Medicaid is a program that has provided free or low-cost health care to millions of low income Americans since 1965. According to Klees, Wolfe and Curtis (2009) congress first elected to approve access to medical care for certain segments of the population in 1950. At this time the government began to fund state payments to providers of medical care for those receiving public assistance. Despite this legislation, inadequacies in medical care for those on public assistance existed until 1965, when congress passed Title XIX of the social security act, which provided joint federal-state funded medical care for the poor. Medicaid is able to provide access to critical health services less expensively than private insurers, who spend more per enrollee for both children and adults. Medicaid funds are spent more efficiently because 94 cents of every dollar is spent directly on health services (Georgia Budget and Policy Institute, 2015, p. 8). Today Medicaid is available in all 50 states and is the largest source of funding for medical services for America’s poorest people (Klees et al., 2009, p. 3).
National guidelines provide federal regulations and policies for Medicaid, but each state administers its own program, and thus programs may vary between states in the “amount, duration, or scope from services provided” (Klees et all, 2009, p. 18). Individual states determine eligibility standards, decide which services will be covered and for how long, and set the payment rate for services. It is up to a state’s discretion to decide which groups their Medicaid programs will cover, but in order to receive federal funding, states have to provide coverage for certain individuals receiving federal assistance, and other identified groups, such as pregnant women with an income level below 133% of the federal poverty level (FPL), children under 19 living at or below the FPL, and those receiving supplemental security income (SSI) (Klees et al., 2009, p. 18).
Georgia’s Medicaid program is administered by Georgia Department of Community Health. It is fairly easy to obtain care with Medicaid in Georgia, as almost 72 percent of physicians in Georgia are currently accepting new patients with Medicaid, which is slightly higher than the national average of 69% (GBPI, 2015, p. 25). According to the Georgia Budget and Policy Institute, which conducts research, data and fiscal analysis, more than 1.9 million Georgians received Medicaid assistance in 2015. Of this 1.9 million people, nearly 64 percent were children. In fact, 1 in 2 children in Georgia and 1 in 5 of all Georgians received Medicaid benefits in 2015 (GBPI, 2015, p. 4).
To qualify for Medicaid benefits in Georgia, “elderly, blind and disabled people cannot have income higher than 75 percent federal poverty level (FPL) or $13,200 for an elderly couple” (GBPI, 2015, p. 5). The maximum income level is lower for parents with minor children. They can earn no more than an annual income of $7,600 for a family of three (38 percent below the FPL). This makes it difficult for working parents to maintain eligibility because even a slight raise or working overtime hours could lead to disqualification. Statistics show only 1 in 5 poor adults in Georgia qualify for benefits, leaving many people living at or below the FPL without health care. Income guidelines are less restrictive for pregnant women, who can earn up to 225 percent of the FPL, and children, whose family can earn at or below between 139-252 percent of the FPL based on the child’s age (GBPI, 2015, p. 5). Once a person qualifies for Medicaid, they will receive an array of services, including preventative and emergency medical care, ambulance and non-emergency transport, laboratory and radiology, and dental and vision care.