Medicaid

“ Using resources now available, I propose improving the Medicare and other Federal health programs to help those who really need protection--older people and the poor. To help States and local governments give better health care to the poor, I propose that we combine 16 existing Federal programs, including Medicaid, into a single $10 billion Federal grant. ”

“ Through Medicaid, Congress has offered the States an opportunity to furnish health care to the poor with the aid of federal financing. To receive federal Medicaid funds, States must provide health benefits to specified categories of needy persons, including pregnant women, children, parents, and adults with disabilities. ”

“ Congress styled and clearly viewed the Medicaid expansion as an amendment to the Medicaid Act, not as a "new" health-care program. To the four categories of beneficiaries for whom coverage became mandatory in 1965, and the three mandatory classes added in the late 1980's, see supra, at 627– 628, the ACA adds an eighth: individuals under 65 with incomes not exceeding 133% of the federal poverty level. The expansion is effectuated by § 2001 of the ACA, aptly titled: "Medicaid Coverage for the Lowest Income Populations." ”

“ The Secretary shall ensure that payments made under the demonstration project are adjusted for severity of illness and other characteristics of Medicaid beneficiaries within a category or having a diagnosis targeted as part of the demonstration project. States shall ensure that Medicaid beneficiaries are not liable for any additional cost sharing than if their care had not been subject to payment under the demonstration project. ”

“ Some people would have you think that Medicaid just helps poor children. Well, it does do that, and that is very important. Almost one in four American children are poor enough to need help from Medicaid. ”

“ In the case of Medicaid, it often goes directly to the service provider, the hospital or the doctor -- or the hospital. It reimburses hospitals for their costs. So it costs the government -- Habitat for Humanity receives federal funding in some cases. ”

“ Today we resolve constitutional challenges to two provisions of the Patient Protection and Affordable Care Act of 2010: the individual mandate, which requires individuals to purchase a health insurance policy providing a minimum [p531] level of coverage; and the Medicaid expansion, which gives funds to the States on the condition that they provide specified health care to all citizens whose income falls below a certain threshold. ”

“ To extend the Medicaid Money Follows the Person Rebalancing demonstration, to extend protection for Medicaid recipients of home and community-based services against spousal impoverishment, and for other purposes. ”

“ In general.—The State shall enter into a Medicaid memorandum of understanding described in section 204 (e) (4) of the America’s Affordable Health Choices Act of 2009 with the Health Choices Commissioner, acting in consultation with the Secretary, with respect to coordinating the implementation of the provisions of division A of such Act with the State plan under this title in order to ensure the enrollment of Medicaid eligible individuals in acceptable coverage. ”

“ Further, I would uphold the Eleventh Circuit's decision that the Medicaid expansion is within Congress' spending power.
↑ According to one study conducted by the National Center for Health Statistics, the high cost of insurance is the most common reason why individuals lack coverage, followed by loss of one's job, an employer's unwillingness to offer insurance or an insurers' unwillingness to cover those with preexisting medical conditions, and loss of Medicaid coverage. ”

“ The demonstration project shall focus on conditions where there is evidence of an opportunity for providers of services and suppliers to improve the quality of care furnished to Medicaid beneficiaries while reducing total expenditures under the State Medicaid programs selected to participate, as determined by the Secretary. ”

“ The ACA, in contrast, relates solely to the federally funded Medicaid program; if States choose not to comply, Congress has not threatened to withhold funds earmarked for any other program. Nor does the ACA use Medicaid funding to induce States to take action Congress itself could not undertake. The Federal Government undoubtedly could operate its own health-care program for poor persons, just as it operates Medicare for seniors' health care. ”

“ And even as we enact savings in these programs, we must have a common commitment to preserve the basic protections of Medicare and Medicaid--not just to the poor, but to people in working families, including children, people with disabilities, people with AIDS, and senior citizens in nursing homes. ”

“ How other programmatic issues should be treated in a post acute care bundle, including rules specific to various types of post-acute providers such as the post-acute transfer policy, three-day hospital stay to qualify for services furnished by skilled nursing facilities, and the coordination of payments and care under the Medicare program and the Medicaid program. ”

“ At the same time, millions of people who are potentially eligible for coverage under the ACA or other laws remain uninsured, and obtaining insurance benefits is more difficult than necessary. For these reasons, it is the policy of my Administration to protect and strengthen Medicaid and the ACA and to make high-quality healthcare accessible and affordable for every American. ”

“ To protect and maintain State Medicaid programs during a period of economic downturn, including by helping to avert cuts to provider payment rates and benefits or services, and to prevent constrictions of income eligibility requirements for such programs, but not to promote increases in such requirements. ”

“ The relevant portion of the Boren Amendment requires States to reimburse Medicaid services providers using
"rates (determined in accordance with methods and standards developed by the State . . .) which the State finds, and makes assurances satisfactory to the Secretary, are reasonable and adequate to meet the costs which must be incurred by efficiently and economically operated facilities. ”

“ To provide for certain reforms with respect to the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, the Food and Drug Administration, and for other purposes. ”

“ It has expanded Medicaid to help cover 12.8 million more Americans, and to help more seniors live independently. And we’re moving our health care system toward models that reward the quality of the care you receive, not the quantity of care you receive. That means healthier Americans and a healthier federal budget. ”

“ It is true that some persons who are eligible for Medicaid coverage under the ACA may be able to secure private insurance, either through their employers or by obtaining subsidized insurance through an exchange. ”

“ Some persons who cannot afford insurance are provided it through the Medicaid Expansion, and others are aided in their purchase of insurance through federal subsidies available on health insurance exchanges. ”

“ REPORTS TO CONGRESS- Beginning April 2015, and annually thereafter, the Secretary of Health and Human Services shall submit a report to the appropriate committees of Congress on the total enrollment and new enrollment in Medicaid for the fiscal year ending on September 30 of the preceding calendar year on a national and State-by-State basis, and shall include in each such report such recommendations for administrative or legislative changes to improve enrollment in the Medicaid program as the Secretary determines appropriate. ”

“ We have many things to deal with; certainly, many things on our plate. But Washington has for many, many years, postponed or put off dealing with the problems that we're now facing.
You know, let's step back for a second and understand, you know -- health care. You've seen members of Congress talk about the fact that given what we're dealing with, why can this administration -- why is this administration contemplating dealing with things like Medicare and Medicaid and the rising cost of health care? The rising cost of health care is one of the principle drivers of our deficit and our debt. ”

“ The guaranteed-issue and community-rating provisions are designed to make qualifying insurance available and affordable for persons with medical conditions that may require expensive care. Other ACA provisions seek to make such policies more affordable for people of modest means. Finally, for low-income individuals who are simply not able to obtain insurance, Congress expanded Medicaid, transforming it from a program covering only members of a limited list of vulnerable groups into a program that provides at least the requisite minimum level of coverage for the poor. ”

“ We have protected Medicaid coverage for 36 million Americans, including about 20 million children, and the Balanced Budget Act I recently signed into law will provide meaningful health care coverage to millions more uninsured children. ”

“ We must also maintain our 30-year commitment to the Medicaid program, which provides services to nearly half of all Americans living with AIDS and more than 90 percent of children with AIDS. Without the protection that Medicaid affords, these individuals and their families would lose all access to health care. ”

“ Only 6 states spent 50 percent or more of their Medicaid long-term care dollars on home and community-based services for elderly individuals and adults with physical disabilities while 1/2 of the States spent less than 25 percent. This disparity continues even though, on average, it is estimated that Medicaid dollars can support nearly 3 elderly individuals and adults with physical disabilities in home and community-based services for every individual in a nursing home. ”

“ Last year, Medicare, Medicaid, and other new programs that you passed in the Congress brought better health to more than 25 million Americans.
American medicine--with the very strong support and cooperation of public resources-has produced a phenomenal decline in the death rate from many of the dread diseases.
But it is a shocking fact that, in saving the lives of babies, America ranks 15th among the nations of the world. And among children, crippling defects are often discovered too late for any corrective action. This is a tragedy that Americans can, and Americans should, prevent. ”

“ One of the greatest barriers to employment for people with disabilities is that, under current law, they often become ineligible for Medicaid or Medicare if they work. That is why I have challenged the Congress to pass the bipartisan Work Incentives Improvement Act. This proposed legislation would extent Medicare coverage for people with disabilities who return to work and improve access to health care through Medicaid. No American should ever be forced to choose between health care coverage and employment, and this legislation will help ensure that no one has to make that choice. ”

“ Americans are fortunate to have the best health care system in the world. The government has an important role to play in our system. We have an obligation to provide care for the most vulnerable members of our society -- the elderly, the disabled, and poor children and their parents. We are meeting this responsibility through Medicare, Medicaid, and the State Children's Health Insurance Program. ”

“ Second, we've estimated that most of this plan can be paid for by finding savings within the existing health care system — a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn't make us healthier. That's not my judgment — it's the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid. ”

“ And everyone who already has health insurance, whether through your employer, Medicare, or Medicaid, will keep the benefits and protections this law has already put in place. Three million more young adults have health insurance on their parents’ plans because of the Affordable Care Act. More than six million people on Medicare have saved an average of $1,000 on their prescription medicine because of the Affordable Care Act. Last year, more than 8 million Americans received half a billion dollars in refunds from their insurers because of the Affordable Care Act. ”

“ In General- A State may award grants to health care providers who treat a high percentage, as determined by such State, of medically underserved populations or other special populations in such State. (b) Source of Funds- A grant program established by a State under subsection (a) may not be established within a department, agency, or other entity of such State that administers the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) ”

“ Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan. Much of the rest would be paid for with revenues from the very same drug and insurance companies that stand to benefit from tens of millions of new customers. This reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money — an idea which has the support of Democratic and Republican experts. ”

“ For example, the Federal Government bears the burden of paying billions for the new entitlements mandated by the Medicaid Expansion and federal subsidies for insurance purchases on the exchanges; but it benefits from reductions in the reimbursements it pays to hospitals. Hospitals lose those reimbursements; but they benefit from the decrease in uncompensated care, for under the insurance regulations it is easier for individuals with pre-existing conditions to purchase coverage that increases payments to hospitals. ”