Summary Of Section 1115 Of The Social Security Act

On January 11, 2018, the Center for Medicaid and Medicare Services (CMS) announced a new policy which would allow states to impose work as a requirement for Medicaid eligibility. Work is referred to as community engagement and includes employment, job search or job training programs for twenty hours per week. Under the new policy, pregnant women, the disabled, the elderly, the medically frail and children are exempted.

Medicaid was established in 1965 as a health insurance program for low income people and people with disability. It is jointly funded by the state and federal government and provides health coverage to more than 70 million Americans. Section 1115 of the Social Security Act gives the Secretary of Health and Human Services broad

In the United States particularly in rural areas, community health centers serve as safety net hospitals providing healthcare mostly to Medicaid and the most vulnerable patients. Safety net institutions are required by law to provide care to all patients regardless of ability to pay. Research show that the states that expanded Medicaid under ACA saw significant reduction in uncompensated care and improved financial status of safety net institutions With people losing coverage the rate of uncompensated care will be on the rise which will adversely affect the safety net institutions and jeopardize their continued existence. This new policy has been criticized as unnecessary and would be counterproductive and add to program costs in the long run. There will be increase in emergency Department (ED) because uninsured people are known to resort to the ED as their source of primary health care. Unfortunately, EDs are meant for urgent care issues and are the most expensive place for treatment. Uninsured patients usually do not seek preventive care as majority of them cannot afford medical bills or manage chronic conditions. They are known to seek care at late stages when the sickness has already exacerbated and costs much more to manage. Lack of access to health care also results in reduction in the workforce and many may die of preventable / treatable diseases. Using Texas as an example, Texas is one of the 20 states that did not expand Medicaid under the ACA. As a result, it has the largest number of uninsured residents compared to any other state of the country with estimated number of uninsured at 766,000. Texas spends close to 5.5 billion dollars annually on uninsured patients. In central Texas, there was 139% increase in healthcare spending between years 1999-2000. In a study by the Commonwealth Fund, Texas was ranked 49th out of 50 states of the US on healthcare performance. It