It seems to me there might be some advantages in combining Medicaid and Medicare – maintaining only one administrative operation, for example. Why were they established as separate programs? Why do they remain separate?
(Mods – I’m hoping for a factual answer, but of course move if you think this thread belongs elsewhere.)
The two programs serve different people mostly. Medicare is for the elderly, and Medicaid is for the indigent. Medicaid is means-tested, and is funded from general tax revenues. Medicare has a dedicated tax that is supposed to be used only for that purpose.
Another major difference is that Medicaid covers nursing home care, and Medicare mostly doesn’t (cite).
Regards,
Shodan
The programs reimburse providers at very different rates, Medicare being significantly more “generous” (though still below commercial rates).
Also, they cover different things. E.g. Medicaid covers nursing home care for elderly, while Medicare does not.
Medicaid has much much lower cost-sharing, based on the notion that the members can’t afford any. There are fewer providers who participate in Medicaid than in Medicare, due to the reimbursement levels mentioned above (and due to the fact that Medicare dominates the healthcare market in a way that Medicaid can’t) but when a provider does accept Medicaid rates you get a better deal - this is particularly relevant for DME.
Medicare is an entirely federal program. Medicaid is jointly funded by the federal government and states (federal funding varies by state) and is generally administered by the states.
People who are eligible for both Medicare and Medicaid are known as “dual-eligibles” - these people tend to be very high utilizers of healthcare benefits.
medicare is a federal program.
Medicaid is partly funded by states and thus they can set their own rules on who can get medicaid . Which means a person could get money in one state but be denied in another state with the same exact situation.
A large part of the bureaucratic overhead cost is in determining whether any given person qualifies, and the qualification criteria are completely different for the two, so there’d be little efficiency gain from combining them.
All that said, CMS runs both of them (on a federal level), just not as a joint program.
[nitpick]
And the disabled.
[nitpick]
Medicare also serves anyone with End-Stage Renal Disease.
Well, if you really get down to it, the reason why we have multiple medical programs is just politics. They COULD have set up a single office to handle everything, but since each little piece has to be shoved through a Congress that is constantly shifting sides, and then signed by a President and supported thereafter by whichever administration gains power, it all gets scrambled.
It’s the same reason why our military services are the way they are. We could have several more separations, or several fewer, depending on the politics of the moment, and gain eficiencies that way. But a politician here and a politician there, gets re-elected by telling their constituents that they voted for or against whatever actually makes sense.
Like me. I was on MA because of my disabilities and started MC at age 62 so I get both.
You are correct - thanks.
Regards,
Shodan