Affordable Care Act (ACA) is a bill that was passed by the senate in 2016 and it paved the way for a more comprehensive, all-inclusive and effective coverage of Medicaid program. Medicaid on the other hand, is an insurance program that strives to provide medical care cover to the poor and vulnerable members of the society (Kongstvedt, 2013). This program is designed to ensure that all citizens have access to proper and cheap medical cover thereby reducing the burden of diseases. Medicaid has successfully ensured that medical cover is available to low income earners who form the bigger part of the population (Kongstvedt, 2013). However, the coverage and efficiency of the program required improvement in order to increase eligibility for members of the community especially those from poor families. For effective management of Medicaid and the implementation of ACA, several authorities have been mandated to ensure transparent and smooth implementation. Among the authorities is Federal Waiver Authority (FWA) that acts on behalf of government in this sector (McLaughlin, McLaughlin & Kaluzny, 2004). Federal Waiver Authority, as the name suggests, is responsible for giving exemptions to particular members of the community
The ACA and FWA have had a considerable bearing in the Medicaid program and have significantly impacted medical costs in the US. To this end, evaluation needs to be made of the extent to which the ACA has increased the eligibility of citizens for coverage under the Medicaid program, and of the role played by the FWA towards the growth and efficiency of the Medicaid and the public, especially in context of giving out waivers. The effect of medical cost trends on the future of provision of medical services and achievements that have been gained due to the implementation of ACA and strides it is expected to make in future make an interesting reading.
ACA and Medicaid
The implementation of ACA has led to the achievement of numerous benefits in the health sector; most important of which is the improvement in the coverage and efficiency of the Medicaid program. Various members of community who were not initially eligible for coverage have been covered and therefore, health burden on the individuals have greatly reduced. Since the program targets the poor and vulnerable in the community, successful implementation of ACA helps in realization of cheap and affordable medication for this group of individuals. ACA has promoted the successful expansion and efficiency of Medicaid program in the following ways:
Firstly, through implementation of ACA, there has been an increase in coverage of children through the Children Health Insurance Program (CHIP) (Congested, 2013). The Act has ensured increased funding to the program thereby increasing its effectiveness in providing medical cover for children from poor and vulnerable families. Further, implementation of the Act has seen the increase of eligibility age by five years; the additional five years means that children have a comprehensive cover that is continuous before their transition to being adult stage. Additionally, the Act also allows for coverage of children from families that have high income, and were therefore, ineligible to have this cover. This has led to increased enrolment into the program and hence it is an indication of the bid to provide increased coverage.
The Act has also seen an introduction of a simple and easy enrolment process brought about by the modernization of the latter that resulted in eliminating tedious paper work associated therewith. Modernization of the enrolment process has also ensured easy tracking of information when need arises; this is because all the systems are integrated and access to information is simple and fast. Further, the Act has also allowed for provision of temporary enrolment of beneficiaries as they await final enrolment which may take some time before finalization. This has ensured that no eligible citizen is left out of the enrolment process because of issues pending for clearance. The temporary enrolment issue is recognized by all the organs that play part in the medical insurance sector.
Additionally, implementation of ACA has also led to the development of a new and more precise formula for evaluating eligibility. The new formula is simple and gives more satisfactory result and therefore more and more people, who were earlier ineligible, can now enrol for the program. The formula, also referred to as Modified Adjustment Gross Income Standard, is more accurate and makes use of the same approach as the one used to determine subsidies on plans offered by the ACA. This means that the approach is credible and precise in determination of eligibility. Further, the approach eliminates the use of asset test, therefore, making it simple for renewal and enrolment of people when the transfer across different Medicaid and different market place Health Plans occurs. This is a big boost in the effort to provide insurance heath cover to much larger population and reduce burden caused by illnesses.
The ACA provides for an extension of age limit for youth who were brought up by foster care. This implies that these youths enjoy a cover up to twenty-six years age, up from the normal age limit of children. This has helped to ensure that there is a smooth transition from one health cover to the other through the different age limits. Finally, the Act compels the states to make contribution to employee’s premiums thereby allowing employees with small earnings to have access to employer’s cover; in essence, it has ensured that these employees can afford medical cover. This is a great achievement towards the aim of providing Medicaid to poor families and those belonging to vulnerable sections of the society.
The above intervention by ACA has led to drastic improvement in the improvement of Medicaid in three aspects: firstly, it has led to an increase in expanse by incorporating the poor and low income earners in the society. Secondly, it has led to the development of a modernized and simple enrolment process, which also ensures easy transfer of money to people across different Medicaid Plans. Finally, ACA has been successful in ensuring increased enrolment and increased outreach activities.
Federal Waiver Authority
Federal Waiver Authority is an organization that is legally mandated to preside over the process of allocation of waivers in the health sector. It provides exemption from paying of contribution by certain members of the community that the authority presumes to be vulnerable and take the burden of providing Medicaid for these people. Additionally, the Authority is a platform through which states implement and manage systems that provide health care services (Congested, 2013). Likewise, it is the duty of the Authority to ensure that federal regulations governing the provision of health care services are adhered to. The regulations are intended to ensure that health care providers are transparent and honest in their undertakings. Regulations to be monitored include ensuring that programs are of desired quality and meet the needs of their clients. Further, the programs must have provision for right to appeal endowed to the people, along with putting a system in place for solving their concerns. Finally, the Authority is mandated to ensure that right to members is conferred for a change in management service providers, should they wish so.
Through the Authority, the state is exempted from following some regulations, such as: exemption from adhering to the law of statewideness. This exemption allows states to implement health care management systems in a particular region or to a particular group of individuals rather than providing the system in whole-sole. Further, the Authority gives states the power to compare services offered by different systems and analyze their benefits before settling on the system of choice. This helps the states to enjoy the advantages of comparison and negotiation for the terms of service provision (Congested, 2013). Finally, the Authority also gives power to the people to choose the best policies that suit their need the most. Therefore, it acts as a bulwark against a service provider’s diktat compelling people to subscribe to its systems.
The Authority has implemented some waivers that are of great benefits in reducing health burden on people. It provides assistance to members of the community living with disability who are above sixty-five years of age and have meagre income (McLaughlin et al., 2004). These people receive a waiver whereby they are registered and thereafter, they receive all Medicaid services contributions free. Further, the Authority provides waivers to women who are aged between fifteen years and fifty-five years who require family planning services throughout the entire duration within this age bracket (McLaughlin et al., 2004). Finally, the Authority provides non-emergency transportation waiver to all members who are eligible for Medicaid benefits.
The cost of providing quality health care is constantly reducing due to the intervention of Medicaid programs. Burden of illnesses has been reduced for members of community and this has been transferred to health care insurance providers. In future, the cost of health care will be affordable to all members of the community from poor families.
Medicaid has played a very vital part in provision of health care services to people, most remarkable amongst which are the poor and vulnerable who would otherwise suffer under the burden of illness and diseases. Introduction of ACA was a great step in the direction of providing affordable health care services to the poor members of the community. The Act paved the way for a more comprehensive, all-inclusive effective coverage of Medicaid program. The Act has led to an increase in enrolment and increased efficiency in the system by introducing modernized platform. Additionally, ACA has led to an increase in coverage of children through the Children Health Insurance Program (CHIP). Further, health care provision has been greatly improved by the Federal Waiver Authority which has introduced waivers for the vulnerable members of the community thereby giving them a chance to have access to quality health care services. Illustratively, it provides exemption from paying of contribution by certain members of the community that the Authority presumes to be vulnerable and takes the burden of providing Medicaid for these people onto itself.
Kongstvedt, P. R. (2013). Essentials of managed health care. Sudbury, Massachusetts: Jones & Bartlett Learning.
McLaughlin, C. P., McLaughlin, C., & Kaluzny, A. D. (2004). Continuous quality improvement in health care: Theory, implementation, and applications. Sudbury, Massachusetts: Jones & Bartlett Learning.