Case Study: Hurley Care Solutions

Mrs Gale is a 70 year old widow and retired unskilled worker. The patient lives alone and relies on her son to provide basic care, medication and meals. Mrs Gale has a history of weight fluctuation owing to lifestyle but is currently at risk of malnutrition due to Parkinson’s disease. Mrs Gale shows signs of early dementia and suffers from poor mobility and pain caused by arthritis. Mrs Gale also has mild depression triggered by loss and has become socially isolated. All names have been changed as per the Nursing and Midwifery Council confidentiality guidelines (2008).

Adults, 65 years old and older and people with disabilities are eligible for Medicare and Medicaid. Physician services and hospitalizations are covered by medicare. An additional supplemental program may be purchased to cover prescription drugs. Low income families and children may qualify for Medicaid and Children’s Health Insurance Program (CHIP). Medicaid has significantly lower copays and out of pocket expenses compared to private insurance. Unemployed individuals may qualify for Medicaid depending on the state.

Medicaid is a social health care program that covers nearly 60 million Americans, including children, pregnant women, seniors, parents and individuals suffering with disabilities. Medicaid is the biggest source of funding for health related services and medical needs for the people with low income in the United States. This program is funded jointly by the state and federal level governments, but it is the state’s responsibility to manage this program. The Medicaid program is not a required program that states have to use, but all 50 states have implemented this program. With the introduction of the Affordable Care Act (ACA), and its passing in 2010, the ACA unveiled its plans to expand Medicaid eligibility to nearly all low-income adults as an addition to the other groups that fall into the Medicaid eligibility. The Medicaid program had “many gaps in coverage for adults” because it was only restricted to the low income individuals and other people with needs in their own specific category. In the past, the majority of the states who had adults that did not have children dependent on those parents were not eligible for Medicaid. These low income adults without dependent children would be without medical insurance assistance before the ACA was introduced. Medicaid is now available to all Americans under the age of 65 whose family income is at or below the federal poverty guideline of “133 percent or $14,484 for an individual and $29,726 for a family of four in 2011” (NSCL).

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.

Medical costs are getting too expensive. Ever fought with your insurance providers because they refused to pay for care, or struggle to find an “in-network” provider? I know a woman whose name I will change for her privacy and the struggles she is going through are a perfect example of an issue many people face when dealing with insurance; Nancy’s (name changed for privacy) story is a perfect example of how our healthcare system is no longer working for the people. Nancy is this woman whose husband recently passed away. Nancy used to work for county and county workers cannot receive social security; and Nancy is too

According to the General Medicaid Requirements (2017) section of the Medicaid website, an individual must have at least one of the following qualifying factors to be eligible for Medicaid Services. The individual must be over the age of 65, have a permanent disability as defined by the Social Security Administration, be blind, be a pregnant woman, be a child, or the parent or caretaker of a child. In addition to these requirements, the individual must be a U.S. citizen or meet certain immigration rules, be a resident of the state where they apply, and have a Social Security number.

The healthcare system is one that will always be needed by society. The amount of abuse the system receives depends on the amount of uninsured citizens. If a patient is uninsured, their bills typically fall to the Medicare system. Because of this, the elderly are unable to use the benefits of Medicare as they should be allotted. By initiating the Affordable Care Act, the government is attempting to realign the balance between the insurance companies and Medicare, and to provide millions of uninsured Americans the opportunity to have medical insurance (King, 2011). The purpose of this paper is to discuss the Affordable Care Act, and how it affects my personal nursing practice.

With slight similarities, federal matching grants were provided by Medicaid to finance medical cost for the low income who were on welfare, disable, and elderly (Rowland, Summer 2015). At first, Medicaid was initially for the welfare population but was extended to be used by other low-come individuals that needed health insurance for medical care (Rowland, Summer 2015). Throughout the years, Medicaid has grown with an array of services it provides and with its population of those utilizing it and has extended to provide coverage to low-income individuals, the permanently disable, and those in need of Long Term Care (Rowland, Summer 2015).

Contact your county department of health or DSS to apply for Medicaid. You must fall into a certain financial classification in order to qualify for Medicaid. It may be in your best interest if your assets or income is greater than the allowable limits to work with an elder law attorney or eldercare financial planner in order to restructure your assets. If you are medically and financially eligible, you must go through the Managed Medicaid Long Term Care Program or Community First Choice to access the CDPAP program.

Long-term care is vital in the United States health care system. As the population ages, more people will need assistance to recover from illness or injury, and others will need end of life care to ease their passing. People who use long-term care are all ages. From young to old, people can receive it if they cannot care for themselves because of a condition, an illness, or an injury that requires assistance for a period of 90 days or more. The concern people face when looking at long-term care is the funding. Medicaid will likely be drained of funds long before the country’s aging population is past its peak and while there are some options of insurance coverage, not everyone may afford them.

Medicaid is program that provides health insurance coverage for people with low incomes, including pregnant women with little or no income, also children under the age of 19 are eligible for Medicaid (Research Starters). So for example, a person that is financially independent would not qualify for Medicaid. “Medicare benefits can be as early as age 62, or even earlier in the case of serious disability covered by Social Security” (Reuters). Medicare only requires a person to be over the age of 62 or to be dependent on someone else to qualify for their healthcare benefits. To conclude, Medicaid goes more toward younger low-income communities, while Medicare leans more toward older

Medicaid is one of the most widely acknowledged sources of health insurance coverage in the United States, benefiting over 48 million low-income children and parents (Hansen, 2012). It also supports those over the age of 65 who may also receive Medicaid. By providing essential health insurance protection, Medicaid supports the growing un- and under- insured population. This federal program for the financially needy is administered at the state level. Coverage varies and each state creates its own rules, typically offering support through county social services, welfare, or other department of human services offices (Goodman, 1991).

The baby boomer generation will need more Medicaid services which would place a large financial burden on the program. Compared with previous generations, the baby boomers generation has a higher rate of "diabetes, hypertension, high cholesterol, and obesity" (Barr, 2014). People with multiple chronic conditions are hospitalized more than those with fall or cold. They are more vulnerable and therefore, are more expensive. As a result, a two-fold problem is created. First, there will be a shortage in health care professionals, because baby boomer makeup such a large part of the healthcare field. The second part of the problem is

Medicaid is for low income: pregnant women, children under the age of 19, people 65 and over, people who

The Fortune 500 company I chose is CVS Health. I chose this for a few different reasons. First, I recently had to visit the Minute Clinic in the CVS store twice within the last month. Secondly, I chose CVS because it is part of the health care initiative and I work for a healthcare company.