Medicaid is an insurance program that is offered by every state to people with lower incomes. The program is, in part, federally funded, but each state is given freedom in how they implement their Medicaid Program.

Medicaid, while federally funded and regulated, varies from state to state, because each state is given freedom to choose how to meet the federal regulations. The same federal agency that administers Medicare, the Center for Medicare and Medicaid Services (CMS,) is responsible for ensuring that the states are meeting the federal regulations.

Medicaid is intended to help those with lower incomes afford medical care, but over 50% of those in poverty do not qualify for Medicaid.

Eligibility for Medicaid is divided into several categories, with each category having several requirements that must be met. The basic categories are children, pregnant women, the parents of eligible children, single parents, and single individuals. The actual requirements can change a great deal between states, specifically because each state administers their own Medicaid Program, but the states are required by the Federal Government to cover individuals who fall into the above categories.

While poverty is an overall requirement to be eligible for Medicaid, being poor by itself does not qualify someone for Medicaid. Instead, an individual or family must both have a low income and fall into one of the specific categories.

Typically, Medicaid is only available to American Citizens or those who are otherwise legal residents. However, in the case of children, as long as the child is a resident, the status of their parent or caretaker does not matter. As long as the child is a legal resident, they may receive Medicaid benefits.

Medicaid is available for a number of disabilities, including HIV. In fact, Medicaid is the single largest source of funding for HIV care from the federal government. However, in order for HIV to be classified as a Disability, the disease must have progressed to Aids, which is defined as having a T Cell count of less than 200.

In order to become enrolled in Medicaid, it is necessary to submit an application to your state. In order to adhere to federal regulations, the state must review and act on the application within 45 days of receipt, although they are given 90 days in the case of disabilities.

Beginning in 2005, as part of the Deficit Reduction Act, there were several changes to Medicaid, which serve to provide tighter control over who can receive these benefits. It is now necessary to provide proof of residency or citizenship before being approved for Medicaid Benefits.

The government has also put in place much stricter financial requirements on an individuals assets. Most states cap an individuals assets at $2000, although this figure does vary. The government now analyzes all money transfers and gifts over the past five years. The total of these assets is then used to penalize the individuals receipt of nursing home benefits. In the case of many seniors that have made gifts of their assets, this penalty prohibits them from qualifying for Medicaid, even though they do not have the money to pay for it.



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Patient: "Doctor, I am having a cold for the past three days"
Doctor: "Did you get wet in the rain? No? Your brother is having a cold? NO? Oh! It is your sister who got cold first? Yes? fine. Don't worry. Get this medicine from the compounder and take it for two days. See me after that."

The compounder takes out a thin strip of paper, folds it thrice, cuts all four corners with a scissors and then pastes the unfolded strip onto the bottle. That is a Dose indicator. You give something less than a rupee for a bottle of eight doses of some colored liquid. You happily go home, consume the medicine faithfully and perhaps don't go the doctor again because you are feeling much better.

After some days, your elder brother goes to the doctor for a sore throat. The Doctor remembers every ailment your brother has had, every injury and knows all about his health in total. He knows that in your brother's case ordinary sore throat may land him into pneumonia easily and takes him seriously, unlike he did with your cold.

Senior citizens will easily recall scenes like the above from their childhood days.

Such family doctors are simply missing. Nowadays we have only specialists for every ailment. Specialists charge heavy consultation fees and often do not know anything beyond their specialization. The specialist refuses to look at you as a whole, leave alone your family as an integrated unit. He would always refer you to other specialists and relies heavily on test results for diagnosis. As a layman you may be confused whether you should go to a nephrologist or Urologist when you have a problem of passing urine. Because they are supposed to be better equipped, should you suffer more?

Should we not bring back the Family Doctors? You may wonder why. Well, they knew the entire family and their ailments. They could treat you holistically. They knew by heart medicines to which you are allergic. Some even remember your blood group. Most of them tried simple things first. Much of the diagnosis was done relying on physical examination, observation and questioning. Diagnostic tests were minimal. Patients had total trust. They did not charge you a hefty consultation fees. They helped you going to specialist in case there were complications. They were patient and clarified your doubts. The Family Doctor was ready to make home visits if you grand father could not make it to the clinic.

If we somehow bring back the culture of Family Physicians they may be very beneficial in another area. Health Insurance for Senior citizens is becoming a nightmare. Premiums are heavy. No affordable policies are available. "Pre-existing disease" clauses simply make Health Insurance policies useless. Insurance claims are becoming a racket with the collusion of patients and corporate hospitals. Thus caught in this vicious circle, the poor senior citizens spend sleepless nights without any insurance cover.

Family Physicians can act as a bridge. He can provide preventive and first level domiciliary care. He can help senior citizens maintain good health through advice and regular monitoring. He can liaise with Insurance companies and hospitals whenever hospitalization and surgical procedures are necessary. He can minimize diagnostic tests and not yield to the pressure tactics of greedy corporate hospitals squeezing every last pie from the insurance company. Getting second opinion may be easy. There are lots of other things the FP can do effectively nowadays.

Insurance Development Authority of India (IRDA) set up a committee in 2007 under the Chairmanship of KS Sastry. The mandate was to study and recommend steps to be taken by the Government in improving Health Insurance system for senior citizens. One of the most important recommendations relates to bringing back Family Doctors system. Can NGOs take it up with the GOI to consider this issue seriously?



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As healthcare evolves into an increasingly competitive field, everyone is feeling the pressure. Patients are being presented with more choices and greater responsibilities. They are responding by seeking health care information and resources that help them make healthy decisions. For their part, individual providers must run more efficient operations that still attract patient base; they are becoming receptive to-and often demanding-connectivity tools that offer a better way. Similarly, an array of economic factors is converging upon provider organizations. Information technology (IT) is still a preferred means to strengthen quality and better manage costs.

With so much emphasis placed directly on cost and quality, the third principle for ongoing health care reform, Access, often gets lost in the shuffle. It's an unfortunate result of competitive dynamics unleashed in the economy's largest, most complex sector. But the problem is actually an opportunity. By addressing Access problems, from work flow bottlenecks, to resource management to complicated payer requirements, providers can positively impact both quality and cost.

It is certainly true that, in order to compete, hospitals, health systems, medical groups, ambulatory care centers and specialty care centers must first collaborate from within. For ideal patient Access, medical stakeholders must have Access to each other. Indeed, providers are perpetually searching for techniques to more tightly integrate internal operations and leverage established business partnerships. But as the long promised gains in IT productivity and returns on investment begin to materialize, how to handle patient Access and consumer connectivity are emerging as the key questions.

Building the bridge for patient/consumer/provider Access finally brings the entire health care continuum online. In the process of resolving the Access Management challenges, providers large and small are recognizing that they are also addressing the economic imperatives to mitigate administrative burdens and differentiate themselves to the general public.



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