Case Study: Medicaid Managed Care

More and more people with medical insurance are relying on the health care system as new technologies and treatments become available. This leads to a grater number of claims for payment by insurance companies, the costs of which are passed back to health care consumers. The baby-boom generation is entering its peak health-care using period. Over eighty million Americans will turn 50 in the next 10 years. The cost of providing heath care for these individuals will be staggering

The Medicare and Medicaid federal programs were put in place as a way to help the less fortunate. Individuals with severe disabilities or over the age of 65 qualify for Medicare. This program helps them with health coverage, so the disabled and elderly who have Medicare do not have to worry about their medical bills and not going to the hospital when they are sick. Medicaid is a similar program, however, it only applies to low income families who cannot provide for their children. Similar to Medicare, this program covers any health related problems and takes away the worry and troubles that come with hospital bills.

The baby-boomer generation is aging and adding more beneficiaries’ at an increasing rate than ever before and is estimated to impact the federal deficit by over 17% by 2020. Many other countries have National Healthcare that provides better care at a much lower cost. Medicare was the motivation for a universal healthcare plan and a program for the U.S. could have a positive impact. (Starr, 2011).

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.

Those who utilize the Medicaid system range from low income families to the over 65 age group. Within this population is also those who are disabled due to physical or mental problems. This is among the sickliest of our American population. A paper based on a study in Oregon stated that “Medicaid significantly increased the probability of being diagnosed with diabetes, and being on diabetes medication as well as high blood pressure and high cholesterol.”(Baicker et al., 2013, p. 1715). Much of this is due to the struggle that the Medicaid beneficiary has

Baby boomer aging is one of the large causative factors of this increase in demand (Glicken & Miller, 2013, p.1883-1889). According to Glicken & Miller (2013), the elderly population will nearly double in the next fifteen years putting a strain on the healthcare workforce. Also, more than half of physicians have intentions on limiting care access with regards to Medicare patients. Many medical doctors are refusing to care for Medicaid patients. This is a result of the growing number of individuals now with the means to afford healthcare due to the

Part A covers hospitalization, emergency hospitalization, subacute care, home health, and end of life care depending on the situation. Part B covers Doctors’ visits, and covers subacute, end of life, and in home care that Part A will not cover if the patient qualifies. While part C covers medications and needed medical equipment (Center for Medicare and Medicaid Services, 2014). What Medicaid pays for depends on what state you live in, and what your specific situation is. Universally Medicaid covers hospitalization, day procedures, doctors’ visits, nursing facilities, home care, child health check, nurse practitioners, and transportation to doctors’ visits (Medicaid.gov, n.d). Medicaid offers different services in each state, but the aforementioned are the mandatory areas of coverage for every state. Medicare is aimed at helping the older population, while Medicaid is aimed at people in every stage of life. But who exactly is covered under which

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

Medicare is the federal health insurance program for people with certain disabilities, end stage renal disease, and for those who are over the age of 65. There are four different parts to Medicare, part A, part B, part C, and part D. Medicare Part A, also known as hospital insurance, covers inpatient hospital stays, care in nursing facilities, hospice care, and some in home health care. Part B is often referred to as medical insurance; it covers certain doctors’ services, outpatient care, medical supplies, and preventative care services. Medicare Part C, otherwise known as Medicare advantage plan is offered by a private

Medicaid initially established that each state is responsible for designing their medical costs to pay medical care for the poor. Also, Medicaid created as a voluntary program for each state; they have to have the choice to participate. For one thing, because of the rising costs of healthcare, it has been difficult to bring Medicaid recipients into the “mainstream” of United States (U.S.) medical care. Donald R. Barr notes, “between 1975 and 1989, the cost of the Medicaid program increased by an average of 11.9 percent per year before adjusting for inflation” (172). The rising costs of healthcare are necessary for each state to determine if it is beneficial for them to participate in the Medicaid program. As the government level of payment is determined by each state economic condition. For instance, a state with lower per capita income will receive more government funding. A state with higher per capita income receives less reimbursement for program costs. Therefore, on December 31, 2010, many states continued to experience budget cuts. As a result on August 2010, Congress increased reimbursement rates through June 2011.

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

There is expected to be roughly 17 million individuals becoming newly insured through the Medicaid Expansion of the PPACA by 2019 (Carrier, Yee, & Stark, 2011). The expansion of Medicaid will create a major supply and demand issue within the health care services. Simply put, the demand for primary care services will exceed the capacity of the current primary care infrastructure. This will only add to health care spending because the newly insured individuals will not have many options to obtain primary care services and they may be forced to use inappropriate services such

There are some problems that must be addressed in the expansion of the Medicaid policy to include; social, economic, ethical, legal and political. First, the social impact of having health insurance removes the burden off of parents, people with chronic diseases, children and the disabled. If access to health insurance is unavailable our nation’s health care costs will continue to rise,

It appears Carl’s monthly United HealthCare premium in the amount of $499 & United Healthcare- Medicare Medical Insurance in the amount of $93 for the month of July has not been debited from his Citi checking account. These payments were set up as a monthly auto debit and I have not seen a debit in the past week. These payments normally are deducted on or about the 5th of the month. We do have log in information to pay the $499 premium using his Citi personal account information; However we do not have a way to pay the $93. Would you happen to know if Carl may have cancelled or changed