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Medicare and Medicaid: Addressing Vulnerable Groups’ Needs


The changes that Medicare and Medicaid introduced were supposed to secure the rights of vulnerable populations. However, reports show that a wide range of people still remain underserviced in regard to healthcare assistance (Olavarria et al., 2017). Because of multiple dents in the policies determining qualifications for receiving health insurance, people belonging to marginalized groups struggle to receive proper care (Selden, Lipton, & Decker, 2017).

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In order to open the access to healthcare services to a wider demographic, the U.S. government will need to reconsider the current definition of vulnerable groups, as well as to introduce a supervision system along with in-depth research defining underserviced and marginalized communities.

Current Medicare/Medicaid Qualifications

The present standards for being defined as eligible for receiving Medicare or Medicaid are quite straightforward. According to the U.S. Department of Health and Human Services (2018), the services delivered in accordance with the Medicare and Medicaid policies are delivered to underage children and pregnant women from households below 138% of the FPL. In addition, Medicare/Medicaid is offered to recipients of Supplemental Security Income (SSI) and parents with the income levels requiring cash assistance (U.S. Department of Health and Human Services, 2018).

Furthermore, the definition of a vulnerable demographic is extended to institutionalized people, pregnant women, parents, and children with income exceeding the mandatory coverage limits, and several other groups (U.S. Department of Health and Human Services, 2018). The problem with the current definition of eligibility is that it is loose enough to exclude a wide range of vulnerable people from it, thus reducing their chances for receiving decent health services despite their financial or physical limitations.

Much to their credit, the present Medicare and Medicaid qualifications have opened numerous chances for people suffering extensive crises to receive proper care. For instance, the opportunities for the victims of disasters were provided in 1988 (U.S. Department of Health and Human Services, 2018). Moreover, the fact that Medicaid and Medicare access principles are pliable enough to be adjusted to the legal specifics of each state deserves credit as one of the essential advantages of the described system. However, the stated characteristics of Medicare and Medicaid also imply a drop in homogeneity, which means that marginalized groups may experience difficulties in accessing care in some states.

Problems in the Existing Qualification Standards

The existing definition for eligibility to receive Medicare and Medicaid services as it is stated by the U.S. Department of Health and Human Services (2016) is quite problematic both because of the generalizations that it makes and the restrictions that it imposes on patients. Among the current concerns, the fact that low-income adults are not deemed as eligible for Medicare or Medicaid until they reach the age of 65 deserves to be mentioned (Northridge et al., 2017).

Due to the age restrictions, underserviced members of the American population are most likely to develop serious health issues until they can receive Medicare/Medicaid health support (Olavarria et al., 2017). Therefore, a significant number of American citizens is likely to suffer.

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Suggested Improvements: Opportunities and Limitations

The observed problems can be attributed to the lack of consistency in the description of groups that are deemed as vulnerable by the U.S. Department of Health and Human Services (2016). Therefore, it is critical to expand the current standards for income eligibility as far as the provision of Medicare and Medicaid support is concerned. According to Cox, Lai, Lewis, and Lenihan (2017), the described step will ensure that underserviced members of the American population are provided with the required care, at the same time reducing the cost of Medicare/Medicaid services.

Furthermore, it is recommended to establish a system of supervision over the implementation of Medicare and Medicaid. The introduction of advanced oversight techniques that include direct feedback from vulnerable groups will help to exclude the scenarios in which the necessary health services were not provided due to misinterpretations of the standards for care eligibility. According to Keast, Nesser, and Farmer (2015), the introduction of oversight strategies and tools will lead to developing a better grasp of the range of groups whose health is in danger due to the presence of economic or social constraints. The described change will help to reduce the pressure experienced by the identified groups of people due to social stigma, the persistent nature of social stereotypes.

The suggested steps toward addressing the problems of Medicare and Medicaid may require additional research to locate the challenges faced by vulnerable populations when attempting to access health care and receiving Medicare/Medicaid. Although some of the obstacles to effective care have been identified, a large number of other hindrances to proper care are yet to be discovered. For instance, the problems encountered by immigrants and migrant workers may demand additional studies (Cox et al., 2017). As soon as the crucial factors that determine the access to Medicare/Medicaid are located, changes in the current healthcare and legal systems will be needed to manage the challenges and improve health services.


Medicare and Medicaid provide extensive assistance to people with regard to their health-related needs. However, with several issues regarding the needs of underserviced populations having been undercooked, the current Medicare/Medicaid system needs improvements. By revisiting and expanding the current definition of a vulnerable population as it is stated by U.S. Department of Health and Human Services (2016), one will create the platform for a vast and profoundly positive shift in the healthcare system. As a result, groups that have been marginalized or are unable to receive the needed health support will be provided with the appropriate services.


Cox, Z. L., Lai, P., Lewis, C. M., & Lenihan, D. J. (2017). Centers for Medicare and Medicaid Services’ readmission reports inaccurately describe an institution’s decompensated heart failure admissions. Clinical Cardiology, 40(9), 620-625. Web.

Keast, S. L., Nesser, N., & Farmer, K. (2015). Strategies aimed at controlling misuse and abuse of opioid prescription medications in a state Medicaid program: A policymaker’s perspective. The American Journal of Drug and Alcohol Abuse, 41(1), 1-6. Web.

Northridge, M. E., Estrada, I., Schrimshaw, E. W., Greenblatt, A. P., Metcalf, S. S., & Kunzel, C. (2017). Racial/ethnic minority older adults’ perspectives on proposed Medicaid reforms’ effects on dental care access. American Journal of Public Health, 107(1), 65-70. Web.

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Olavarria, O. A., Holihan, J. L., Cherla, D., Perez, C. A., Kao, L. S., Ko, T. C., & Liang, M. K. (2017). Comparison of conflicts of interest among published hernia researchers self-reported with the Centers for Medicare and Medicaid Services Open Payments Database. Journal of the American College of Surgeons, 224(5), 800-804. Web.

Selden, T. M., Lipton, B. J., & Decker, S. L. (2017). Medicaid expansion and Marketplace eligibility both increased coverage, with trade-offs in access, affordability. Health Affairs, 36(12), 2069-2077. Web.

U.S. Department of Health and Human Services. (2018). Centers for Medicare & Medicaid services. Web.

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