Medicaid provides insurance for health care as a safety net for children, the elderly, blind and disabled, and the poor.

With the possibility of cutbacks on the horizon, maybe it’s time we looked at each of those groups individually instead of Medicaid as a whole to try to preserve services for our most vulnerable citizens.

As of April 2017, 345,954 residents in Hawaii have enrolled in Medicaid or the Children’s Health Insurance Program. That’s one in four residents in the islands.

Medicaid is indispensable for some elderly recipients who have nowhere else to turn to pay for nursing home care.

Vinoth Chandar/

After the passing of the Affordable Care Act, Hawaii expanded Medicaid enrollment to include low-income adults who were previously excluded.

Recent Republican recommendations to change the system have proposed a different type of funding for the federally run Medicaid program.

Each state would receive a set amount of money to cover for the care of their citizens who have Medicaid, based on an analysis of previous years of enrollment and projections for future numbers. Currently the overall amount of care provided is reimbursed in large part by federal funds that match or exceed state funding for Medicaid recipients.

With more limitations on federal funding, the costs of running the program and deciding on essential benefits would be turned over to individual states, providing localized control over the programs and also transitioning financial liability to the state level.

No one really wants to strip coverage from children, the elderly and the disabled, do they?

Arguments against that relate to the overburdening of local governments that have no way to limit who moves into the state, and no way to predict what could amount to a major shortfall in funds to care for these individuals.

Perhaps the best way to save federal Medicaid funding for the most vulnerable would be to split it up, because currently the recipients are lumped into one group.

After all, no one really wants to strip coverage from children, the elderly and the disabled, do they?

For low-income people, frankly, it may be a different matter because they at least have some control over their circumstances.

Articles abound regarding elderly nursing home residents with nowhere else to go who fear for their future, should their benefits be cut. Medicare does not pay for long-term care, and for anyone who has not saved up enough money to cover the average cost of almost $100,000 a year for a nursing home, once their assets are spent, they rely on Medicaid to cover their care.

Having elderly patients who have no alternatives endure further limitations on their benefits and care just doesn’t make sense. These are seniors receiving basic care at homes that are paid by Medicaid at some of the lowest rates of reimbursement already.

One quick walk into a nearby nursing home with large numbers of Medicaid patients reveals that there are no flat screen televisions, plush furniture or fancy accommodations. The numbers of Medicaid covered nursing home beds is extremely limited because care homes can’t afford to stay operational if there are no privately paying patients to make up the difference.

Those who are disabled make up another population that has no options regarding further employment to help cover the cost of care. Often, those receiving Medicaid benefits with a disability are completely unable to function in society, while others can only do so on a limited basis.

No one chooses to be disabled, and it’s not anyone’s fault if they become disabled and need extra help. As one of the richest societies in the world, we should be able to care for those who can’t care for themselves.

Currently the federal government provides a safety net with the Medicaid system to cover the lifetime costs of care for the disabled. States can’t control who is born disabled, or who becomes disabled due to accidents or medical conditions.

With the GOP  health plan proposal, funding beyond the set amount provided by the federal government has to be provided by the individual states. No disabled person should feel like their care is going to be cut because the state they live in doesn’t have enough money to care for them.

Children don’t ask to be born into poverty either. Nationwide, Medicaid covers almost half of the births in the United States, and provides coverage for women and children in order to promote healthy life choices early on with vaccinations, good prenatal care, early childhood interventions when necessary, and an equal playing field compared to those with private insurance.

The benefits are basic, but cover the foundational elements of care that can help a child to grow up healthy and become a contributing member of the workforce.

If Medicaid split into different groups, it might be easier to provide protections for the most vulnerable members of society. Medicaid D for the disabled, C for children, E for elderly. It might help to calculate the true costs of recipients at different age groups and help provide protections for those states that have a younger populace of Medicaid recipients, or those that have more disabled or elderly people who need care.

Hawaii has an increasingly aging population and will need to consider that if any federal health care funding cuts take place.

To suggest that there is a one-size-fits-all approach to funding Medicaid for each state is to forget about the demographic differences between states that might be an extra challenge if per capita funding is put in place. Protecting the most vulnerable in society should be a priority, and differentiating the types of Medicaid beneficiaries might help.

Creating different types of Medicaid coverage for the various groups that receive care could help to stabilize the program long term. After all, the whole purpose of Medicaid is to ensure that people who need it the most receive the care they deserve. That’s a mission we can all believe in.

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