A Crumbling Medicaid System

The dominant story about Medicaid in many states is serious cutbacks in services. Recipients are unable to gain access to basic care: dental and vision coverage has been cut; the elderly don’t qualify for dentures and hearing aids; mental health services have been restricted; and day centers have been eliminated or seen their hours cut back.

Besides these cutbacks in services, reimbursement rates for doctors under Medicaid tend to be less than reimbursement rates for equivalent services under Medicare, which itself is causing doctors to reject Medicare recipients. Thus, Medicaid recipients are finding it harder and harder to find doctors who will treat them.

The burden on Medicaid is being increased from another direction. Poverty is at its highest level in nearly 20 years and the number of children living in deep poverty — in families with incomes less than 50 percent of the poverty line — is at its highest level since the late 1970s. Once more, the unemployment rate for single mothers is at a 25-year high. Welfare rolls are rising at a time when states are tightening restrictions on getting help.

What is happening to Medicaid recipients will have a profound impact on President Obama’s healthcare reform legislation. The young law is heavily dependent on the expansion of Medicaid to provide coverage for millions of uninsured Americans. Millions of the uninsured will need to be added to the seven million who have enrolled in Medicaid since the financial collapse of 2008.

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