...Medicaid is the State and Federal joint venture that provides medical coverage to the eligible individuals. The purpose of Medicaid in Texas is to improve the health of people whose income and resources are insufficient to pay for health care. The Texas Health and Human Services Commission's (HHSC) Medicaid Office is responsible for statewide oversight of Texas Medicaid. The mission of the Texas Medicaid program is to improve the health of Texans by emphasizing prevention, promoting continuity of care, providing a medical home for Medicaid recipients and ensuring that each recipient can receive high quality, comprehensive health care services within the community. (6) Medicaid serves primarily low- income families, children, caretakers of dependent children, pregnant women, cash assistance recipients, people aged 65 and older, and adults and children with disabilities. Medicaid pays for acute health care (physician, inpatient, outpatient, pharmacy, lab, and x-ray services), and long-term services and supports (home and community-based services, nursing facility services, and services provided in Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICFs/IID)) for people age 65 and older and those with disabilities. Texas Medicaid provides major portion of healthcare services through managed care model. (1) There are basically four Medicaid programs in Texas. The type of coverage an individual gets depends on his/her...
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...Medicaid And The Problems The Program Faces Research Paper Introduction Medicaid is the largest health insurer in the nation, providing care to more than 50 million Americans with an annual cost around $250 billion. With Medicaid being the largest insurer in the United States, they face many problems and concerns, including limited access, low quality of care, financing and reimbursement concerns, and increased costs. Medicaid Reform is in the near future and with Medicaid’s spiraling costs, mandated managed care ought to be. The Medicaid program, created by the Social Security Amendments Act of 1965, is a partnership between the federal and state governments to provide healthcare to low income and vulnerable populations. The Federal Centers for Medicare and Medicaid Services (CMS) monitors the Medicaid program and establishes broad guidelines for program eligibility, services covered, the delivery of services, and the quality. Each state administers their own program with specific eligibility standards including the type, amount, duration, the scope of services covered, and the payment levels for services provided, (Perlino, 2010). Medicaid operates as an entitlement program making the federal government, under federal law and the budget process, obligated to pay their share of each state’s Medicaid program. The federal government matches the states spending services, varying from 50 to 77 percent depending on the state. Currently the federal government finances...
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...Evolution of Medicaid Genesis65 HCS/310 April 19, 2010 Barbara Sinacori, RN, MSN, CNRN The Evolution of Medicaid Prior to 1965, the poor elderly in the United States were left with little options when it came to accessing and paying for preventative health related services. As a result, many of the poor in the U.S. went without routine health care or treatment for known illnesses. In response to this growing issue, the Federal government, under the direction of President Lyndon B. Johnson and in conjunction with state governments, established the Medicare program on July 30, 1965 through Title XIX of the Social Security Act (Centers for Medicare and Medicaid Services, 2010). Along with passage of the Medicare Bill in 1965, Congress also passed an insurance program known as Medicaid that would provide health care insurance for various groups of disenfranchised U.S. citizens. This paper will briefly discuss the evolution of the Medicaid program and examine how Medicaid has influenced the current health care system in the United States. The ever-rising cost of health insurance has prohibited many businesses from providing health insurance to their workers, effectively leaving millions of Americans uninsured or underinsured. According to the U.S. Census Bureau (2007), “The number of people without health insurance coverage [in the U.S.] rose from 44.8 million (15.3 percent) in 2005 to 47 million (15.8 percent) in 2006.” Medicaid is a program...
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...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...
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...angry at the mere thought of the homeless, disabled, and mentally ill leaving on the streets, and yet it seems the one program that helps the lower-income bracket Americans is the one program that keeps receiving budget cuts, restraints, and reduction in services. Affect of Budget Cuts According to Curry (2013), “The new health reform is said to bring “massive automatic cuts” and “deep indiscriminate cuts” too so many departments and programs it is a wonder doctors or organizations can provide proper care, and service (p. 1). Of course, like many county clinics budget cuts did not discriminate against Clair County Clinic Medicaid clients who will see a 15% budget cut in the services and programs that Medicaid offer. This average size clinic provides service and care to a large volume of Medicaid patients. The constant budget cuts and restraints are leaving...
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...Medicare versus Medicaid A Brief Comparison Medicare versus Medicaid: A Brief Comparison The Federal government has two distinct programs to provide health insurance coverage to citizens, Medicare and Medicaid. The two programs, while helpful to those individuals who qualify, are not available to everyone. In this paper, I will briefly define and discuss the two programs, their similarities, and their differences. The first program I will discuss is the Medicare program. President Johnson signed Title XVIII of the Social Security Act, also known as Medicare, into law on July 30, 1965 with coverage beginning in 1966. When Medicare first began, it consisted of two basic parts, known as Part A, and Part B. Medicare Part A provides hospitalization coverage automatically to all citizens age 65 and older. It helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Most people do not have to pay a premium for this service because they or their spouse has already paid for coverage through payroll taxes. (Medicare Gen Info) For those who do not qualify for premium free service, an annual deductible of forty dollars per year was established. . Since then, like everything else, Medicare Part A premiums have increased. “The $1,024 deductible for 2008, paid by the...
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...Universal healthcare for the United States has been a work in progress for many years. Since the United States doesn’t have universal health care, we refer to the Medicare and Medicaid system. Medicare is referred to as “the universal health insurance for elderly people” (Barr, 2011, pg.132). Medicare is a federal program that helps all people 65 years or older pay for healthcare. Those who qualify for Social Security benefits are automatically eligible for Medicare (Barr, 2011). When Medicare was passed in 1965, only 56 percent of elderly people have hospital insurance. It was a strong national consensus that none of the elderly in United States should face financial ruins because serious illnesses were seen as a threat to financial security of seniors (Barr, 2011). Due to that reason, Medicare was created to ensure financial stability. Not only does Medicare cover people 65 years and older, but it also covers individuals with certain disabilities, and individuals with End-Stage Renal Disease that requires dialysis or transplant (Medicare.gov). Unlike Medicare, Medicaid was not created as a program for all people who fall below that poverty line. It only covers certain subgroups of poor people (Barr, 2011). Medicaid provides medical benefits to groups of low-income people, some who may have no medical insurance or inadequate medical insurance, health care to children, pregnant women, parents, senior, and individuals with disabilities (Medicaid.gov). Medicare is made up of...
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...The Affordable Care Act and Medicaid Albany State University Healthcare in America is the most talked about topic today. This seems to be true since the Patient Protection and Affordable Care Act, commonly known as “Obamacare”, is in place. This act was signed into law back in 2010. It took four years for the changes to take place and now citizens of America are required to have a health insurance plan in 2014. Open enrollment for “Obamacare”, insurance plans ends March 31, 2014. Those who do not have insurance by then, will be taxed 1% of their salary by the IRS or receive a tax penalty of 95 dollars. The Affordable Care Act has made many changes to health insurance coverage, such as Medicare and Medicaid, family insurance plans and more. If one cannot afford health insurance, Medicaid will be extended under certain conditions. Medicaid will be extended to individuals or families who earn up to 133% of federal poverty level. According to About.com, federal poverty level for an individual is $15,281. For a family of four, the federal poverty level is $31,321.50. Individuals or families who earn too much for Medicaid will receive tax credits only if their income level is below 400% of poverty level. According to About.com, for an individual to qualify for a tax credit, their income would have to be $45,960. For a family of four, 94,200. The credit is then applied monthly instead of a yearly tax rebate. There are also reduced copayments and deductibles for these individuals...
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...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...
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...Historical Legislation from 1965: Medicare and Medicaid Liliana Martinez Dr. Smith Grand Canyon University: HCA-460 3/7/13 Historical Legislation from 1965: Medicare and Medicaid The Medicare and Medicaid programs were signed into law on July 30, 1965 by President Lyndon Johnson ("Centers for Medicare," 2012). Before this decision was even taken into consideration, many other healthcare reforms had previously been introduced by earlier presidents, but failed to pass the Senate. Healthcare issues have always been on board for the United States, but during this time the elderly and the poor were desperately screaming for help. The government had no choice but to come up with a solution to their healthcare needs; these two populations were left with no options but to trust the government and their ideas towards solutions. These solutions are called Medicare and Medicaid, which at that time served more than 19 million individuals ("Key milestones in," 2006). After the implementation of these government health programs, almost yearly new premiums were added and adjusted to them. Medicare as previously stated is a government insured program provided for the elderly usually starting at the age of 65 and older along with certain younger people with disabilities. There are four different parts to the Medicare program. Part A deals with hospital insurance, this part helps cover inpatient care in hospitals, hospice, and skilled nursing facilities. The majority of the people...
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...Are Doctors accepting Medicaid Patients as Obama has Signed the Affordable Care Act Rider University 2083 Lawrenceville NJ 08648 5/2/2013 Rider University 2083 Lawrenceville NJ 08648 5/2/2013 Arunabh Sinha Arunabh Sinha Abstract On March 23, 2010 President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), also known as Obama Care. As a direct result of this there are going to be more people on Medicaid and also more “baby-boomers” are going to be turning sixty-five thus qualifying for Medicare. Although fewer doctors are accepting government insured patients! This paper will research the number of doctors accepting governmentally insured patients and also if there is a shortage in the number of providers as the PPACA goes into effect. With data provided from the American Medical Association (AMA), Center for Disease Control (CDC), and other academic journals an evaluation is going to be made of if there is enough doctors to meet the demand of newly insured patients in the US. Issues of access and quality of care will also be addressed in this paper. Are Doctors accepting Government Insured Patients as Obama has Signed the Affordable Care Act On March 23, 2010 President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), also known as Obama Care. As a direct result of this there are going to be more people on Medicaid and also more “baby-boomers” are going to be...
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...Introduction The purpose of this paper is to give an overview of two federally and/or state funded programs. The programs that will be discussed are Medicare and Medicaid. In this paper will be information about who receives Medicaid/Medicare, the services offered by these programs, and those long term services that are not. Medicaid Medicaid is a joi8nt federal and state program. It provides health coverage to nearly 60 million Americans including children, pregnant women, seniors, and individuals with disabilities. As well as those people who are eligible to receive federally assisted income. Eligibility does however vary state to state. Medicaid may help pay for: Doctor bills, hospital bills, prescriptions, vision care, dental care, Medicare premiums, nursing home care, personal care services, in home care under the community alternatives program, mental health care, and services for children under 21. Medicaid can help pay for cost and services that Medicare doesn’t cover. In most states, Medicaid will pay for long term care services. In most instances they will cover services that will help and individual stay in their home such as personal care, case management, and help with laundry and cleaning. They won’t however pay for rent, mortgage, utilities, and/or food. Medicare “Medicare is the federal health insurance program for people who are 65 and older, certain young people with disabilities, and people with End Stage Renal Disease requiring dialysis or a transplant...
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...Consequences of Refusing Medicaid Expansion in Louisiana Perhaps the most significant of Barack Obama’s presidential achievements will be the passage of the Patient Protection and Affordable Care Act (ACA). He signed ACA, also frequently called “ObamaCare,” into law on March 23, 2010, but several milestones had to be overcome before the act went into effect in 2014. ACA was intended to increase the affordability and accessibility of quality healthcare to the American people. While these goals, at their most rudimentary form, appear to be benevolent enough, the law has been the source of many heated debates and lawsuits over the past few years. ACA was intended to use several mechanisms to increase people’s access to health insurance. (Dickman, Himmelstein, McCormick, & Woolhandler, 2014) The law called for states to set up online health insurance exchanges for people to compare and shop for health insurance policies. Individuals and families earning up to 400 percent of the Federal Poverty Level (FPL) would be eligible for a subsidy to help pay for their policy. The 2014 FPL for a family of four is $23,850. (2014 Poverty Guidelines, 2014) The law also required most uninsured people whose income exceeds 138 percent of the FPL to either purchase health insurance or be subject to penalties. Another condition called for states to offer Medicaid coverage to people with incomes below 138 percent of the FPL. This would mean a family of four earning $33,000, would make too much to...
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...Medicaid and the Children’s Health Insurance Program Student Name Name of Instructor University Location of School Date Introduction The Children’s Health Insurance Program (CHIP) was initially created in the U.S. in 1997 in an effort to respond to the needs of millions of children that lacked health insurance coverage. Although the primary focus of the program was to assist in improving the access to health care services among children, it was also a relief to parents who became more motivated to take care of the additional needs of their children. While Medicaid was introduced as a publically funded health care program to assist people seeking access to health care services, CHIP was specifically tailored to meet the health care needs of children. The main purpose of this essay is to present an exploration of Medicaid and CHIP. One of the key areas to explore includes examining the legislation that introduced Medicaid and its funding sources. Medicaid Legislation and Funding One of the key areas to examine with regard to Medicaid is the legislation that introduced this particular program and its funding sources. The legislation of Medicaid, Moore and Smith (2006) observe that it took advocacy groups like Trade Unions, Advocates, and Public Welfare Associations to enhance the visibility of medical concerns that were evident in the population. One of the challenges that seemed to persist before the legislation of Medicaid is the fact that not many...
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...According to Barton (2010) Long-term Care “emphasized continuous care over a period of at least 90 days for a range of acute and chronic conditions. Regardless of the length of time (i.e., from weeks to years), LTC is an array of services provided in a range of settings to people who have lost some capacity for independence because of an injury, a chronic illness, or a condition” (pg. 349). This is the description of someone who may have been in a debilitating car accident, an elderly person with Alzheimer’s and dementia, a person diagnosed with chronic mental illness, and individuals who are developmentally delayed or “disabled.” People who are placed in these type of long-term care facilities are usually screened using two different measures, Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Those individuals have problems or concerns with completing their (ADLs), such as bathing, cooking, cleaning, and grooming. When we think about long-term care, we think that the elder population are the ones who would be more likely to need help with performing ADLs due to illnesses associated with old age. However, this could be further from the truth. There is a great portion of individuals who are in need of long-term care and over 40 percent of them are of working age, with 3 percent being children (Barton, 2010). This percentage of the population who requires LTC, are those who have mental illness or who have developmental disabilities. A lot of...
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