Essay on Emergency Room Overutilization

Under Medicaid, "except for those over age sixty-five, the federal government would only provide benefits to persons not in state hospitals, to shift financial burden to the federal government, states had to send the patients back into the community." (Davoli, 2003).

A part of the problem of cost was the establishment of “free” healthcare for those eligible for Medicare and Medicaid, between 1965 and 1971 where there was no limitation on benefits. The cost of healthcare increased from 39 billion in 1965 to 75 billion in 1971. Providers had no concern for the cost of their care seeing that SSA recipients had no limits

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.

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).

In a survey conducted in 2003, it highlighted that the recurrent problem is the reimbursement rate from Medicaid to the physician (O’Shea, 2007). The Center for Studying Health System Change (HSC) show that 21% of physicians that state they accept Medicaid have reported they will not accept a new Medicaid patient in 2004-2005(O’Shea, 2007). This number would only logically be assumed to have risen in 2013 A survey conducted by the U.S. National Health reported that researchers have found two standout trends among Medicaid beneficiaries: they have more difficulty getting primary care and specialty care and they visit hospital emergency departments more often than those with private insurance (Seaberg, 2012). The lack of primary and specialty care access is mostly contributed to the following barriers; unable to reach the MD by phone, not having a timely appointment with the MD and lastly unable to find a specialty MD that will accept Medicaid. In a recent report released by the Partnership to Fight Chronic Disease, it stated that about 30% of Medicaid patients experience “extreme uncoordinated care”, there is a strong correlation between this situation and higher Medicaid spending and less quality of care given (Bush, 2012). After January 1st 2013, healthcare providers have experienced a 2% reduction in payments for Medicaid beneficiary, this will only create more of a problem for these patients to seek the

Eligibility for Medicaid expanded to groups like childless parents, all children and other parents not entitled to the Medicaid. To kick start this reform, the state would cover the whole cost for the non-eligible population for a period until they can cover the costs. Enrolment to the Medicaid made easy through websites and those who are disabled would get care in the community.

The potential opportunity for the state to opt into the Medicaid expansion is the fact that low-income citizens will be insured. The decision of the state to opt into the Medicaid expansion will also impact the state’s budget, and this is the main challenge (Frakt, 2013). The government will cover majority of all the cost even as Medicaid expansion provides coverage for the low-income uninsured citizens. Expansion of the Medicaid is also a broken system that has poor outcomes, not severe federal strings, high inflation and no incentive for the personal responsibility of the citizens who

Medicaid is defined as being a jointly funded state-federal health care program administered in Texas by the Health and Human Services Commission. Medicaid was established in 1967 and also stemmed from Patient Protection and Affordable Care Act P.L. 111-148 (Strategic Decision Support Team, 2010). Some of the goals and objectives within Medicaid are to make it less of a struggle for clients to get care, protects against out-of-pocket through the roof cost, and also to achieve cost savings for the state and federal government through the many improvements in coordination, as well as care (Eighty-First Texas Legislature, 1967).

As a health policy analyst for the state of Texas which has not elected to expand Medicaid as part of the Affordable Care Act (ACA) and now has been notified that the state leaders have taking into reconsideration their recent decision during an upcoming session in order that we begin gathering data on the benefits of adapting the Medicaid expansion. As a health policy analyst our goal is to assure data quality, interpret data, and discover new information in the data. Medicaid is a federal and state partnership with shared authority that is a health insurance program for low-income individuals, children, their parents, the people with disabilities and the elderly. Nationally Medicaid covers health care for over 72 million people. Even though participation is optional, all 50 states participate in the Medicaid program. However, Medicaid benefits eligibility varies widely among the states all states must meet federal minimum requirements, but they have options for expanding Medicaid beyond the minimum federal guideline (http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx). In this research we will identify the state of interest which is Texas, compare the state’s decision, determine the alternate approaches to expanding access and provide a recommendation on whether or not the state should opt in to the Medicaid expansion.

In order to more fully delve into this issue, this literature review will be focusing on three main areas of study as it applies to the topic of Medicare/Medicaid reimbursement and its relation to the Affordable Care Act. These areas of focus will include

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.

In this research paper it will identify how Medicaid came about and what Medicaid used for, the different between Medicare and Medicaid, the benefits and disadvantage in the use of Medicaid. Medicaid is a state administrated program that provides medical support for a broad range of people. Medicaid was established in 1965 through the Social Security Act, which was an act to provide for the general welfare by creating a system of senior citizen benefits as well as low income people not all but limited to and by enabling that many states to make more acceptable provision for aged people, blind, dependent and crippled children, maternal and child welfare, and public health. Medicaid program was one of many programs created to

Emergency room overcrowding is a major issue throughout not just the United States but in many countries. There have been many strategies on how to combat this issue as patient satisfaction is often being a major variable on hospitals being reimbursed, which interventions are most helpful? One intervention that is gaining more and more popularity is advertising wait times. Through a PICO search with key words of “ED triage” and “patient satisfaction” or “wait times” provided some great original research over the past five years that has been peer reviewed in the Journal of Canadian Association of Emergency Physicians. While multiple research papers came up, the methodology and potential of taking this particular study further was of great interest.

Medicaid is a joint program shared between the state and the federal government to provide help with medical cost for those with low income and resources. The program itself has grown to become one of the largest expenditures in the budget, spending over $553 billion in 2016 (The Henry J. Kaiser Family Foundation 2017). Medicaid started under the Johnson administration when he signed amendments to the Social Security Act on July 30, 1965 (Koba 2014). Medicaid was apart of Johnson’s movement towards social reform known as the “Great Society”, it aimed towards eliminating poverty and racial injustice (Koba 2014). Today, funding for Medicaid works by the federal government giving grants to the states, it provides health insurance to over 74

In contemporary America, Medicaid constitutes a program that wields the prerogative to finance medical and