Medicaid Coverage and Eligibility Requirements for Low-Income Adults in Texas
Medicaid eligibility rules and regulations vary depending on the different states (DeNisco & Barker, 2016). Medicaid’s major consideration is the level of income of individuals. The federal government as well as support from the state government of Texas fund Medicaid program (DeNisco ; Barker, 2016). Medicaid eligibility requirements are dependent on the level of income in a household considering the number of people in a household. Any adult with a monthly income of 1,784 dollars or less or a yearly income of 21404 dollars is eligible for Medicaid coverage (DeNisco ; Barker, 2016). Adults with low-income with kids under the age of 19 are also eligible for Medicaid coverage. Other requirements include a social security number and a declaration of all sources of income (DeNisco ; Barker, 2016). The Federal Poverty Level, which is a department of Health and Human Services, determines individuals living in poverty (DeNisco ; Barker, 2016).
Medicaid Coverage and Eligibility Requirements for Pregnant Women in Texas
Medicaid covers all care related to a pregnancy, which involve pre-natal, during birth, and post partum for up to 60 days (DeNisco ; Barker, 2016). Pregnant women are eligible for Medicaid coverage. The requirements for eligibility include proof of residency and citizenship (DeNisco ; Barker, 2016). Pregnant women must be uninsured and should have a low-income level, which should be below 133% of the Federal Poverty Level. Pregnant mothers should also provide proof of pregnancy (DeNisco ; Barker, 2016).
Medicaid Coverage and Eligibility Requirements for the Aging/Blind/Disabled in Texas
Medicaid in Texas has played a big role in ensuring that the uninsured have health insurance. This includes the aging, the blind, and the disabled who are neglected by private insurance providers due to their high costs of healthcare services (DeNisco ; Barker, 2016). These groups are also unable to afford health insurance due to their low-income or lack of income due to their physical states (DeNisco ; Barker, 2016). Eligibility for Texans with disabilities and the aging include a social security number, which is used in determining the benefits to be received and proof of disability, which must be provided by the Social Security Act. The disabled must also complete a disability evaluation to determine if they are eligible for Medicaid services (DeNisco ; Barker, 2016).
The eligibility requirements are reasonable for pregnant women and adults with low income but restrictive for disabled people as the process of evaluation is not reliable and a doctor’s recommendation should be enough evidence to confirm a disabled person (DeNisco & Barker, 2016). The coverage is reasonable as it focuses on the low-income individuals who may face a challenge in accessing healthcare services. Medicaid coverage is a program, which has been implemented to ensure that the Affordable Care Act is successful in increasing the number of the insured citizens (DeNisco & Barker, 2016).
Benefits and Drawbacks to Keeping These Populations Insured Through Medicaid
A benefit of keeping these populations insured through Medicaid is providing the citizens of Texas with access to health care, which will have positive impacts on the efforts of improving the healthcare status of the citizens of Texas (DeNisco & Barker, 2016). Majority of low-income individuals do not have access to healthcare services, which Medicaid aims to address. The number of patients has also increased which provides healthcare practitioners with a steady source of income by providing their services to the Medicaid beneficiaries (DeNisco & Barker, 2016).
A drawback of Medicaid coverage is the limited coverage plans which can negatively affect patient outcomes and result in a complex process of determining what treatment procedures to implement as provided by Medicaid (DeNisco & Barker, 2016). Medicaid reimbursements are low which is discouraging to healthcare facilities and healthcare professionals in providing their services to Medicaid patients. The payment process is also a long process, which might take more than 40 days, which is also discouraging to healthcare facilities (DeNisco & Barker, 2016).
DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession. Burlington, MA: Jones & Bartlett Learning.