This discussion is brought to you in part by the official CMS website. Medicare and Medicaid are two of the health care pieces that are paid for by the government. The Centers for Medicare and Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services.
Note: View the previous post, “Losing Medicare & Medicaid – Part A: Medicare”
What about the Medicaid seats? Both individual state governments and the federal government are involved with this seat at the ballpark. Its target population is the poor and disabled. While the government funds both Medicaid and Medicare, Medicaid’s coverage differs from Medicare. Medicaid is the only game on the block where those at or below poverty-level and/or have significant disabilities may have access to healthcare. “Nearly 73.8 million individuals are enrolled in Medicaid and CHIP in the 51 states reporting data for April 2018.” “More than 52 million were low-income individuals.” There are certain requirements that may vary from state to state.
Medicaid accounted for a 17 percent share of all National health care spending in 2016. Total Medicaid spending increased 3.9 percent to $565.5 billion. Stronger growth in 2014 and 2015 was partially due to the initial impacts of the ACA’s expansion of Medicaid enrollment during that period. The Federal Government bore the heaviest burden as federal Medicaid expenditures increased 4.4 percent. State and local Medicaid expenditures grew 3.2 percent. 
THE VALUE OF MEDICAID is that “(a)dults and children enrolled in a Medicaid health plan had significantly better access to care and preventive services than people with no health coverage.” In fact, the study indicated that “(a)dults and children enrolled in Medicaid health plans appeared to have access to care and preventive services at levels similar to people who have commercial health coverage.” 
The biggest issue that needs to be addressed as America’s healthcare transitions is how the state and federal governments pay for Medicaid. This is where you may be impacted regarding loss of Medicaid coverage; it’s the tectonic plate affecting this seat at the ballpark. Medicaid’s current funding is a guaranteed federal matching rate based on what each state spends, except for an adjustment that allows a greater funding for the less affluent.
And this funding debate will only continue to grow. According to the Kaiser Family Foundation Tracking Poll, half of those living in states which had not previously expanded Medicaid, want that expansion to include their state.
If all states implement the ACA Medicaid expansion, the federal government will fund the vast majority of increased Medicaid costs. The Medicaid expansion and other provisions of the ACA would lead state Medicaid spending to increase by $76 billion over 2013-2022 (an increase of less than 3%), while federal Medicaid spending would increase by $952 billion (a 26% increase).” 
As you can see, over one quarter of the increase could be driven not by rising health-care costs but by the dramatic raise in Medicaid participants (through the ACA), especially if all states implemented the Medicaid expansion. Republicans in Congress insist that Medicaid and other federal programs have become unsustainable. Medicaid’s current funding, which is a guaranteed federal matching rate based on what each state spends (give or take a boost to less affluent states) should be replaced with a lump sum of money in order to reduce the federal share of Medicaid costs. This sum would be called a block grant, or funding based on the number of people enrolled in their program.
Those in favor of the change say that it would cut costs and provide better care for the needy; the program has become unsustainable. Those on the other side believe that states would be forced to cut eligibility and benefits. The debate is another tectonic plate to be aware of. Before we leave this issue, I would like to remind you that there are three other government sponsored forms of healthcare. I have not seen them discussed in terms of defining the American healthcare in transition, but I will take a minute to mention them briefly.
There is a far-reaching geographical impact of the Veterans Integrated Service Networks (VISN). The Veterans Health Administration (VHA), the health care entity of the VA, began as Old Soldier’s Homes established after the Civil War. The road has been long from ‘Old Soldier’s Homes’ established for Union Civil War veterans to what is now the “template for succeeding generations of federal Veterans’ hospitals” After World War I the eligible population was increased to include veterans of all wars. Today’s VA healthcare system now includes 152 hospitals, 800 community-based outpatient clinics, 126 nursing home care units, and 35 domiciliary. Like other pieces of the healthcare “system” there are faults in the VA system.
Tricare is under the auspices of the Department of Defense (DOD) and “provides health care for 9.5 million military service members, retirees, and family members.” Tricare includes the brick and mortar on-post military treatment facilities (MTFs) as well as the insurance arm which is self-funded, self-administered (TRICARE). Having served 21 years in the military and then becoming the Corporate Medical Director for the West Region Tricare Contractor for 13 years, I must admit to a fondness for this program.
Indian Health Service 
This is an agency within the Department of Health and Human Services (HHS). Those eligible for federal health services include American Indians and Alaska Natives. There is a long historical interaction between the federal government and the Indian Nations that goes all the way back to 1787 — and it wasn’t always a positive one.
Over two million American Indians and Alaska Natives are members of one of the 567 federally recognized tribes. This has become a large and complicated task, as this population is exposed to all of the non-health care related determinants that impact health status. Would it surprise you that this group of health care beneficiaries has lower health status when compared with other Americans?
 The Children’s Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. CHIP is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.
 Modern Healthcare: Pattern of problems with Veterans Affairs healthcare system By Rachel Landen, May 7, 2014
 Insight August 27, 2015 TRICARE: THE MILITARY’S HEALTH CARE SYSTEM by Tara O’Neill Hayes