Medicaid plays a key role by providing affordable health coverage for vulnerable populations that includes a wide range of medical, behavioral health, and long-term care benefits.

By Al Norman

One of the most controversial health care debates in the upcoming federal elections is the creation of a single, federal-level, universal health insurance program known as “Medicare For All” (MFA). There are several versions, but they all replace most current public and private health insurance with a new national program that would guarantee health coverage for nearly all U.S. residents.

Much of the debate has focused on ending private insurance companies (but it maintains private health care providers. Very little attention has focused on what happens to the Medicaid program for 75 million low income Americans.

Medicaid plays a key role by providing affordable health coverage for vulnerable populations that includes a wide range of medical, behavioral health, and long-term care benefits. It also is the largest source of federal funds to states. According to a recent study by the Kaiser Family Foundation, MFA plans create one national health plan — so by definition —- there is no need for a separate plan just for poor people.

Because Medicaid benefits and eligibility today are administered at the state level, some states offer better coverage and wider eligibility than other states. MFA plans would treat all enrollees the same, rich or poor. Some benefits that are optional in Medicaid for adults and not available in all states — like dental and vision care, mental health and substance use treatment services — would be the same everywhere.

The variability in enrollment and renewal, benefits, payments, and delivery, would end — a great relief for anyone now struggling with Medicaid’s complex regulations. MFA proposals would establish uniform coverage for prescription drugs across states, but Kaiser says it’s not clear such coverage would be as comprehensive as today.

Norman

Under both MFA and current Medicaid, all covered services must be medically necessary. MFA would create a national fee schedule for paying providers, eliminating variation in payment rates across states and payers in Medicaid today. Protection for patients from high out-of-pocket costs would continue.

“One of the most fundamental changes under MFA,” Kaiser says, “would be uniform coverage of community-based long-term care services for all Americans.” Medicaid currently is the primary payer for these services, with “substantial variation” in eligibility and coverage. MFA makes home care services “explicitly prioritized” over nursing facility care.

Under both MFA and current Medicaid, all covered services must be medically necessary.

Not all MFA plans cover nursing homes, but those that don’t continue the current Medicaid coverage of these services, locking in state spending. The Bernie Sanders MFA program requires states to maintain their existing Medicaid eligibility standards and spending on institutional long-term care services and provides federal matching payments to states — which would no longer be allowed to cap enrollment for community-based long-term care services — ending Medicaid waiting lists for care at home. “Given the scope of MFA programs,” Kaiser says, “it is likely a broader array of providers will participate, expanding the choice of providers for current Medicaid enrollees.”

It is Medicaid, not Medicare, which today provides most of the coverage for long-term services, including home care and nursing home care. MFA would cover the community-based long-term care covered by Medicaid currently. But unlike Medicaid, where most community-based long-term care services are optional, MFA would make these services required and prioritized over institutional care.

Everyone, regardless of income or assets, would be eligible to receive home care services without having to transfer assets, or “spend down” to impoverishment to become eligible.

Many details about how a new MFA program replacing all or most current public and private health insurance would be implemented and financed are not yet known. But MFA programs would extend coverage for most Medicaid services to more Americans, most notably community-based long-term services and supports.

The scope of MFA benefits would provide most Americans with real health care security, and protection against financial devastation. That security makes Medicare For All priceless. For more information see: www.kff.org/medicaid/issue-brief/how-will-medicare-for-all-proposals-affect-medicaid/

Al Norman worked as an elder advocate in the Massachusetts home care system for 38 years. He can be reached at alnormaneldercare@gmail.com