Poverty and Health, A Conversation with a Resident Physician in New Jersey

Government Bureaucracy

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I’m fascinated by the connection between poverty and health care. It seems obvious after all – if someone lives in poverty, chances are the amount of time they spend taking care of their health is limited due to other more pressing needs. Less expensive food options are probably throughout low income communities leading to greater temptation to not eat healthy. So I decided to talk to someone in the healthcare space – a resident physician in New Jersey, who works with low income families.

What is Medicaid and What Isn’t Covered?

Medicaid is a joint federal and state program in the United States that provides health coverage to eligible low-income individuals and families. It is the largest source of health insurance coverage in the country, helping millions of Americans access essential healthcare services.

The program was established in 1965 under Title XIX of the Social Security Act and is administered by the Centers for Medicare and Medicaid Services (CMS), a federal agency within the U.S. Department of Health and Human Services (HHS). However, Medicaid is implemented and operated at the state level, with each state having some flexibility in designing and managing its own program, within certain federal guidelines.

Medicaid is primarily targeted towards individuals and families with limited income and resources. Eligibility criteria, including income limits, asset limits, and other factors, vary by state, as states can set their own specific eligibility rules within certain federal parameters. However, there are certain mandatory eligibility groups that all states must cover, including low-income children, pregnant women, parents of dependent children, individuals with disabilities, and low-income seniors.

Under Medicaid, the specific coverage for alcoholism and mental health can vary by state, as each state has some flexibility in determining the scope of services covered. However, all states are required to cover mental health services as part of their Medicaid programs, and many states also cover substance abuse treatment, including services for alcoholism.

Some of the services that may be covered by Medicaid for alcoholism and mental health include:

  1. Outpatient counseling: Medicaid typically covers outpatient counseling services, such as individual therapy, group therapy, and family therapy.
  2. Inpatient treatment: Medicaid may cover inpatient treatment for alcoholism and mental health conditions, including detoxification programs and residential treatment centers.
  3. Medications: Medicaid often covers medications prescribed for alcoholism and mental health conditions, including medications for detoxification, addiction treatment, and mental health disorders.
  4. Case management: Medicaid may cover case management services to help individuals navigate the treatment system and access necessary services.
  5. Rehabilitation services: Medicaid may cover rehabilitation services, including vocational rehabilitation, to help individuals recover from alcoholism and mental health conditions.

What are the Implications of some services not being covered?

Follow-up appointments are absolutely essential for low-income families when it comes to healthcare. – yet there is a higher volume of missed appointments with low income families perhaps due to the immediate nature of other concerns. Some issues include the following:

  1. Missed diagnoses or delayed treatment: Regular follow-up appointments are important for monitoring ongoing health conditions, identifying new health issues, or evaluating the effectiveness of treatment. By not attending these appointments, you may miss the opportunity for early detection of potential problems or delays in receiving necessary treatment.
  2. Progression of health conditions: Without proper follow-up, certain health conditions can worsen over time. Regular check-ups and follow-up visits allow healthcare professionals to assess your condition, adjust treatment plans if necessary, and provide appropriate interventions to manage and control your health conditions.
  3. Increased health risks: Neglecting follow-up appointments may result in increased health risks. Undiagnosed or untreated conditions can lead to complications, exacerbation of symptoms, and a decline in overall health. Regular monitoring and follow-up can help prevent these risks and keep your health on track.
  4. Missed preventive care opportunities: Follow-up appointments often include preventive care measures, such as screenings, vaccinations, and health education. Skipping these appointments means missing out on important preventive interventions that could detect diseases early, prevent future health issues, and promote overall wellness.
  5. Poor management of chronic conditions: For individuals with chronic conditions, regular follow-up appointments are crucial for managing their health. These appointments provide an opportunity to discuss symptoms, adjust medications, receive counseling, and address any concerns or challenges faced in managing the condition. By not attending follow-up visits, you may experience difficulties in effectively managing your chronic condition, leading to worsening symptoms and a decreased quality of life.

Follow-up Appointments and Diagnoses

While there is no link between disorders such as Autism Spectrum Disorder and low-income communities, there are related challenges that can come up. These include the following:

While there is no direct causative link between low income and increased autism rates, some factors associated with lower socioeconomic status may indirectly influence the identification and access to autism diagnosis and services. These factors can include:

  1. Barriers to diagnosis: Limited access to healthcare resources, including diagnostic evaluations and specialized professionals, may result in delayed or missed autism diagnoses in low-income communities.
  2. Disparities in accessing early intervention and treatment: Children from low-income families may face challenges in accessing early intervention services, therapies, and specialized educational programs that can support their development and improve outcomes.
  3. Health disparities and co-occurring conditions: Low-income communities may experience higher rates of health disparities and co-occurring conditions, such as intellectual disabilities or mental health disorders, which can overlap with autism and complicate diagnoses and interventions.

The Path Forward – Vaccinations and More

There is evidence to suggest that children from low-income families may have lower immunization rates compared to children from higher-income families.

Several studies have shown disparities in immunization rates based on socioeconomic status. Factors contributing to lower immunization rates in low-income families can include:

  1. Limited access to healthcare: Low-income families may face barriers to accessing healthcare services, including immunizations. This can be due to financial constraints, lack of transportation, or limited availability of healthcare providers in their communities.
  2. Lack of health insurance coverage: Uninsured or underinsured families may face challenges in accessing affordable immunizations for their children. Programs such as the Vaccines for Children (VFC) program in the United States help provide free or low-cost vaccines to eligible children who are uninsured or underinsured.
  3. Limited health literacy: Families with lower socioeconomic status may have limited health literacy, which can impact their understanding of the importance of immunizations and how to access them. Lack of information or misconceptions about vaccines can contribute to lower immunization rates.
  4. Vaccine hesitancy: Vaccine hesitancy, influenced by various factors including misinformation, concerns about vaccine safety, and distrust in the healthcare system, can be more prevalent in certain communities, including low-income populations.

Overall, these concerns need to be discussed further to help along the very important conversation on poverty and healthcare.