Health Policy Formulation and Analysis
Health care reform is a continuously evolving and changing process which focuses on the nation’s efforts to expand medical insurance coverage to all individuals as intended by the Affordable Care Act (ACA) of 2010. The expansion has several key components including: employers purchased insurance, income-based premium discounts, the addition of an insurance marketplace, and expanding the Medicaid program to include individuals 138% below the poverty level. (Hahn & Shenigold, 2013) Affordable medical insurance is important to all individuals and families across the United States, but for some low-income families, buying food is a bigger priority than paying for medical insurance benefits.
With the implementation of the Medicaid program in 1965 medical coverage was expanded to low-income households and grown to be the nation’s largest health insurance program servicing 65 million members with an estimated yearly price tag of over $400 billion. (Knickman, Kovner, & Jonas, 2015) However, there is a need for improvement in the certification and renewal process for individuals who are currently eligible for Medicaid benefits. The proposed policy below will address the need for improvement in the current processes, provide alternative solutions to the problem, predictions on possible outcomes as a result of the new policy, confront the trade-offs of not addressing the problem, and make a determination on the best possible recommendation.
According to Knickman & et. al. (2015) between 1995 and 1997 the number of adult and children Medicaid recipients declined 5.5% and 1.4%, respectively. The authors (Knickman & et. al., 2015) reported that this was due to the fact that millions of Americans did not know they were eligible for Medicaid, while others failed to apply because of the stigma that was attached to being a recipient of public assistance. The need for the improvement of the certification and the renewal process is important to increasing the overall health and wellness of low-income families.
Another obstacle facing potential Medicaid recipients is their inability to adequately read and understand the recertification policy and process, which is the leading cause of lapse in medical coverage. (Pati, Kavanaugh, Bhatt, Wong, Noonan, & Cnaan, 2012) Unfortunately, the struggle to comprehend medically related material can have an adverse affect on adults and children resulting in negative patient outcomes.
Orzol, Hula, & Harrington, (n.d.) states that coverage instability in public health insurance programs have also resulted in consequences, documented in several studies. The review and revision the current Medicaid certification and renewal Medicaid policy will more than likely not only have a positive impact on the health care provided to these individuals, but may also contribute to the decrease disparities in services and in health care delivery systems nationwide. The main goal of this policy is to increase enrollment and renewal to those individuals eligible for Medicaid, while improving and streamlining the entire process.
There is not one specific solution to the problem presented, however policy makers may consider increasing the availability of online applications to include several different languages, this may be helpful to those individuals who struggle with the English language and are literate in their own language.
In addition, through the implementation of multilingual online applications combined with user-friendly interfaces will create a culture in which the perspective Medicaid recipient is able to create a direct link with the messaging and policies to the Health Insurance Marketplace available in their area. The ease of the new application process combined with that ability to message a live person, while reviewing available policies will streamline the selection process and simply the certification and renewal procedure.
The new application program should also allow for documents to be uploaded and attached the application being filed Another solution may include the education of perspective Medicaid recipients when it comes to the enrollment and recertification process, in order to clarify any misconceptions or confusion. Unfortunately, individuals must seek assistance and ask for help if this proposed solution is to be successful. Some individuals still believe in the stigma of receiving public assistance and therefore will not ask for the help they needed in maneuvering through the current system.
Technology continues to be a driving force and catalyst, influencing many changes to current health care policies and procedures. If continued progress is to be made in the Medicaid enrollment process then policyholders must explore technological advancements and implement new policies accordingly. The implementation of this new online Medicaid application will offer a user-friendly interface in the individuals own language, while providing an line of open communication with someone who can assist them in real time, while exploring all the health insurance options on one platform should increase the enrollment and recertification process for all those who are eligible. Even those individuals who are not computer savvy are more than likely to have family members who are able to help them navigate the new system.
Health care reform continues to unfold as many states are investigating new and different approaches towards helping to remove the barriers in Medicaid enrollment and renewal policies and procedures. It was reported by Pati, & et. al. (2012) that Medicaid recipients can renew their coverage online in only 20 states across the United States. The proposal of increasing the availability of online application, certification and renewal process will definitely help increase and promote enrollment in Medicaid services.
Streamlining these processes is important in reducing the numbers of barriers facing low-income families from receiving health insurance coverage. If policy makers decide not to make improvements regarding the current Medicaid online application process, this program that was originally designed to help and benefit needy families will not be completely utilized. This may also result in increased health care costs due to lack of health care coverage. Public Health assistance programs are important to the health and wellness of many Americans today, therefore policy makers must make improvements to this process if agencies are going to increase the access and availability to health care.
Hahn, J. A., & Sheingold, B. H. (2013). Medicaid Expansion: The Dynamic Health Care Policy
Landscape. Nursing Economics$, 31(6), 267-297. Retrieved from:
Knickman, J. R., & Kovner, A. R. & Jonas, S. (2015). Jonas & Kovners: Health Care Delivery
in the United States, 11th Edition. Retrieved from: http://gcumedia.com/digital-resources/springer-publishing-company/2015/jonas-and-kovners-health-care-delivery-in-the-united-states_ebook_11e.php
Medicaid.gov. (n.d.). State Meidcaid & CHIP Profiles. Retrieved from:
Medicaid.gov. (n.d.). January 2018 Medicaid and CHIP. Retrieved from:
Orzol, S. M., Hula, L., & Harrington, M. (n.d.). Program Churning and Transfers Between
Medicaid and CHIP. Academic Pediatrics, 15(3), S56-S63. Retrieved from:
Pati, S., Kavanaugh, J. E., Bhatt, S. K., Wong, A. T., Noonan, K., & Cnaan, A. (2012). Reading
Level of Mediciad Renewal Applications. Academic Pediatrics 12(4), 297-301. Retrieved