...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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...T ackling Fraud, Waste, and Abuse in the M edicare and Medicaid Programs: R esponse to the May 2 Open Letter to the Healthcare Community Dan Olson, CFE June 2012 Tackling Fraud, Waste, and Abuse in the Medicare and Medicaid Programs White Paper C ontents I. Introduction ............................................................................................................ 1 II. Recommendations................................................................................................... 3 Recommendation 1 – Expand the Medicare Fraud Strike Force Model....................................... 3 Potential Savings .......................................................................................................................... 4 Recommendation 2 – Expand Integrated Data Repository .......................................................... 4 Potential Savings .......................................................................................................................... 5 Recommendation 3 – Expand “Do Not Pay List” .......................................................................... 5 Potential Savings .......................................................................................................................... 6 Recommendation 4 – Publicize Drug Expiration Dates ................................................................ 6 Potential Savings ....................................................................
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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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...Budgetary Analysis Angel Lowe HCS/550 March 2, 2015 John Dean Budgetary Analysis Medicaid counts as one of the largest sources of public health insurance in the United States, and also in the whole world. It provides essential medical cover to vulnerable population within the United States. This population includes elderly individuals, expectant mothers, children, low income families and individuals with different physical disabilities and the disadvantaged in the American society. In 1965 President Johnson signed into law under the Social Security Act to improve the health care of the elderly with Medicare. Medicaid would provide improved health care for the poor, unwed mothers, children, and the disabled. The program involves a joint initiative between the states government and the federal government hence the two governments jointly fund the program and ensuring its success through putting up laws to guide its implementation. President Obama’s legacy will be protecting the health of the individual American. The health care policy rules, regulations, and legislations are the consequence of the policy procedure which involves legislators, all the decision-making branch leaders, and public also. The budget for Illinois starts when the Governor submits a bill each January to the House of Representatives. After the bill has been submitted by the Governor then the house is responsible for ways and means review then they budget and develop their own recommendations...
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...percent of its residents don’t have a health plan. The report covers people younger than 65; those 65 and older qualify for the government’s Medicare program. Across Colorado, the uninsured rate is as high as 37.8 percent, in Saguache County. More than a third of residents in San Juan, Phillips and Custer counties also are lacking health coverage. Breaking out the numbers along demographic lines, Hispanics in Colorado were more likely to be uninsured (35.3 percent) than blacks. Barriers To decrease health disparity age low socio-economic status language & cultural/religious beliefs personal biases Barrier to decreasing disparity in the uninsured need specific skills to match the unique and challenging needs of this group. Lack of financial resources, lack of options for consultation referrals, socioeconomic and cultural barriers, and a mistrust of health care providers are a few of the characteristics of this population that necessitate specific skills. Plan of Action financial resources A trusting relationship Emphasis on strong history and physical examination skills A strong knowledge of behaviorally based interventions generic vs brand Available Resources Benefit check-up- is a free online service that helps thousands of people every day to connect to government programs that can help them pay for...
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...Administrative Ethics Paper Administrative Ethics Paper Medicaid currently has over 58 million enrollees (familiesusa.org, 2012). Medicaid is supported jointly by each state and the federal government. The ethical administrative issue at hand is the shortage in the amount of PCP’s, Dentists, and specialist which are willing to accept the reduced reimbursements Medicaid offers compared to commercial insurance companies. CMS or Center for Medicaid and Medicare services controls, regulates, and is basically the middle man between the states and government. CMS also keeps records on hand of all physicians who accept Medicaid reimbursements. The problem in some states in the lack of doctors willing to accept Medicaid patients. Some individuals have to travel two to three hours just for well checkups, let alone if an illness arises. The lack of enough doctors is not the only problem. The eligibility of Americans to qualify for Medicaid is strict, as they should be. However There is still a large number of Americans who have no health insurance because they make too much for Medicaid and other state programs such as family health plus. And make too little to afford commercial healthcare, either independently or through their employer. Now the government is considering fining those who are uninsured. This is an interesting development since it is the state and governments own doing that this group cannot be approved for services, or afford to purchase it. The government has...
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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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...13.15 Solution to Assignment Exercise 4–2 Other Managed Public Commercial Care Medicare Medicaid Programs Patients Insurance Contracts (1) Intensive Care Unit X (2) Laboratory X One suggested solution is as follows. Physical/ Cardiac/ Occupational Pulmonary Therapy Rehab Training Administrative Nursing Salaries X X Physical Therapist Salaries X Occupational Therapist Salaries X Solution to Assignment Exercise 5–2 Yes I believe the expense grouping………… HSA 525 Week 2 Assignment, Solution to Assignment Exercise 4–1 Contracted Contractual Payer Full Rate Rate Allowance FHP $72.00 – $35.70 = $36.30 HPHP 72.00 – 58.85 = 13.15 Solution to Assignment Exercise 4–2 Other Managed Public Commercial Care Medicare Medicaid Programs Patients Insurance Contracts (1) Intensive Care Unit X (2) Laboratory X One suggested solution is as follows. Physical/ Cardiac/ Occupational Pulmonary Therapy Rehab Training Administrative Nursing Salaries X X Physical Therapist Salaries X Occupational Therapist Salaries X Solution to Assignment Exercise 5–2 Yes I believe the expense grouping………………………………………. HSA 525 Week 2 Assignment, Solution to Assignment Exercise 4–1 Contracted Contractual Payer Full Rate Rate Allowance FHP $72.00 – $35.70 = $36.30 HPHP 72.00 – 58.85 = 13.15 Solution to Assignment Exercise 4–2 Other Managed Public Commercial Care Medicare Medicaid Programs Patients Insurance Contracts (1) Intensive Care Unit X (2) Laboratory X One suggested solution...
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...disability in fact, become adults with a disability. A Special Needs trust is a way for parents or caregivers to set aside money for the future care of their loved one living with a disability while protecting government benefits (Supplemental Security Income and Medicaid) that are crucial in providing the medical and income necessary to supporting the individual. These trusts are supposed to supplement the benefits a disabled person receives from the government — paying for additional services or equipment not otherwise covered — but not to supplant them (Sullivan, 2010). The government does offer medical and financial assistance to adults with special needs through programs such as Medicaid and Supplemental Security Income to offset the high costs of care. However these programs provide the bear minimum. Medicare is a health insurance program for U.S. citizens at least 65 years old, or those aged younger than 65 years who suffer from certain disabilities. This program was developed on July 30, 1965 when U.S. President Lyndon B. Johnson passed the Medicare Benefit legislation as an amendment to the Social Security Legislation (History of Medicare – A Quick Look at How it Got Started | The Medicare & Medicaid Center, n.d.). Supplemental Security Income (SSI) benefits for the low income and disabled were first introduced during in 1974 when the House of...
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...budget deficits. Many organizations are now required to cut or eliminate clinical services in order to remain operational. Determining which clinical services should be cut requires managerial staff to make the difficult decision. Managers require tools that enable them to best make that difficult decision to best address the health care needs of the community served. The New York State Medicaid program is the largest single payer of healthcare in the state of NY to the tune of about $47 billion dollars (“Advocates,” 2008). New York has the nation’s highest total and per-patient Medicaid spending and must link spending to healthcare priorities. The number of uninsured patients has steadily increased over the past few years. Funding losses and projected increased operating expenses have left many healthcare organizations with budget shortfalls. In New York State alone various facilities face losses of up to $300 million in Medicaid funding based on proposed state budget cuts (NYCHHC, 2009). I am employed as a manager in a county clinic that provides various clinical services to Medicaid clients. Clinics are an essential setting for the delivery of primary and preventive services...
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...throughout Ohio. Recommended ways to increase these scores will be provided. Interviews with vital (OSUWMC) management took place and ideas, as well as, results revealed the purchase of electronic medical record (EMR) system, with computerized prescriber-order-entry (CPOE) capabilities, along with an automated call distributor (ACD) line would increase the patient’s experience enhancing this upcoming year’s patient satisfaction scores. The new Affordable Care Act will be discussed and how it will affect any hospitals reimbursement because a vast majority of the patients being serviced will now qualify for more Medicaid programs than last year. This patient population has been determined to be indigent, not having any source of income or insurance to pay for their hospital bill. Research shows that if hospitals are not in alignment with the CMS Medicare and Medicaid patient satisfaction rules and regulations, we could lose this patient population and funding. It was expressed in the interviews with (OSUWMC) management that if the customer service training was more consistent and received additional resources the patient experience would have a greater impact on the responses on the questionnaires, drawing a more positive direction with the hospitals scores and cultural direction. The Research The primary research took place with interviews with a customer service manager and a financial manager of OSUWMC hospitals that provided some enlightening information on complaints...
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...who knowingly submits or causes the submission of false or fraudulent claims for payment or approval. In the healthcare context, examples of conduct that can arguably lead to charges of violations of the statute include, but are not limited to: billing for medical services not rendered; misrepresenting the level of services rendered; falsely certifying compliance with federal laws; and submitting a claim for payment that is contrary to Medicare or Medicaid payment requirements. The Federal Anti-Kickback Statute: prohibits providers of services or goods covered by a federal healthcare program ("Federal Healthcare Program") from knowingly and willingly soliciting or receiving or providing any remuneration, directly or indirectly, in cash or in kind, to induce either the referral of an individual, or furnishing or arranging for a good or service for which payment may be made under a Federal Healthcare Program. The Stark Law: also known as the "Physician Self-Referral Statute", generally prohibits the referral of Medicare and Medicaid beneficiaries by a physician to an...
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...Elaine Bobo Budgetary Analysis The Medicaid program is one of the largest sources of health insurance in this country in addition to employer-based health insurance and Medicare. Medicaid delivers crucial medical related services to the most at risk populations in society. The importance of Medicaid's part in providing health insurance cannot be exaggerated; “the Medicaid program covers millions of low-income women, children, elderly people and individuals with disabilities” (U.S Department of Health and Human Services, 2000). Funding for Medicaid is limited through various federal policies, leaving much of the program’s budget burdened on the individual states to make necessary spending cuts in order to provide the funds needed for the demand of the program. Budgetary decisions need to be thoroughly reviewed before any immediate action is taken as these decisions can create a domino effect on other programs and their participants as sections of this paper will describe. Medicaid Overview Medicaid is a cooperative federal and state program with a common goal to provide a vital service for the general public. “Medicaid is the largest source of federal revenue for states. Medicaid funds support health care providers, jobs and state economies overall” (Kaiser Family Foundation, 2013). Every state institutes its own eligibility criteria, benefits platform, payment rates and program organization under the broad federal recommendations. Medicaid provides three types of vital health...
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...Health Care Spending in the United States Lisa Patti HCS/440 April 23, 2012 Caryn Callahan Introduction Heath care in the United States is costly and confusing. Many do not follow the facts, policies or cost the government has controlled in health care. This leads to obtaining the incorrect insurance that causes high out of pocket expenses to choosing no health insurance at all. In today’s society many cannot afford health insurance, in 2010 49.9 million people in the United States were without health insurance (Overview of the Uninsured in the United States: A Summary of the 2011 Current Population Survey, 2011). The issues that will be discussed are the level of current nation health care expenditures, whether spending is too much or not enough, where the nation should add or not, and why, and how the public’s health care needs are paid for and financed by various payers. The current level of national healthcare expenditures U.S. health care costs have risen rapidly in the past few years, imposing increased stress on families, businesses, and public budgets. Health spending is increasing more rapidly than the economy and workers' earnings. In recent years, insurance administrative overhead has been rising faster than other components of health spending, while pharmaceutical spending has increased more rapidly than spending on other health care services (The Common Wealth Fund, 2007). The national health care expenditure is a total amount spent in the United States...
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...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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