Free Essay

Medicaid and the Children's Health Insurance Program (Chip)

In: Business and Management

Submitted By dlprice
Words 1316
Pages 6
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 people were able to see and fully understand the potential of Medicaid and therefore much attention was paid to Medicare instead. However, over time, some Federal Administrators among other key advocacy groups passed the Medicaid program into legislation.
Funding for Medicaid is the responsibility of both the Federal Government and each state as they share responsibility in financing the. The Centre on Budget and Policy Priorities (2015) points out that when it comes to the amount of money spent on Medicaid, individual state policies have a large impact on the same. However, the Medicaid program is considered as a lean program since the program costs less when compared to what other private insurance companies pay for the coverage of people with a similar health status.
Changes in the Medicaid Program Over the years, several changes occurred in the Medicaid program since its inception, which includes the Children’s Health Insurance Program. According to Weil (2007), it is necessary to be mindful of the fact that while the CHIP program is one of the major changes that took place in Medicaid there are still some challenges along the way. He goes on to explain that parents that have jobs that are low paying are usually not in a position to pay for health care insurance hence the need to make some key amendments.
Some of these changes are evident in the fact that low-income earning adults are given the opportunity by some states to access health care with the federal government covering most of their costs. Another change that has taken place in Medicaid since its inception is that which concerns eligibility. However, individual states have the responsibility to determine Medicaid eligibility requirements, which vary from state to state. Given the drastic overhaul that has taken place for Medicaid over the years, there are some concerns from various individuals and bodies to have additional flexibility in the program (Camillo, 2012).
Demographics of the Medicaid Program Another key aspect to consider is the demographics of the majority of people covered by Medicaid and this includes the number of people covered by the same program. One of the key factors that the Centre on Budget and Policy Priorities (2015) makes clear is that Medicaid is a program that can be described as an “entitlement” program considering the fact that anyone who meets the eligibility rules can be part of the cover.
However, the Federal Government established guidelines for identifying people eligible for mandatory coverage under Medicaid. All children under 18 years of age, whose families have income below a certain level, are covered under the Medicaid program. The program would also cover pregnant women whose income falls below a certain income level. The program also takes care of the medical needs of most senior citizens and persons with a disability or disabilities that usually receive monetary assistance through the program known as Supplementary Security Income (SSI). Lastly, there are those families whose income lies within the eligibility limit range of the state for cash assistance before the reform in the welfare.
Changes facing Medicaid with ACA
It is necessary to describe some of the anticipated changes that are expected to occur or are already changing as a part of the Accordable Care Act (ACA). Vernon, Gifford, and Ellis (2015) acknowledge the significant role that Medicaid plays in the health care of the United States. One of the changes is that of the control of covered benefits accorded to patients and this includes controlling the cost of prescription drugs that has been on the rise. Another major change is with regard to eligibility and enrolment, one that causes the states to make changes concerning applications, enrolment, and renewal process, and payment reform systems among other aspects of the program. In addition to ensuring that the health care sector embraces initiatives to enhance their effectiveness, other changes include considering payment and delivery of care options and alternatives. However, the National Conference of the State Legislatures (2011) observes that enhancing the expansion of Medicaid may lead to some funding issues that need to be addressed beforehand. In addition, some states do not receive a financial increase from the Affordable Care Act so additional studies should be conducted on how to grow the enrolment of Medicaid funding when the economy faces budget constraints.
Conclusion
The Children’s Health Insurance Program (CHIP) is a program that came in to assist in ensuring that the millions of children that were previously uninsured can now have access to health care services. Over the years, since its implementation in 1997, the CHIP health care program has enabled the health care sector in the United States of America to have a tool that ensures the expanding of health care coverage for children. However, it is necessary to point out that just like any other program; the Children’s Health Insurance Program has also had some success stories, shortcomings, and some challenges along the way. However, it is more important to consider the successes of this health care program as it has ensured that children have access to health care services while also working on some of the shortcomings to improve the program in the years to come.
References
Camillo, C.A. (2012). Implementing Eligibility Changes under the Affordable Care Act: Issues Facing State Medicaid and CHIP Programs. State Health Access Reform Evaluation (SHARE). Retrieved From http://www.mathematica-mpr.com/~/media/publications/PDFs/health/eligibilitychangesstateissues_brief1.pdf Centre on Budget and Policy Priorities. (2015). Policy Basics: Introduction to Medicaid. Policy Basics: Introduction to Medicaid. Centre on Budget and Policy Priorities. Retrieved From http://www.cbpp.org/research/health/policy-basics-introduction-to-medicaid Moore, J.D., & Smith, D.G. (2006). Legislating Medicaid: Considering Medicaid and Its Origins. Health Care Financing Review. Vol. 27, No. 2. National Conference of State Legislatures. (2011). Medicaid and the Affordable Care Act. National Conference of State Legislatures. Retrieved From https://www.ncsl.org/documents/health/HRMedicaid.pdf Vernon, K.S., Gifford, K., & Ellis, E. (2015). Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016. The Henry J. Kaiser Family Foundation. Retrieved From http://kff.org/medicaid/report/medicaid-reforms-to-expand-coverage-control-costs-and-improve-care-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2015-and-2016/ Weil, A. (2007). A Health Plan to Reduce Poverty. The Next Generation of Antipoverty Policies. Vol. 17, No. 2.

Similar Documents

Premium Essay

Medicaid Programs

...Medicaid Programs By: S. Nichole Sewell AJS/522 - FINANCE AND BUDGETING IN JUSTICE AND SECURITY Instructor: HENRY PROVENCHER Medicare is a national social insurance program, administered by the U.S. federal government since 1965, which guarantees access to health insurance for Americans ages 65 and older and younger people with disabilities as well as people with end stage renal disease (Medicare.gov, 2012). Medicare is a program that offers everyone a well defined benefit that includes different hospital parts. The Medicare parts are: Part A, Part B, Part C & Part D. Part A is known as hospital insurance. This part covers medical necessary such as hospital stay, nursing home, home health care and also hospice care. Medicare Part A is free to people who have worked and paid in Social Security for at least 10 years. There will be a monthly premium charge if you have not worked for at least 10 years and paid Social Security taxes. Part B is medical insurance that covers things such as doctor visits, medical equipment and various other forms of other outpatient services. Part B also covers mental health care and ambulatory services. To receive the Part B medical insurance you have to pay a monthly premium. Part C is the portion of your policy that allows private insurance companies to cover your medical expenses.......

Words: 1957 - Pages: 8

Free Essay

Chip Executive Summary

...CHIP Executive Summary HCS 550 June 30, 2014 CHIP Executive Summary The process of implementing a health care policy involves important steps of legislation formulation before execution and monitoring for progression and improvements. Committees and subcommittees on levels of the government, state, and local legislation are inclusive in ensuring the policy is enacted both efficiently and effectively. To accomplish these goals and objectives legislators must develop rules and regulations that align with goals and objectives, and take precautions to form the proper language to explain the actions suitable toward a successful operation. Some steps in the process are repeated each time a modification in the policy occurs. Examination of the Children’s Health Insurance Program (CHIP), justification of the policy, the responsibility of legislative committees appropriated to the policy, the implementation process, and the impact on the community, are addressed in the contents of this paper. CHIP Policy Description The Children’s Health Insurance Program (CHIP) provides low-income families with health coverage because they are not eligible for Medicaid. Funds for this program derive from state tax collections, and are matched by the federal government. Individuals under the age of 19 may receive coverage for immunizations, routine examinations, office visits, hospitalization, diagnostics, prescriptions, emergency room services, vision, and dental care. CHIP......

Words: 1646 - Pages: 7

Premium Essay

Health Insurance

...Health Insurance Guide Health Insurance Guide * What is health insurance? * How does health insurance work? * What are the different kinds of health insurance? * Individual mediclaim policy * Floater Policy * Critical illness policy * Overseas mediclaim policy * Student medical insurance * Tax saver * So, what kind of coverage can I get? * Accidental death benefit * Permanent and total disability cover * E opinion rider * Children's education allowance * How much does health insurance cost? * The no of people to be covered * Amount of coverage needed * Age of the oldest family member who is proposed to be covered * Can I get tax benefits with health insurance? * Are there any alternatives to health insurance? * Critical illness benefit * Hospital cash benefit * Things to watch out for What is Health Insurance ? Health Insurance also known as Mediclaim in India provides you the cover against the medical care costs arising from disease or accidental injuries. Health insurance is a crucial financial product that every individual must have irrespective of their age. It allows you to focus on getting the best treatment without bothering about the financial costs of the same.   Depending on the terms of the health insurance policy it covers all or part of the medical costs of treating the disease or injury including......

Words: 6450 - Pages: 26

Premium Essay

Medicaid in Texas

...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......

Words: 1829 - Pages: 8

Premium Essay

Current Health Insurance Market

...Assessment of the Current Health Insurance Market Health insurance, whether it is private, public or commercial, is a system that distributes the financial burden of medical care among insured members (Austin and Hungerford). To explain how health insurance works, insurance companies first collect premiums from their members and use the funds collected to pay for members’ medical expenses. On one hand, some members may be sick and incur a significant amount of medical expenses. On the other hand, most members will remain relatively healthy and have a small amount of medical expenses. Even though, insurance companies will not know which members will become sick, they are able to calculate the average cost of medical expenses among a large group of members. Insurance companies use the premiums collected from members who are healthy to pay for those who become sick. Before the Patient Protection and Affordable Care Act, having a health insurance was optional for all Americans. It was mainly the risk-averse consumers who bought health insurance, and these individuals wanted to avoid the financial risks of unpredictable health care expenses by paying a known amount of premium. However, since 2014, people have been penalized for not having health insurance and the fee for not having insurance coverage will be higher every year. Resulting from the healthcare law change, individuals who did not have the health insurance will have more incentives to buy insurance since they will......

Words: 961 - Pages: 4

Premium Essay

Health Insurance

...Why do we need the health insurance industry? Need for health insurance The health insurance industry (XLV) mainly provides a risk management tool for an individual. People cannot predict the extent and timing of their future healthcare expenses. By paying regularly for health insurance, people can get protection against financial losses resulting from high health care expenses. It also enables them to better manage their cash flows as most health insurance plans specify the maximum amount an individual will need to pay in excess of the charge paid for buying the insurance, in a calendar year. Risk pooling According to study by the Congressional Research Service, the top 5% of the total population accounted for about 50% of the health expenses in 2011 and 2012. This uneven distribution of spending forms the basis of risk pooling, where people contribute an amount of money, at least equal to the per capita cost of medical services, expected to be used by the group of insured people. Risk pooling in insurance is essentially a cross-subsidy paid by low-risk members to high-risk members of the insurance plan. The above diagram shows that the performance of healthcare system or the efficiency of health insurance and effectiveness of risk pooling increases as the size of the group increases. However, the benefit of reduced risk resulting from the increasing size of the insured population reduces as the size increases a certain optimal size, S*. As size increases, the......

Words: 2759 - Pages: 12

Premium Essay

Chip

...Children’s Health Insurance Program Tracy D Cotthoff Western Governors University Table of Contents Abstract 3 History of Children’s Health Insurance Program 4 The Impact of Licensure, Certification and/or Accreditation on CHIP 7 CHIP Reimbursement 8 Clinical Quality 9 Patient Access to CHIP 10 CHIP Impact on the Workforce 11 References 13 Abstract Americans have always had an insurance gap, but the hardest hit seem to be the children. There was a program created to try to fill that gap. Children’s Health Insurance Program was created to insure children that would otherwise be without health coverage. This program was started under Medicare to ensure that children would have medical, dental, vision, prescription, substance abuse and some mental benefits. History of Children’s Health Insurance Program The following is the history and facts of the Children’s Health Insurance Program: * In 1997, The Children's Health Insurance Program (CHIP) was created via federal law. For children’s families that have income above the Medicare limits, this program helps states to provide health insurance to uninsured, low-income children living with families. * The original CHIP funding for fiscal years 1998 thru 2008 was between $3.1 billion and $5.0 billion. The federal and state governments share in the cost for CHIP, and states have leeway in setting criteria for eligibility and which healthcare services to cover. * By 2007, 13 states had......

Words: 2618 - Pages: 11

Premium Essay

Health Insurance

...Health Insurance Basics: Key Words and Phrases You Need to Know Shopping for insurance can be confusing, but the new health care law makes it easier to understand. This simple guide will help you make smarter choices for you and your family. KEY WORDS AND PHRASES What You Pay There are different costs associated with health insurance. When choosing a plan, it is important to take into account all of the costs for each plan. Premium The money you pay the insurance company to buy the plan. You usually pay this monthly or every pay period. If you get coverage through your job, your employer may also pay a part of the premium. Deductible $ The amount you have to pay for your $ health care each year before your $ insurance starts paying for care. Similar to car insurance, many health plans require you to pay a certain amount “out of pocket” before their coverage kicks in. For example, if your deductible is $300, you have to pay the first $300 of your medical costs yourself before the insurance starts paying. In some plans, the deductible applies only to services that you get outside their “provider network.” Also, some plans have a separate deductible for prescription medications. Usually, the deductible does not apply to preventive services. KEY WORDS AND PHRASES What You Pay Copay/Co-insurance The money that you may have to pay “out of pocket” for each service you receive. This could include an office visit with a......

Words: 1209 - Pages: 5

Free Essay

Children’s Health Insurance Program

...Assignment 7.1: Children’s Health Insurance Program Jennifer Heuring Maryville University Dr. Jean Gordon NURS602 Assignment 5.1: Children’s Health Insurance Program Introduction It is of vital importance for Americans to have the ability to access health care to maintain health and wellness. Many disease processes are modifiable and even avoidable but the lack of proper access to healthcare can heighten the risk of people’s ability to reach their full potential in life. This issue ranges from older adults to newborn children. According to the Children’s Defense Fund (n.d.), 7.2 million children under the age of 19 remained uninsured in 2012. That is 1 out of every 11 of our children. The pediatric population does not have the ability or choice to change the circumstances that their life has handed them. The Children’s Health Insurance Program (CHIP) seeks to provide health insurance to uninsured children. Working cooperatively between the federal government and individual state governments, SCHIP provides an alternative to families whose wages are too high to qualify for Medicaid yet too low to make private coverage affordable. The Children's Health Insurance Program (CHIP) was created by the Balanced Budget Act of 1997, enacted Title XXI of the Social Security Act. It has allocated about $20 billion over 10 years to assist states insure low-income children. Problem definition Research has found that people within the United......

Words: 1432 - Pages: 6

Premium Essay

Ha 3900 - Public Health Insurance

...Public Health Insurance ------------------------------------------------- The Impact on Low Income Individual Medicaid is the U.S.’s primary public health insurance program designed to provide health coverage for low-income children and families who lack access to private health insurance because of their limited finances, health status, or severe physical, mental health, intellectual, or developmental disabilities1. Currently, 1 in every 5 Americans uses Medicaid as their primary form of insurance. This means that as of 2015 over 65 million Americans, by guidelines of the department of health and human service, live on or below the federal poverty line 2. Although those numbers may seem large, former guidelines for Medicaid have left a large portion of the low-income population excluded from coverage and uninsured. Currently, adults under age 65, in nearly 25 states, no matter how low their income, are ineligible for Medicaid unless they are disabled or pregnant. As a solution to this problem the Supreme Court passed The Affordable Care Act (ACA), which would provide an expansion of Medicaid to millions of low-income, uninsured adults who were previously excluded. However the choice to expand remains a state option. While many states have chosen to move forward with the expansion, many have either opted out or lie in debate. One of the major arguments against the expansion of Medicaid lies in the debate of whether “Medicaid is worse than no coverage at all 3.” My paper...

Words: 1230 - Pages: 5

Premium Essay

Health Insurance

...seek services from any health care provider. The members of this particular plan do not to limit themselves to either physicians or hospitals under a single network. Under the indemnity plan, the medical bill incurred by the users is sent directly to the health insurance company where a portion of the expenses is paid (LaTour, Maki and Oachs, 2013). For example, the insurance company may pay 80% of the total medical bill where the remaining 20% is paid by the member. Individuals under this plan pay a deductible sum, and once the member has reached the deductible phase, only a small portion is remitted under to the insurance company. The fee for the plan varies from one physician to another an aspect driven by government regulations. Managed care plans Managed care plans refer to a type of health insurance where members have contracts with specific health care providers and medical facilities at a reduced cost. Under this plan, the healthcare provider makes up a planned network of the portion the plan will incur as medical expenses according to the agreed contracts (Cleverley, Cleverley & Song, 2010). As a result of government regulation, managed care plans affect the health care delivery because of financial incentives directed to providers. Government sponsored health plans Under this health insurance policy, various policies cover individual’s health. The policies encompass the following; • Medicare alludes to a federal health insurance program that covers......

Words: 1164 - Pages: 5

Premium Essay

Health Insurance

...seek services from any health care provider. The members of this particular plan do not to limit themselves to either physicians or hospitals under a single network. Under the indemnity plan, the medical bill incurred by the users is sent directly to the health insurance company where a portion of the expenses is paid (LaTour, Maki and Oachs, 2013). For example, the insurance company may pay 80% of the total medical bill where the remaining 20% is paid by the member. Individuals under this plan pay a deductible sum, and once the member has reached the deductible phase, only a small portion is remitted under to the insurance company. The fee for the plan varies from one physician to another an aspect driven by government regulations. Managed care plans Managed care plans refer to a type of health insurance where members have contracts with specific health care providers and medical facilities at a reduced cost. Under this plan, the healthcare provider makes up a planned network of the portion the plan will incur as medical expenses according to the agreed contracts (Cleverley, Cleverley & Song, 2010). As a result of government regulation, managed care plans affect the health care delivery because of financial incentives directed to providers. Government sponsored health plans Under this health insurance policy, various policies cover individual’s health. The policies encompass the following; * Medicare alludes to a federal health insurance program that covers......

Words: 1176 - Pages: 5

Free Essay

Health Insurance

...the three types of health insurance in the U.S. The three main types of insurance in the United States include the Individual Health Insurance, Group Insurance and State Sponsored Insurance. The Individual Health Insurance policies allow the policy holder to hold health coverage on themselves, their spouse and dependants. It is usually more expensive that other insurances offered however. This type of insurance is tax deductable. With this type of insurance you are able to choose the coverage needed for your lifestyle. As long as the policy holder pays the premiums due they do not run the risk of prices going up as in group health insurance where the employer has the ability to pick and choose what coverage’s they are willing to use on their plans offered to the employees. The Group Insurance is offered to employees at a rate the employer chose. The insured can choose coverage for themselves or for family coverage. The benefits can include a lesser cost insurance since the employer pays a portion of the costs, better coverage in health care needs and the insured and their family members will not be excluded due to preexisting conditions. The last of the three is the State Sponsored Insurance which includes Medicare and Medicaid coverage for low income families and senior citizens. This coverage is usually a free insurance or low cost that covers 100% of health care needs and medications. Describe the three methods for categorizing of health insurance in the......

Words: 1161 - Pages: 5

Premium Essay

Health Insurance

...Health Insurance- Blessing for people with busy life The word insurance truly mentions security. Security against life, health, family,vehicle,homes, shops,etc. In earlier years, there was no need to this kind of thing for the protection. I am talking about days of our grandfathers or may be even before that. The life was so great and slow, nothing to worry about any future, would involve in their daily occupational jobs like farming and living life in their own way. But it is said that nothing is permanent. The time has change now. Today we live in a much advance world. The change is faster than time. The daily routine got so much fix that we cant even take out some time to enjoy. People work in office as well as in home too. Social life is like getting extinct from their life. No time to eat even hygienic food on time. Just grabs some cafeteria served items and forget about its effects. As “no time” kind of thing ruling our life. We almost neglect our health and when any weird kind of stuff happens! Doctor is the second word that comes in our mind. First is the expense if the condition got severe. We can’t change this situation, neither can we escape from it. We have to work, look at our family and their future, about your dreams, and so to earn this, we have to get a job that offers salary far from your expectation but if salary is well then the work load will also be high. In fulfilling your daily task, you forget about your health! So it’s better to have an......

Words: 4671 - Pages: 19

Premium Essay

Health Insurance

...Summary The health care in the United States has often been credited with being some of the best money can buy, though with the caveat that it does not provide health care to all its citizens, and millions are left with woefully little or no health care coverage. However, in Canada, universal health care serves its entire population, though there is also criticism that the care it does provide lacks the quality of the most expensive health care services in the U.S. This paper will examine the truth behind the quantity and quality argument between the universalized health care in Canada and the health care system in the U.S., while also taking into account the recent reforms made to the U.S. system and how it impacts such a comparison. Canada and the United States Comparison of the health care systems in Canada and the United States are often made by government, public health and public policy analysts. The two countries had similar health care systems before Canada reformed its system in the 1960s and 1970s. The United States spends much more money on health care than Canada, on both a per-capita basis and as a percentage of GDP. In 2006, per-capita spending for health care in Canada was US$3,678; in the U.S., US$6,714. The U.S. spent 15.3% of GDP on health care in that year; Canada spent 10.0%. In 2006, 70% of health care spending in Canada was financed by government, versus 46% in the United States. Total government spending per capita in the U.S. on health care was......

Words: 4813 - Pages: 20