Free Essay

Medicaid and Stakeholders

In:

Submitted By Timothyfla2002
Words 1078
Pages 5
Medicaid 1
Medicaid and Stakeholders

On July 30th 1965 the Medicaid program was created to address the poor and elderly uninsured population in the United State. This voluntary program is administered on a State level but regulated on a Federal level. The Center for Medicare and Medicaid Services (CMS) is the organization that over sees the delivery, quality, funding, and eligibility of the program. Each individual State can choose how to operate the Medicaid itself. The program is design to help people with low income, children, parent of those children, pregnant women, disabled and elderly people in need of a nursing facility. Medicaid is a complex system because it is not a single program and runs differently in each State. It is a very costly system because its serves the poorer population and the long term patients. Currently Medicaid is experiencing changes on all levels. The rise in unemployment has caused an increase in applicants who qualify thus driving up the costs associated. With the passage of the Patient Protection and Affordability Care Act (ACA) the general consensus is that the Medicaid has some current issues to address before more people fall under their umbrella of services. Currently there are more than 59 million people enrolled the Medicaid system for health care. The system is expected to add nearly 16 million more people by 2019. With State governments facing a budget crisis many are looking to cut the Medicaid program. The Federal government has purposed cutting $33 billion for the fiscal 2012 budget. The ACA has increased eligibility to all legal residents earning up to 133 percent of the Federal poverty rate. The Provider Tax Program will be cut by $18.4 billion over the next ten years. This program in the past has allowed State governments to expand coverage and fill budget gaps. The ACA also plans on reducing $14 billion in funding through 2019 for the Medicaid Disproportionate Share Hospital Program. Money from this program is usually allocated to
Medicaid 2 hospitals that serve a disproportionate number of Medicaid and uninsured patients. The purposed cuts to programs such as these, the budget cuts on both the Federal and State level coupled with a poor economy has create a major challenge for the Medicaid program. The Medicaid Program is a driving force in the healthcare industry that extents coverage to nearly 1 out of every 5 children in the United States. All players involved such as the American Hospital Association (AHA) and related stake holders must look at techniques in which they can properly maintain the current system standards and cut costs while increasing the amount of eligible clients. Moving forward when addressing the financial future of such a vital entity of the healthcare system that provides benefits to the most vulnerable people in our society, all parties involved must implement innovative measure to reduce their Medicaid spending growth. Holding providers accountable for best practices is one way to accomplish this. The Medicaid RAC program is a fee-based approach to audit providers on processed paperwork. The auditors themselves get a percentage of any errors a provider is fined for. The program which was implemented on April 1st, 2011 has received some negative review because of the merit on which denials are being made. Also State and Federal government has not properly educated providers on processes that are inflicting fines for. The implementation of the RAC program is just one solution to limit the amount of fraud and abuse within the entire system. Another initiative set forth by the Federal government is the implementation of section 1903(a)(3)(I) and 1903(a)(3)(B) of the Social Security Act. The Center for Medicare and Medicaid Services will set standards in technologies in which all States must comply. The ultimate purpose is to enhance communication when collaborating on both the Federal and State level. The computer based system will run more efficiently than the old paper system. It will allow faster processing time to handle the added
Medicaid 3 number of clients enrolling while ensuring all eligible people are proper awarded claims. This process is an ongoing process and must be implemented State by State because of subtle different among States. After doing my research it is clear to see the importance of the Medicaid program within the United State. Ninety percent of the clients I serve are Medicaid clients which is why I think we must focus our resources on making it a better service. I think the reimbursement process must be revamped on all levels. One example by revamping would be to replace visiting nurses with another lower cost personnel to carry out the function. Currently in the Behavioral Health System a nurse get a premium per visit fixed payment decided by the company they work for. A half visit is perform daily or it may be perform twice daily (BID). During this visit a nurse administers meds and does a visual assessment. I think because there is such a demand associated with nurse the service rendered is overpriced. By training a qualified person those two functions at a lower rate of pay we will be able to contain costs across the board. With homecare being the fastest growing segment within the healthcare system we must find innovate, safe, and reliable alternatives to administering a high quality service. This is just one cost savings measure that must be implement to maintain quality standards in the Medicaid system. Each and every stakeholder must look at ways to improve this system.

Medicaid 4
References
Abelson, Reed. New York Times, Whatever Courts Rules, Major Changes in Health Care Likely to Last. Retrieved November 24, 2011 from http://wwwnytimes.com/2011/11/15health/policy/health-care-is-changing-despite -federal.html
Cauchon, Dennis. USA Today, Medicare, Medicaid Tab Keeps Growing. Retrieved November 24, 2011 from http://yourlife.usatoday.com/health/healthcare/story/2011/08/medicare-medicaid-tab-keep-growing/497769981/1
Centers for Medicare and Medicaid Services. Http://www.cms.gove/home/medicaid.asp
Ono, Micheal. Abc News, Could Health Care Cuts Curtail Fastest Growing Jobs Sector. Retrieved November 24, 2011 from http://abcnews.go.com/blogs/politics/2011/11/could-health-care-cuts-curtail-fastest-growing-jobs-sector
Rivkin, David. The Wall Street Journal, ObamaCare and the Limits of Government. Retrieved November 24,2011 from http://online.wsj.com/article/SB10001424052970204323904577038232724779286.html
Rowland, Diana. October 8, 2003. Medicaid Issues and Challenges. The Kaiser Commission on Medicaid and the Uninsured

Similar Documents

Free Essay

John Q

...John Q. Crystal Beere HCS/235 March 16, 2015 Steve Linerode John Q. John is like many people in the country that have a low income job. He is working a full time job but still doesn’t make enough to afford insurance on his own so he has Medicaid. This limits his options on coverage and who he can go to. He has a condition that needs medical attention, high blood pressure, but because of his insurance he is finding it hard to get the care he needs. Many people have that problem but there are solutions to get the care you need. John lives in a rural area that doesn’t have any primary care doctors that take his insurance. He was able to find two doctors in his area but not a primary care physician. The closest primary care physician he found is forty minutes away from his home. This is a challenge for him because he catches a ride to work or relies on public transportation. These problems are mutable, which means they can change. He could move to a different place, closer to the doctor he needs to see. Although with his low income job he might not be able to afford a place closer to the doctor he needs to see. He could also invest in getting a car. The cheapest option for him would to be get a car so he doesn’t have to rely on others to take him and possibly miss an appointment. He could still catch a ride with a friend or use public transportation if he wants to save on gas so he has it to get to his appointments...

Words: 1127 - Pages: 5

Premium Essay

Expansion of Medicaid

...Expansion of Medicaid Name School Abstract On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law, allowing all Americans access to affordable health care. Despite the urgent need to provide health care to all Americans some Governors and elected Congressmen continue to debate over the necessity to expand Medicaid and the ACA. The Supreme Court on June 28, 2012 ruled in support of the ACA by upholding the individual mandate which require Americans to have health care insurance. Americans without health care insurance, because of this new health care policy will be able to either purchase insurance through the exchange market or through the expansion of Medicaid. Some states are against the expansion of Medicaid even though the government will fund 100% of the program for the first 3 years. The states that decide to opt out of the Medicaid expansion will heap some negative impact on several stakeholders. The ultimate goal of the ACA and the expansion of Medicaid was to provide quality health to the many uninsured. Expansion of Medicaid The implementation of an important component of the Affordable Care Act (ACA) is the expansion of Medicaid. The expansion of Medicaid ensures health care coverage for children, poor people, disabled people and some elderly citizens. Unfortunately, 20 states have decided to opt out of this policy leaving access to health care unavailable to millions of needy people. It remains unclear why so many...

Words: 2326 - Pages: 10

Premium Essay

Regulatory Agency

...Implementation Resources Long-Term Supports and Services Medicaid Policy Primary Care Improvement Quality and Equality About UsBoard of TrusteesStaffPresident's MessageJobsHistory & FundersDirectionsFAQs About CHCS Slide Deck_Dec_2010 (229K) Medicaid Fact Sheet (44K) About CHCS Fact Sheet (61K) Download Adobe Acrobat Reader to read PDF files. Our Mission The Center for Health Care Strategies (CHCS) is a nonprofit health policy resource center dedicated to improving health care quality for low-income children and adults, people with chronic illnesses and disabilities, frail elders, and racially and ethnically diverse populations experiencing disparities in care. We work with state and federal agencies, health plans, providers, and consumer groups to develop innovative programs that better serve people with complex and high-cost health care needs. Our Priorities Enhancing access to coverage and services. Under health care reform, Medicaid is poised to serve more than a quarter of all Americans. CHCS is helping states and health plans to understand the care needs of the Medicaid expansion population and streamline linkages between Medicaid and the insurance exchanges. Improving quality and reducing racial and ethnic disparities. Medicaid currently serves more than 60 million Americans including a significant portion in racial and ethnic minority populations. Quality outcomes in Medicaid are significantly lower than in commercial insurance. CHCS...

Words: 508 - Pages: 3

Premium Essay

Competition in Health Car

...“Although Medicare and Medicaid are still the most significant buyers of long-term care services they are no longer the only buyers. Managed care has become a buyer with considerable influence in all of health care” (Pratt, 2010). A few years ago one looked at long-term care facilities as being in nursing homes. Today facilities are opening up that is not a setting for nursing home though that is what others thinks. With the government involved today it has restraints with the pricing and the quantity of service one provides. When the government gets involved with making decision on health care they divert resources away from one provider and looks at another. “to be competitive, long-term care providers have to know where they stand in the market. That means that they need to know how they compare with their competitors and their relative strengths and weaknesses” (Pratt, 2010). Most providers does not look at the strength and weaknesses of other facilities since this was not a big factor before. One must do research to find out the pricing and check the competition to see what is more readily available. With the rising cost of health care one needs to look at the price of long-term care and what type of care one would get. With Medicare and Medicaid caring the burden of the expense one is looking at managed care to help what these programs does not cover. “Medicare and Medicaid are dominant purchasers in the nursing home market. Medicaid...

Words: 1203 - Pages: 5

Premium Essay

Bringing It Altogether

...1) Distinguish the marketing approach that a health care marketer would take to handle products and services to a marketer of consumer goods. An approach to marketing is important to know and analyze the different views that marketers have about the future. This vision of the future will strongly condition the entire strategic planning of marketing for healthcare. In order to continue to thrive, companies must acquire and keep customers. As a result, marketing and sales has become an area of increasing focus for companies of all sizes. Marketers create an effective marketing strategy is based on a five-step process: 1: Understanding the market climate and marketing strengths and weaknesses 2: Developing a marketing strategy 3: Building a marketing plan 4: Implementing the plan 5: Monitoring the success of the plan (Burgemeister, 2003). A solid marketing strategy provides a roadmap to creating and delivering true value to distinct groups of customers. All successful marketing strategies must begin and end with the customer, they cannot be an afterthought or taken as a given, so marketers must test their assumptions about their customers constantly. These are the thing that goes into a marketing strategy. A cohesive combination of: Targeting—to whom are you going to market your products and services? Positioning—how are you going to differentiate yourself from competitors? Product/Service Attributes—what attributes/features will the product/service have? Marketing Communications—how...

Words: 2111 - Pages: 9

Premium Essay

Enrollment and Access

...Aspen County Access and Enrollment Assistance Aspen County has opted not to participate in the expansion of the Medicaid program in the state. There was strong support of dropping the Medicaid program from commissioners of the county, and citizens who want less government involvement in their lives. Additionally, healthcare providers in the county are reporting that they are seeing more Medicaid, Medicare and uninsured patients, and delivering higher levels of uncompensated care. With that, the largest primary care practice in the county, Basalt, has decided to terminate its Medicaid and uninsured patients. They can no longer afford being uncompensated for care. There are several issues that are important in evaluating the state of health care in Aspen County and evaluation of if obtaining a grant from the government for enrollment assisters to help patients enroll in Medicare, Medicaid or purchase insurance coverage. There is the potential to benefit the county's medical groups positively if patients have insurance and they can be compensated for their care. The stakeholders here are the healthcare facilities, county commissioners, citizens and the public health department. Most of the stakeholders in this situation are in support of dropping Medicaid, which needs to be delicately addressed. Leaving 1/3 of the population or more without coverage or help needs to be emphasized and the advantages of providing services for citizens to get coverage explained efficiently...

Words: 264 - Pages: 2

Premium Essay

Student

...United States are outsourced to private businesses. Like anything performed by any business, organization or government body, there are potential improvements that could be implemented. Here, I will discuss the stakeholders involved in the federal healthcare systems of Medicare and Medicaid, and how the strategies might be improved within outsourcing practices. Multiple groups hold interest in the strategies used by Medicare and Medicaid to provide healthcare to patients. Medicare contracts with private health insurance companies to provide specific benefits to people with Medicare. People eligible for Medicare include those over 65 years old, or those who are disabled. Medicaid is operated at the state government level, and generally covers disabled, and people over 65 years old with low income and minimal assets. In addition to the people covered under these systems, additional stakeholders include doctors, hospitals, insurance brokers and agents, and public policy-makers (legislators). An easily forgotten group of stakeholders within these systems are taxpayers not currently receiving direct benefits from these systems, but who are directly contributing funds which are used to fund Medicare and Medicaid expenditures. Those who are recipients of Medicare and Medicaid benefits want to receive the best possible care, with the least amount of cost to them personally. Meanwhile doctors and hospitals want to receive the highest possible amount of reimbursement for their services...

Words: 1408 - Pages: 6

Premium Essay

Health and Promotions

...promotion plan to address the lack of adequate assistance to low-income pregnant women and their families. This plan will allow one to make a great impact in healthcare, attests to the art of nursing even as a student, the whole multidisciplinary team and the most important of aspect of healthcare; the patients that are being served. This paper will offer insight into the community, including a thorough assessment of low income pregnant women and their families’ lack of access to adequate care in Delray Beach Florida. In addition, this paper will highlight a health promotion plan for improving quality of life and health of low income, underinsured Delray Beach residents by discussing state and local programs. Also, discussing the community stakeholders as well as the financial and political implications of the health promotion project is a pivotal point. By addressing the barriers in creating the health promotion in the community, the community health nurse can serve as a patient advocate and present a plan an alternate plan and any possible interventions in case of unforeseen, confounding issues that may arise. The Aggregate Being poor and having to take care of other children can increase the likelihood of negative health outcomes especially for their unborn children. Pregnant women need resources that can easily be accessed and utilized. Thus, this writer have chosen to write about cthis aggregate for the Health Promotion Plan paper as low-income pregnant women with families living...

Words: 1982 - Pages: 8

Premium Essay

Health

...Policy Critique Sarenceya Maxwell Dr. Gordon September 28th 2014 Health Care: Treatment of mental and physical illness through special services with excellent approach is considered to be called health care. A health care consists of specialized doctors, trainers and physicians. Who effortlessly work for the betterment of the patient. Specialized health care’s are found everywhere in the world. Health Care Advisors: Health care advisors charge with advising customers with health care desires. Whether or not the authority will answer the question or suggests a resource for the client to contact, he or she provides calm, comforting recommendation to people who call or e-mail. These advisors generally act as role models and use a customer-led approach in their exchanges. A primary responsibility of a health care authority is client service. Expertness and compassion are very necessary for the fulfillment within the field. The goal is to depart customers with the sensation they referred to as the correct place for facilitate. Additionally, the client ought to feel comfy contacting the authority succeeding time a retardant or concern arises. Client services skills can promote goodwill and facilitate make sure that customers come. Maintaining information of all accessible services and merchandise is additionally the work of a health care authority. People who work for a corporation can perceive the way to advise customers with...

Words: 2108 - Pages: 9

Premium Essay

Health Law, Regulation, and Policy

...Health Law, Regulations, and Policy Paper Michelle Hobbs HCS/545 June 13, 2016 Qiana Amos Health Law, Regulation, and Policy Paper Today’s health care industry is more than just providing medical services to individuals in need; it encompasses various laws, regulations, and policies that direct how care should be provided and what the ramifications of non-compliance will have on the health care provider and the organizations where services are rendered. There are various kinds of laws, regulations, and policies that affect the health care industry. Some may believe that laws, regulations, and policies all have the same requirements, benefits, and implications, but there are differences between the three and the impact they have on health care. As the ability of the health care industry continues to expand, the need for additional laws, regulations, and policies will be necessary to ensure the quality and equitable delivery of medical services continues to improve alongside the medical services. Title VI of the Civil Rights Act of 1964 One law that governs the manner in which health care services are rendered is Title VI of the Civil Rights Act of 1964. This law states “no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance (United States Department of Labor, n.d.). For health...

Words: 2400 - Pages: 10

Premium Essay

Policy Analysis

...these trauma centers are nearly exhausted and can potentially cause catastrophic effects on the areas patients. Soon the trauma centers will be refusing the patients who rely on Medicaid and Medicare resources. What can be done to prevent the refusal of healthcare to these patients and ensure that bailouts are not the solution to this healthcare crisis? To provide more in depth about this problem involves the background for a policy analysis. It has been stated that with numerous amount of undocumented workers and the state’s unemployment rate to continually remain high, it is making it difficult for these trauma centers to accept these patients. They rely soley on Medicaid which has caused a depletion of the state’s budget. This has caused two of the three trauma center to rely on private payer instead of federal aid programs. In the long run how can these HCO’s say they are providing quality effective healthcare to their people by denying it to certain groups? This will now lead us to the next step of a policy analysis and its key stakeholders. In regards to the landscape of the policy analysis, the main stakeholders who are affected will be the taxpayers/community. The community may start to feel the financial burden of what will happen when these two trauma centers do not accept Medicare/Medicaid patients. There can be a strong possibility of taxes being increased and a...

Words: 672 - Pages: 3

Premium Essay

Content Management System

...HIMS 110 Professor Pharissa Robinson Final Current Event CMS Quite a few changes have been going on with CMS. These change started after the signing of the American Recovery and Reinvestment Act, which included the creation of the Medicare and Medicaid EHR incentive programs a few years ago. The nation has seen a groundbreaking growth in the adoption of the Electronic Health Records. The Centers for Medicare and Medicaid Services, CMS, have created a new timeline which is in reference to the implementation of meaningful use for the Medicare and Medicaid EHR Incentive Programs. The Office of the National Coordinator for Health Information Technology, ONC, also has proposed a better approach to update their, the ONC, certification regulations. One of these major changes is the timeline extension given for stage 3 from stage 2. CMS and ONC both feel that more time is needed to better structure the program and its requirements. The program has three stages. Stage 1 is the approach to the program’s participation. Stage 2 is the exchange of the health information. Stage 3 focuses on the improved outcomes. The goal and purpose of the extension is to focus all efforts on enhanced patient engagement, interoperability, and health information exchange in stage 2 and to utilize data from stage 2 to “inform policy decisions” for stage 3, as stated by Robert Tagalicod, Director of CMS’ office of eStandards and services. Stage 2 will continue throughout 2016 and stage 3 will commence...

Words: 501 - Pages: 3

Premium Essay

Business Analysis

...Business Analysis Part 1 The company chosen for the business analysis is Humana, Inc. Humana, Inc is a health care company offering a wide range of insurance products from long-term care to well-being. Humana, Inc headquartered in Louisville, Kentucky. Humana defines their corporate social responsibility stating, “We are dedicated to making business decisions that reflect our commitment to improving the health and well-being of our members, our associates, the communities we serve, and our planet” (Humana, 2012) SWOT Analysis The SWOT analysis will cover Humana’s strengths, weaknesses, opportunities, threats, internal factors, and external factors. Humana’s internal factors are the strength and weaknesses of the company. Humana’s external factors are the opportunities and threats of the company. Humana’s strengths are the company has 400,000 -plus physicians on staff and 5,000 -plus hospitals throughout the United States and Puerto Rico. Humana offers a wide range of products to sell to the consumer. For individuals, the products are Humana One medical insurance, Humana dental, and vision insurance, financial protection plans, Rx drug plans, and Medicare plans. On the employer side of Humana’s products, they offer medical plans, spending accounts, dental and vision plans, disability coverage, life insurance plans, employer paid plans, and Rx drug plans. For the military Humana offers Humana Military Tricare programs. The military plans. The Tricare plans offer...

Words: 1370 - Pages: 6

Free Essay

Ppa 601 Foundations of Public Administration

...Affordable Care Act PPA 601 Foundations of Public Administration Timothy Smith December 20, 2015 If an individual needs emergency medical care, the first place that most would seek treatment is through the emergency room at the closest hospital. Even if that individual does not have any medical insurance, they know that they can and will receive treatment if they go to the emergency room instead of going to the doctor’s office. The reason that individuals can count on this serves is because of the many women and men in Congress that have spent many hours making public policies around health care that showcase how providers will attend to their patients. Public policy is the way that the government maintains order and also how the government addresses the needs of its supporters through actions that are outlined by its constitution. That definition seems vague because public policy is not a concrete thing but rather it is a term that is used to describe a plethora of laws, mandates, or guidelines that are founded through a political process. There are many types of public policies because policies are put in place to address the needs of individuals and those policies are divided into different categories as they relate to society. For example, health policy includes not only insurance but also includes all policies that are related to the heath of a certain group. When the AIDS epidemic came about in the early 1980’s, governments from all over the world had to initiate...

Words: 3049 - Pages: 13

Premium Essay

Financial Environment

... and care. Each health care organization fits differently within the environment. Financial management of each organization is needed for external and internal operations and financial status. The provision of health care services is dominated by not-for-profit (NFP) organizations, for-profit (FP), and governmental, (Gapenski, 2008). The job of finance in health services organizations is to plan, acquire, and utilize resources to maximize the efficiency and value of his or her industry. These health care organizations will have similarities and differences between them. Each organization will receive him or her funding from different sources. These same organizations have differences in who makes the financial decisions. The stakeholders of each organization will be varied or none at all. This paper will examine and discuss these similarities and differences. This paper will provide three examples of each FP, NFP, and government. Examples of For Profit Organizations (FP) 1. St. John’s Health System: Tulsa, Oklahoma 2. Oklahoma University Medical Center: Oklahoma City, Oklahoma 3. Hillcrest Medical Center: Tulsa, Oklahoma Examples of Not-For-Profit Organizations (NFP) 1. Integris Health: Oklahoma City, Oklahoma 2. Jane Phillips Medical Center: Bartlesville, Oklahoma 3. Cornerstone Hospice: Bartlesville, Oklahoma Government Financing 1. Jack C. Montgomery VA Medical Center: Muskogee, Oklahoma 2. Three Rivers Health Center: Muskogee...

Words: 1091 - Pages: 5