II. Read the text closely and answer the questions.

1. How many senior citizens are insured by Medicare?

2. Who is eligible for Medicare?

3. What Services does Medicare Pay for?

4 „What additional support does Medicare provide?

5. Are Medicare services cheap or costly for elderly people?

6. What corrections should Medicare undergo?

3. Discussion.

   1. Why do you think Medicare has been called a dinosaur?

   2. Do you think the program should be repealed or not in future? Explain your reasons.

4. Skim through the text and say.

   1. For what groups of the population does Medicaid provide its ser­vices?

   2. How is Medicaid financed?

   3. What services does Medicaid pay for?

   4. What are the advantages of Medicaid?

MEDICAID

^Medicaid, a federal-state program, is ysuall^operated by state wel­fare, or, health departments. Medicaid mnSffies^t least five basic services to needy persons: inpatient hospital care, outpatient hospital care, physi­cians' services, skilled nursing-home services for adults, and laboratory and X-ray services.J^he people who are eligible include families and cer­tain children who qualify for public assistance and may include aged, blind, and disabled adults who are eligible for the Supplemental Security Income program of the Social Security Administration ^ States may also include persons and families termed "medically needy" who meet eligibil­ity requirements except those for financial assistance. Kach state decides who is eligible for Medicaid benefits and what services shall be included. Some of the benefits frequently provided are dental care; ambulance ser­vices; and the cost of drugs, eyeglasses, and hearing aids. In determining eligibility for the program, a state may not hold adult children respon­sible for medical expenses of their parents.

All the states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands operate Medicaid plans.

Who is eligible for Medicaid? ^Eligibility for Medicaid is determined by states within broad federal guidelines.^Uniformly, states must cover certain^ persons who are poor, aged, blind, disabled, or pregnant or are either a child or the parent of a dependent child.

On a national basis, Medicaid covered nearly 50% of Americans younger than 65 years below the federal poverty level in 1992. Indi­viduals younger than 65 years who are not pregnant and have no children or disabilities do not qualify for Medicaid, no matter how poor they are or how high their medical expenses are. The share of the poor covered by Medicaid is expected to 58% in 1994.

How is Medicaid financed? ^FederaLJJtd state gaverninents jointly finance Medicaid. Some states, such as New York and California, require local government contributions toward the state share. The federal gov­ernment matches state spending on a slidjogjacale-based on state per capi­ta income. States with high per capita income, like New York, receive a 50% federal jnatch rate. States with low per capita income, like Missi­ssippi, receive a higher federal match ratp, up to about 80%. The nation­al average federal match_xrate is 57%. W ^{1 A} ^ ^>1 ^c

What Services аоШ MedicaidJPay for? - Because Medicaid ^intend­ed to provlde^access to healttPservices for those in poverty, it covers broad range of preventive acut^, and long-term care services with few or no cost-sharing requirements. States determine limits on the amount, duration, and scope of covered services. Federal statute requires states to cove»inpatient and outpatient hospital services; physician, midwife, and nurse practitioner services; laboratory, X-ray, nursing home, 1 "careenri Jtom^lpj^^i¹¹^ services; and early and periodic detection, and treatment for children. The early and periodic screening, detection, and treatment requirement covers preventive services and attempts to detect and treat conditions early to mitigate disability in la­ter years.

- States have the option to cover additional services, and many do so, such as prescription drugs, kearing,„aid&, ^prosthetic devices, and inter­mediate care facilities for the mentally retarded.

Medicaid i^^ significant source of health coverage for certain popu­lation groupswor example, Medicaid covers 33% of all birth, 25% of all children, and^at least 40% of people with acquired immunodeficiency syn­drome (AIDS)jj Many people with AIDS become disabled, lose employment and health insurance, and qualify for welfare (described herein) and hence Medicaid. Medicaid's increasingly important role in financing maternal and child health services reflects the impact of eligibility expansions noted previously, which have greatly increased Medicaid's coverage of low-income pregnant women and children.

Conclusion

The enactment of Medicare and Medicaid extended health insurance coverage to the nation's poorest, sickest, and most vulnerable population groups; the elderly, disabled, and poor families with dependent children. Before enactment, many of these individuals were unable to secure health Insurance in the private market place because of inability to pay the cost of private insurance premiums or because of health conditions that insur­ance companies refused to coverf Many elderly, disabled, and low-income

parents worried that the onset of serious illness could force them to go without care, turn to charity, or rely on family members to finance need­ed health services.

Medicare and Medicaid have improved access to care and health sta­tus for program^eneficiarigas They have been a major source of financial support for the entire health care system, which has in turn benefited all Americans. Covering nearly one in four Americans and spending nearly $1 in $3 of all health care dollars, the importance of the two programs to the US health system can hardly be overstated.