At Doctors for America, we believe that coverage is good medicine. Challenge #2 in enrollment is the 3,600,000 people who will be left out in states that do not accept Medicaid expansion. Congress enacted Medicaid in 1965 to provide health care for low-income families and individuals. Medicaid Expansion allows citizens and legal residents with income up to 133% of the poverty line to qualify for the program. Jointly funded by the federal and state government, states must conform to federal guidelines in order for the state to receive matching funds and grants.
Expanding Medicaid means expanding benefits to our children. In response to an influential 1964 report that many disabilities were conditions whose effects could have been ameliorated through early childhood prevention, Congress broadened Medicaid to include children. In doing so, Congress adopted a set of Early and Periodic Screening, Diagnosis, and Treatment guidelines that all Medicaid-eligible children were required to receive from state-run Medicaid programs. These guidelines mandate that states must provide comprehensive services and furnish all Medicaid coverable, appropriate, and medically necessary services needed to correct and ameliorate health conditions, based on enumerated Federal Guidelines. EPSDT is a required for all categorically needy children until age 21. The spirit of this benefit reflects the responsibility of Medicaid to account for the greater health care needs of low-income children and children with special health needs.
Last week, the American Medical Association officially recognized obesity as a disease, a move that will prompt more research into treatment and screening. As our country struggles to contain the obesity epidemic, the need to cover low-income adults and children becomes even more urgent. Low-income children and adults are at highest risk for obesity, and allowing these groups coverage under Medicaid expansion is the first step towards access, treatment, and success in curbing this epidemic.
Studies show that Medicaid and EPSDT does indeed currently include comprehensive, obesity-related pediatric health care services and that no new legislation or guidance is needed. Therefore, the legal benefit exists; the issue is in the implementation. The AMA represents physicians and practitioners, and their public acknowledgment of obesity as a disease should signal the beginning of implementation into clinical practice.
Our work now lies in getting these patients to these doctors.