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Medicaid and Stakeholders

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Submitted By Timothyfla2002
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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 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

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