A Brief Note On Medicare And Medicaid Services

Both Medicare and Medicaid are administered through a division of Health and Human Services called the Centers for Medicare and Medicaid Services (CMS).

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.

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

As we become older, issues with our health begin to take affect and finding ways to fund for that care is becoming even more difficult. In the article “Some Elders Must Take Drastic Measures to Obtain Long-term Care”, national magazine journalist Mary A. Fischer (2011) states that many Americans must face demeaning and disempowering choices in order to qualify for Medicaid or Medicare—federal funded health insurance programs— such as refusing to pay for a spouses institutionalization, divorce, and spending down assets. The author argues that these choices leave the healthy spouse with decreased funds to plan for their own retirement expense (Fisher, 2011). Working in the health care field for 4 years, along with my family’s own personal experiences I can relate to this article, since I have seen a variety of ways that federal funded health insurances have been unable to meet the expectations and demands of its beneficiaries.

One of the states that have not participated in the Medicaid expansion is Florida. States that are opting out in the Medicaid expansion can leave several citizens uninsured and their health will be at risk. Currently, since the America’s Supreme Court has given the states more flexibility relating to the Affordable Care Act, some states are opting out of the Medicaid expansion plan that is intended to give low-income citizens in the state dependable healthcare. To reasons the state of Florida opting out the Medicaid expansion, the governor of Florida stated, that Floridians are more interested in economic growth and employment, better quality of education for their children, and that they keep the cost of their living low. Florida State is

Medicare enrollees in Utah have saved about $78 million on prescription drugs due to the ACA. Coverage for both brand name and generic drugs will continue to increase until the coverage gap is closed. The ACA also allows Medicare beneficiaries to seek preventive services without worrying about cost, due to the lack of deductibles and copays. This aids in detecting and treating health problems early on. In Utah in 2014, 220,972 individuals with Medicare used free preventive services. In addition to that, fraud is at a minimum due to tougher screening procedures, penalties, and technology developments.

The Accountable Care Organization (ACO) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients (McCarty, B., 2016). For example, Medicare Shared Savings Program was created by The Center for Medicare & Medicaid Services to monitor and establish that all ACO’s are meeting the quality performance benchmarks and reduce Medicare spending by certain percentages (H., 2017). The growth of ACO’s from 2011 to 2016 is astonishing, in 2011 there was 64 ACO’s and by 2016 they have risen to 838 in the U.S. (H., 2017).

Medicare has gone through many changes through the years since President Johnson signed the programs, including Medicaid into law in 1965. Almost ¾ of the senior population, over 65 were uninsured. Even before that President Truman was eager to start a national health insurance plan, in 1945. In 2003, President GW Bush added a prescription drug plan to Medicare. Even President Teddy Roosevelt proposed a national health insurance plan when he was running in 1912. In 1972, President Nixon signed a bill allowing people with long-term disabilities under the age of 65 and patients with ESRD (End Stage Renal Disease), to be covered. Over the years more services were accepted for Medicare coverage, including hospice and home health. 2010 brought good

Is national certification important with respect to billing and reimbursement? When? Discuss reimbursement barriers and issues that hinder or prevent APNs from receiving reimbursement for services rendered. What are steps APNs must take to increase the likelihood for reimbursement?

The accountable care organization I researched is called the Physician Organization of Michigan ACO (POM ACO). The POM ACO is a joint venture of the U-M Health System and physician groups around the state, with the aim of improving care for 81,000 Michiganders enrolled in traditional Medicare and slowing the growth of health care costs, according to the announcement by the U-M Health System (Daly, 2013). The group was launched on January 1, 2013 under the Medicare Shared Savings Program. 12 physician organizations from around Michigan came together to take part in a Medicare-sponsored program that strives to improve on the quality of care for traditional Medicare recipients, while also containing cost growth. In 2014, POM ACO expanded to include all the University of Michigan faculty physicians and thousands of other providers from the University of Michigan Health System. The POM ACO is now one of the largest accountable care organizations nationwide. More than 5,700 physicians and other providers are now involved in the POM ACO. Therefore, the POM ACO is organized as a physician-hospital organization. Hence, the patient has more flexibility in where and how their care is delivered. The patient can still use any doctor or hospital that accepts Medicare at any time.

States are being pressured to expand Medicaid to families earning up to $30,000 a year, just like the Affordable Care Act permits. While several respected governors have agreed to expand the program, many other governors and state legislators are cautious. These officials do not want to deny Americans their access to health care, however they do want to slow the expansion of a program that will provide them with limited access to quality care while destroying state budgets. One of the strongest arguments that can be made against the expansion of Medicaid is the fact that States simply can not afford it. The appeal to states to expand Medicaid is that the federal government will cover 100% of the cost through 2016 and eventually lowering to

This paper covers the topic of Texas refusing to expand Medicaid. We will look at where the social welfare program came from, and also look at Obama and his affordable healthcare act in relation to how that is ties into the expansion of Medicaid and why Obama president felt that it was important. We will look at Governor Rick Perry’s along with Governor Greg Abbott’s viewpoints and why it is they that feel expanding Medicaid would not have been in the best interests of Texas. Finally we will take a look at my viewpoints on all of the issues currently at hand.

"We don't believe it’s right and we know it's going to basically bankrupt the states."(Hensley 2012) quote given from Texas Governor Rick Perry about Medicaid expanding in Texas. The Medicaid expansion "would simply enlarge a broken system that is already financially unsustainable," he wrote. "Expanding it as the PPACA provides would only exacerbate the failure of the current system, and would threaten even Texas with financial ruin." (Hensley 2012). Texas is among the twenty-two states that did not expand Medicaid, and for good reason at that.

The government has two programs that provide health care to specific groups of people in the United States known as Medicaid and Medicare. After President Johnson signed the Social Security Act in 1965, the government created these two programs. Each of the programs have their own eligibility requirements, coverage, and cost. The Healthcare reform effected both programs eligibility requirements, cost, and coverage.

Merriam-Webster dictionary defines social insurance as, “protection of the individual against economic hazards (as unemployment, old age, or disability) in which the government participates or enforces the participation of employers and affected individuals” (1). The United States government operates several national social insurance programs. Medicare is the United States’ first medical social insurance program. This program was designed to provide health insurance to the elderly and protect them from financial hardship due to illness. A thorough investigation of this program reveals the overall history, financial cost, and the total effect that it has had on the healthcare system.