Public Policy making is a central task of the Government. There has been concerns regarding the influence federal mandate on intergovernmental relations. In order to understand and evaluate these influences we will discuss the influence of the intergovernmental lobby over the Medicaid program. We will also analyze the importance of interest alignment between the federal and states Governments and auditing transparency in order to ensure smooth working of these public programs. Medicaid is the health insurance program that is administered by the states and funded jointly by federal and state governments (Weissert 1992).
The Medicaid has an important place in the history of medical treatment in the U. S. An organisation noble in conception has two dimensions to put up with. The dual dimension challenges are to cope up with the changing needs of patients with ever increasing costs due to advances in medical knowledge, medicines and technology. From the other side the pressure is to find solutions in the restricted budget and to handle the changing political pressures. From its beginning the Medicaid gone through many reforms. Researchers have identified few challenges facing Medicaid in order to cater the needs of the patients.
They are keeping it clear to engage service users in decisions or engaging the wider public. Secondly to develop a link between the public and the health system. Third, Quick solutions through open discussions. The fourth is to take a long run at this. Finally, achieving above goals and much more from the Medicaid by engaging users and patients in the decision making process. The last few decades have seen a major change in the Primary care requirements, increase in the ageing population, widespread of chronic diseases, increase in the patient’s awareness, and greater accountability due to increased exposure (Coote, 2005).
This has created a paradigm shift in the requirements of patients. The increasing trend of client centred services has made it important for the Medicaid to find ways to provide rapid and easy to access primary care to the patients. According to the Department of Health change plan the vision of change in Medicaid should be directed towards the needs of the patients rather than the service providers. In order to undertake the change process effectively the professional role of the NHS staff should also be transformed.
These steps towards modernisation were indicated: ) Adoption of change by the Medicaid staff. 2) Government’s role in getting rid of barriers in the way to change. 3) The method for education and training should also be restructured. Since the Medicaid program is undertaken with the combine efforts of the federal and state governments it can clearly provide the picture of the influence of states in intergovernmental relations. The administration of the Medicaid program provides the state governments with experience, management abilities and the information of the important aspects of effectiveness of such programs for low-income group.
Both the federal and state governments fund the Program. It is often the case that there is vast difference in the goals of both state and federal governments. In order to justify the expenses it is mandatory for the federal government to undertake audit programs (Anton 1997). The process of testifying Medicaid program has always remained controversial as it has been noticed many times that state agency faces lesser criticism while warranting on the Medicaid program.
This has remained a moot issue between the state and federal governments as often conflict arises on the same issue between the two government levels. A lack of collective action has been felt between both the federal and state level governments. The situation seems to threaten the federalism. State governments have the expertise to undertake analysis and suggest improvement measures but these expertise are not used to promote intergovernmental relations hence adversely effecting the potential program improvements. Both the state and federal governments at a set rate fund the cost for the Medicaid program.
It has been observed that the governments of different states keep on experimenting with different payments mechanisms mostly aimed at reducing their cost through transferring their the cost of the program to the federal treasury (Weissert and Weissert 2006). The states use different funding processes in order to draw down funds from the central government without spending their own funds. One such way is to increase the payment rate for the eligibility of public care providers. This higher payment rate in turn gives rise to the share of the federal government.
The state governments get back the portion of the surplus through tax imposition or voluntary contributions. Although many states use this surplus amount in the provision of other public facilities to the people but still there has been doubts regarding the proper and transparent use of these funds. States use two such programs: Under disproportionate share hospital payments (DSH payments) program the state governments provides higher amounts of funds to public hospitals and community health centers which serve people from low income group.
Through the Upper payment limits (UPL) states reimburse some of these providers up to the highest Medicaid reimbursement rate (Weissert and Weissert 2006: 267). These programs are implemented to cover the costs of care provision to low-income Medicaid and uninsured patients. The states use intergovernmental transfers (IGTs) to transfer back the funds at the different levels of government. The reliability of these (IGTs) as the evidence of payment recycling is suspicious.
Although it is through the federalism the possibilities for acquiring information regarding the policies increases because of the improved chances of experimentation due to decentralization but on the other hand it is also federalism which acts as a constraint to undertake measures according to that information. The higher degree of discord between the federal and state level governments’ results in shape of the wastage of the state potential which can be used for the well being of the nation at federal level. This is what we call the “failure of federalism,” where the state level expertise are not acknowledge in national policymaking.