.
References
KaiserCommission. (n.d.). The California Medicaid Program at a Glance. Web.
StateCoverageInitiatives. (2009). Florida: Medicaid, SCHIP & Feceral Authority. Web.
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