NURS 8100 Discussion: Federalism’s Impact on Policy ANSWER

By Day 3

Post a cohesive response that addresses the following:

  • Provide an example of two policies that address similar needs, passed at two levels of government (i.e., federal, state, or local).
  • What are the advantages and/or disadvantages of this duplication? How does this example reflect the implications of federalism? Provide support from the literature for your position.
  • To what degree should the federal government get involved in health care policy making? Provide concrete examples to support your position.

Read a selection of your colleagues’ postings.

RE: Discussion – Week 8

Overlapping of Federal-state Health Policies

Historically, the elderly and the disabled receive long-term care in institutionally setting because Home and Community Base Care services (HCBS) were less available. However, in the 1980s, an amended federal law passed a federal-state Medicaid waiver authority for states to expand HCBS services to cover individuals at risk for institutionalized care (Musumeci et al., 2020). These individuals will receive broader services that were not allowed by Medicaid state plans. The HCBS 1915 (c) waivers authorized states to provide targeted services to populations such as seniors, people with physical or developmental disabilities, and individuals with specific conditions such as HIV/AIDS or traumatic brain injuries(Merryman et al., 2015). Essential to note every state’s eligibility requirement and criteria are different; however, HCBS waivers are limited to three years but may extend five years for those dually enrolled in Medicaid and Medicare (Merryman et al., 2015).

In response to the COVID-19 pandemic, President Biden signed the American Rescue Plan Act (ARPA), which provides $1.9 trillion for several provisions to include in the pandemic relief package (Miller & Beauregard, 2022). This legislation will significantly impact state and federal health policies and programs, such as federal funding for state Medicaid spending on HCBS. The ARPA will provide a one time10% increase in federal matching payment to states’ HCBS to supplement state expenditure which would only be available for a year(Miller & Beauregard, 2022. Therefore, states would have the flexibility in overlapping with federal policies targeting HCBS to specific populations. Nonetheless, the ARPA ensures that states benefit from the federal investment for HCBS to achieve the best outcomes for Medicaid beneficiaries to receive high-quality, cost-effective, person-centered care in their home (Watts et al., 2020).

Duplication Advantages & Disadvantages

The advantage to the federal-state funding of HCBS is that it provides states with good flexibility to utilize these funds that align with the priorities of local policies (Musumeci et al., 2020). As a result, states will be able to enhance their HCBS models (Watts et al., 2020). Furthermore, states taking advantage of access to federal funds will also address the shift in demand for healthcare needs because of COVID public health emergencies (Miller & Beauregard, 2022). On the other hand, states will need to determine how they will sustain this investment once the expiration of federal matching.

Implications of Federalism

Nevertheless, the enactment of the American Rescue Plan Act (ARPA) with the inclusion of increasing state funds to HCBS foreshadowed the United States as a federalist system. Oversight of health policy decisions responsibility is shared among federal and state in areas of administration and funding. The state and federal are jointly responsible for the healthcare financing for the health and long-term care of low-income populations with the appropriate balancing of these responsibilities (Collins, & Lambrew, J2019). However, federalism contributes to the fragmentation of the U.S healthcare system due to the different financing and service delivery modes, leading to duplication of services.

Federal Government Involvement in Healthcare Policymaking

According to Bialik (2018), the Pew research reported that 60% of American believe that the federal government should be responsible for ensuring healthcare coverage for all Americans. Essentially, the federal government plays a central role in the oversight and shaping of the American health care arena to develop policies that support cost-effective quality programs for the population’s health needs. Therefore, the federal government should maximize its involvement given its unique position as regulators, healthcare purchasers, sponsors of applied healthcare research, healthcare provider education, and healthcare providers (Crowley et al., 2020). Furthermore, federal leadership is a crucial stakeholder having extensive healthcare programs and market influence, which helps acquire sustainable healthcare reform and better quality and value in healthcare (Gluck & Huberfeld, 2018). For instance, the federal government has been a critical player in establishing Medicare and Medicaid to ensure access to insurance coverage for a large segment of the population, legislation for employer-sponsored health insurance, and expanded federal healthcare programs (Collins & Lambrew, 2019 ). Currently, the federal leadership plays a pivotal role in the Affordable Care Act by expanding health insurance coverage to the uninsured. Hence, the federal government plays an essential role in promoting healthcare services that contribute to healthcare efficiency and saving, so the federal government should maintain a central role in healthcare policymaking.


Bialik, K. (2018). More Americans say government should ensure health care coverage. Universal Health Care94.

Collins, S. R., & Lambrew, J. M. (2019). Federalism, the Affordable Care Act, and health reform in the 2020 election. The Commonwealth Fund.

Crowley, R., Daniel, H., Cooney, T. G., Engel, L. S., & Health and Public Policy Committee of the American College of Physicians*. (2020). Envisioning a better US health care system for all: coverage and cost of care. Annals of Internal Medicine172(2_Supplement), S7-S32.

Gluck, A. R., & Huberfeld, N. (2018). What is federalism in healthcare for. Stan. L. Rev.70, 1689.

Merryman, M. B., Miller, N. A., Shockley, E., Eskow, K. G., & Chasson, G. S. (2015). State adoption of Medicaid 1915 (c) waivers for children and youth with autism spectrum disorder. Disability and health journal8(3), 443-451.

Miller, E. A., & Beauregard, L. K. (2022). Enhancing Federal Revenue under the American Rescue Plan Act: An Opportunity to Bolster State Medicaid Home and Community-Based Services Programs. Journal of Aging & Social Policy, 1-15.

Musumeci, M., Watts, M. O., & Chidambaram, P. (2020). Key state policy choices about Medicaid home and community-based services. Kaiser Family Foundation.

Watts, M. O., Musumeci, M., & Chidambaram, P. (2020). Medicaid home and community-based services enrollment and spending. Kaiser Fam Found.