Major problems with Title XIX include access to minimally adequate care or any care at all. Since the reimbursement rate for Medicaid providers does not meet the actual costs of care, many medical practitioners limit the numbers of Medicaid recipients they accept as patients or do not participate in the program at all. For example, access to dental care and pediatric dental care is quite problematic, given the few providers of this basic medical necessity. Also, because doctors and clinics that accept Medicaid reimbursement are limited, the wait for appointments is often long.

Fraud is another concern, leading states to set up fraud units to investigate false or duplicate charges by providers that could easily be lost in a large bureaucratic system. Fraud committed by patients ineligible for benefits is another problem.

With the passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (commonly known as the Welfare Reform Bill), more restrictions exist on who is eligible for Medicaid services. Also, recent trends indicate that the federal government is shifting the costs of Medicaid care back to the states. Ten years ago, Congress acted to ensure health care access for low-income and near-poor children by passing SCHIP. But SCHIP programs are dependent upon congressional reauthorization, and the federal government renewed the program until 2009, after unsuccessful conservative attempts to tighten financial guidelines to reduce eligibility standards so as to disqualify many children from the SCHIP medical safety net.

The next steps for Medicaid legislation include a nationally standardized Medicaid program to set minimum standards of care for those deemed eligible. Since federal law permits wide flexibility in providing Medicaid services to low-income people, a minimum standard could ensure a medical safety net on a national level. Other advocates propose universal access to health care for all, which implies a major funding increase in the future.

References:

1) Centers for Medicare & Medicaid Services. (http://www.cms .hhs.gov).

2) Kaiser Commission on Medicaid and the Uninsured. 2007. (http://www.kff .org/about/kcmu.cfm).

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