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Starting in January, the nation's most populous state will test the idea that Medicaid is reserved for the poor, determined by income and asset standards that reflect our income and wealth. Become. That could create a burden that takes payments away from poor Americans to wealthy Californians.
Medicaid is a state-run health insurance program that is partially funded by the federal government and has as many as 50 unique programs. Each state has different resource constraints, and no two local residents of poor or disabled recipients look the same. However, the federal government sets income and asset standards beyond which an individual cannot qualify. It is both imperfect and to some extent necessary. But what happens if a state completely eliminates eligibility criteria?
A California bill signed into law in 2021 will take effect soon. Exclude All asset eligibility for certain populations, especially those most in need of long-term care. This opens up programs for individuals with net worths in the hundreds of thousands and even millions of dollars. Such changes have a particularly negative impact on poor people who need long-term services and support. California is facing huge budget deficitnow is not the time to extend government services to individuals who can otherwise pay for themselves.
As neurosurgeons (AMDs) and hospitalists (ANMs) working in safety-net hospitals in California, we see many patients who survive their injury or illness but require long-term care.If you have Medicaid, these are Patients may be hospitalized for many monthsEven after you are medically stable because very few facilities accept Medicaid payments. Giving the wealthy access to Medicaid would further strain an already strained health care system and further deprive those truly in need of critical health services.
The intent behind California's move is understandable: to prevent long-term patients from having their assets depleted to pay for expensive long-term care. But in reality, intergenerational wealth is ensured to last while state governments cover the costs. Not only that, but Medicaid is co-funded with the federal government, so federal taxpayers are funding California's excess.
Nationally, the Centers for Medicare and Medicaid Services (CMS) should do more to keep the wealthy from taking advantage of the program.some are misappropriate billions of dollars It is targeted at the poor through various loopholes, and there is no need for California to turn these loopholes into law. There are already countless ways for wealthy people to pass on their savings to their children. Abusing Medicaid for long-term care should not be among them.
This move also has implications far beyond long-term care. Most Medicaid spending is already directed to this category, with funds needed to pay for doctors, hospitals, therapists, and drugs being diverted to benefit other Medicaid recipients. And when Medicaid reduces reimbursement for routine medical services, access to care worsens. Making pro-poor programs available to more people who can afford to pay for treatment on their own will only perpetuate program disparities.
For these and many other reasons, CMS must ensure that Medicaid is reserved for people who have no other means of financing their health care. Changes to state Medicaid programs, including eligibility requirements, must be approved at the state and federal levels. California's Medicaid eligibility changes have been approved by CMS.It is noteworthy that this exemption was approved Enable participation in public comments without using a CMS. Ironically, the Biden administration Texas exemption revoked The lack of public comment has led to calls for other reforms.
Congress therefore needs to step in, ensure asset limits remain in place, and restate Medicaid's intent. Its biggest bargaining chip is the threat of withholding federal matching funds to states that don't comply.
This is a bipartisan issue. Free lunches don't exist. The more programs expand in one area, the less funding and services are available in other areas. Extending programs to the wealthy puts access and care for the less fortunate at risk. The federal government must intervene to stop California from exacerbating health disparities with short-sighted policies.
Anthony DiGiorgio He is an assistant professor of neurosurgery at the University of California, San Francisco (UCSF) and a senior affiliate scholar at the Mercatus Center at George Mason University. Anil Makam University Hospital Medicine Physician and Associate Professor of Medicine at UCSF. Both are faculty members at UCSF's Philip R. Lee Institute for Health Policy Research.
