National Academies Press: OpenBook
« Previous: FOOD STAMP PROGRAM
Suggested Citation:"MEDICAID PROGRAM AND HEALTH CARE." National Research Council. 1998. Providing National Statistics on Health and Social Welfare Programs in an Era of Change: Summary of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/6097.
×
Page 6
Suggested Citation:"MEDICAID PROGRAM AND HEALTH CARE." National Research Council. 1998. Providing National Statistics on Health and Social Welfare Programs in an Era of Change: Summary of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/6097.
×
Page 7

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

WHAT IS CHANGING IN HEALTH AND SOCIAL WELFARE PROGRAMS? 6 which allows for a single set of rules for the food stamp and TANF programs. While generally restricted to TANF recipients, states may apply for a waiver to expand this simplified program to include non-TANF households. The new law also grants states expanded authority to apply for waivers from the federal food stamp regulations. The U.S. Department of Agriculture will now consider a broad range of waivers, including those that reduce benefits, require work, and institute consistent multiprogram rules. A number of changes will not be considered, including new projects to cash out food stamps and experiments with eligibility requirements that target behavior, such as a family cap that limits benefits for newborn children or time limits on benefit receipt. While new cash-out waivers will be denied, PRWORA allows certain states to cash out food stamp benefits for TANF recipients who are working in unsubsidized employment. This cash-out program is restricted to states in which at least 50 percent of the food stamp recipients received AFDC in 1993. BENEFITS FOR IMMIGRANTS PRWORA limits assistance to legal immigrants: legal immigrants are barred from receiving SSI and food stamps, while states have the option to determine the eligibility of current legal immigrants for assistance under TANF and Medicaid.4 Newly arriving legal immigrants are barred from all means-tested, federally funded public benefits for the first 5 years they are in the United States, after which states may provide services. Exceptions to these restrictions are made for refugees and asylees, who are eligible for their first 5 years in the United States; veterans; lawful permanent residents with 40 qualifying quarters of work; and Cuban-Haitian entrants. MEDICAID PROGRAM AND HEALTH CARE While comprehensive changes to the Medicaid program were not included in PRWORA, important modifications were made to the Medicaid eligibility requirements for welfare recipients and, as described above, immigrants. Under the previous law, people who were eligible for AFDC were automatically entitled to receive Medicaid. The TANF grant severs this automatic link, instead tying eligibility to the state's AFDC plan as it existed on July 16, 1996.5 Other recent changes to the Medicaid program and the broader U.S. health care system affect the ability of existing national surveys to measure costs, access, and quality of health care. The Medicaid program, for instance, continues to encourage state experimentation through the waiver process. Some key changes due to waivers include changes in the eligible population, in the copayments required of beneficiaries, and in the types of health care plans that are available.6 Overall, there has been an increase in the number of Medicaid beneficiaries in managed care programs, reflecting the changes in the broader health care industry that are transforming relation 4 No state may deny coverage of emergency medical services to either illegal or legal aliens. The Balanced Budget Act of 1997 eased the restrictions on immigrants' eligibility for SSI: eligibility for SSI and associated Medicaid benefits (but not food stamps) was restored for all elderly and disabled immigrants who received SSI at the time PRWORA was enacted in August 1996 and for all legal immigrants in the United States at that time who become disabled in the future. The Balanced Budget Act of 1997 also extended the number of years for which refugees are entitled to SSI and associated Medicaid benefits from 5 to 7 years and expanded the groups of immigrants who are treated as refugees (see Fix and Tumlin, 1997). 5 When applying these "frozen" rules, states can choose to index the income standards to the Consumer Price Index. 6 In addition, the Balanced Budget Act of 1997 includes several provisions that affect Medicaid, notably, new funding for states to expand Medicaid eligibility for children (see Weil, 1997).

WHAT IS CHANGING IN HEALTH AND SOCIAL WELFARE PROGRAMS? 7 ships between patients, health plans, and providers. Because of these changes, such classifications as Health Maintenance Organization, Independent Practice Association, Preferred Provider Organization, and fee-for- service no longer adequately distinguish among types of health care plans. Finally, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates several changes in the private health insurance market that may affect participation and costs for Medicaid and other social welfare programs. For example, HIPAA extends the portability of health insurance coverage for workers who change jobs, and it limits restrictions on pre-existing conditions for new coverage. (For a more detailed description of the changing public and private sector health care systems and the implications for the adequacy of existing data, see Harvey, 1996.)

Next: SURVEY MEASURES OF PROGRAM ELIGIBILITY, PARTICIPATION, AND BENEFITS »
Providing National Statistics on Health and Social Welfare Programs in an Era of Change: Summary of a Workshop Get This Book
×
Buy Paperback | $47.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF
  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  6. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  7. ×

    View our suggested citation for this chapter.

    « Back Next »
  8. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!