Hospital Medicaid Case Study

Per our conversation: When the provider bills an amount, we don’t always pay that billed charges. Providers tend not to change the amount they are bill with different insurances. Amerigroup pays 100% of the Medicaid Fee Schedule. The claims that your referencing below paid code 20160RT at $66.09 per the Medicaid Fee Schedule. However, code J7324 denied for authorization. I understand that authorization was waived for April, I will have this claims reprocessed. Once the auth. wavier is put in place, code J7324 pays $223.39 of the Medicaid Fee Schedule. This bring the amount of the claim to $289.48 of the $473.00 the provider is billing.

A Spanish-speaking member of Kentucky medicaid called in to the call center where I working in Louisville, KY. She quickly started to talk, she sounded very afraid. she was crying and begging me not to cancel her childrens medicaid. Once there was a pause I quickly stepped in and comforted her by telling her that I am here to help her the best way I can. She was acting this way because she receive a letter from the state and assumed they were going to cancel her kids medicaid because she missed an appointment, she didn't understand the letter very well and couldn't translate it for me but she did mention the name of our company was on the letter. I had an idea of what is what about but just to be 100% I asked the customer if it was not too

On October 1, 2015, Ms. Booth was approved for Medicaid coverage through the BCC program. It was determined by the Mississippi State Department of Health that Ms. Heigle was eligible to receive Medicaid coverage for two (2) years or during the course of her treatment for breast cancer. The Office of Eligibility issued a Notice of Adverse Action on September 5, 2017, informing Ms. Booth that her eligibility would terminate on September 30, 2017, because her two (2) year treatment period was ending.

Bill Haslam, the Tennessee state governor, announced that the state of Tennessee would accept the Medicaid expansion offer. The Medicaid expansion expands Medicaid eligibility to the region’s underserved populations living near or below the poverty line. The Medicaid expansion offer looked to be a major win for the state; however, others disagreed with this idea. Some of Tennessee’s lawmakers decided to deny the federal government’s Medicaid offer, even though many others wanted the offer to be accepted. The deal’s breakdown might be the result of “squabbling along party lines” which is a common theme at all levels of government. Although the deal was denied, it is still possible that the bill could still be passed with the help of the governor. The likelihood of Tennessee reviving its Medicaid expansion is a difficult one considering the state would have to fight. The Medicaid expansion could offer the state low-income citizens medical insurance, the state would come out of the deal with a net financial gain, and the state hospitals would come out on top.

Texas ranks number one with the highest uninsured rate in the nation, accounting for nearly 6 million people (1). The federal government has nearly $100 billion for Medicaid expansion, out of which $15 billion is needed for expansion in Texas (1). Opting out of Medicaid expansion has left 1.5 million eligible Texans without health insurance (2). Consequently, a 300 percent increase in costs for primary care services, being provided in the emergency department, has been observed (1). Similarly, most hospitals are facing nearly $3-5 billion in losses due to uncompensated care (1).

In the state of Texas Medicaid is funded by state and federal programs. Those eligible to receive Medicare benefit is the low income individuals, families, children, pregnant women, elderly and individuals who suffer with disabilities (Hegar). The Texas Health and Human Service commission (HHSC) distributes the Medicaid (Hegar). Those receiving Medicaid benefits in the fiscal year of 2010 were found to be 55 percent female and 77 percent under the age of 21 (Hegar). Children accounted for 66 percent of all Texas Medicaid recipients in that year; however, 32 percent of those children actually received health care (Hegar).

Data: Client came to appointment on time with a decent attitude, and engaging during session. Today’s individual session was focused on addressing client’s treatment attendance issue. Client has not attending treatment group consistently, which will put her not in compliance with Kaiser Permanente suboxone program, as well as CD treatment at THS. Client has 7 absences from 03/01/17 – 05/25/17. Client reported no use of alcohol or other substances since started treatment. Client reported going to Kaiser Permanente weekly for counseling, UA, and obtain Suboxone prescription at Capitol Hill, Seattle. PC provided client with information for different OP groups but client stated, “I will make it work. Wednesday group works for me better.”

The decision to reject Medicaid expansion by the former and current governors of Texas has left at least one million low-income earning nonelderly adults Texans uninsured resulting in the loss of several millions of dollars in uncompensated health care services extended to this vulnerable demographic, coupled with high insurance premiums (Mangan, 2015) which begs for the expedient conception and implementation of a statewide solution to address this unsustainable economic burden and create a more healthy, and productive society in the great state of

Following the death of a Medicaid recipient, the program not only can but must attempt to recover costs from the estate of the deceased. Medicaid's official site says:

Effective May 30, 2018, the Virginia General Assembly approved Medicaid Expansion as a part of the 2019-2020 budgets. Virginia’s Governor Northam signed this approval into law on June 7, 2018, and as a result, approximately 400,000 low-income adults now qualify for health insurance (Norris, 2018). The General Assembly vote ended a “long-running partisan stalemate” with some Republicans joining the Democrats in support (The Associated Press, 2018). The Kaiser Family Foundation reports that Virginia is the 33rd state to approve the Medicaid Expansion (The Associated Press, 2018).

The Medicare and Medicaid programs were signed into law on July 30, 1965 by president, Lyndon Baines Johnson. The Centers for Medicare & Medicaid Services (CMS) is an agency within the US Department of Health & Human Services in charge of administration of several key federal health care programs. CMS is responsible for health care programs such as, the Health Insurance Portability and Accountability Act (HIPAA), the Clinical Laboratory Improvement Amendments (CLIA), and the Children’s Health Program (CHIP) amongst other services.

With the implementation of the ACA, many states have expanded their Medicaid programs to include a larger population of low income individuals and families that were not able to obtain health insurance prior to the law. Some of the issues that state legislators struggle with are the overall cost of providing services for the additional recipients, staying within budget, determining an adequate approach of offering quality care, and providing adequate coverage for each recipient. Even though the cost of Medicaid expansion within each state has increased the budget for the program, new appraisals has shown that Medicaid programs spend less per enrollee than commercial health insurance and much of the increase in Medicaid expenses originate from the increase in enrollment in the programs (Coughlin, Long, Clemens-Cope, & Resnick, 2013).

It was in 1977 that the United Healthcare United Health group was founded by Richard Burke. The headquarters of the company are in Minnetonka, Minnesota. This organization works towards the betterment of people's health, it help them in living a healthy life by providing them with the kind of health care that would be best for them. The main focus of United Healthcare which is a major division of the United Health group is to provide the people with better health benefits and coverage.

People don’t like being sick, however, some Missourians forego preventive care, required doctor visits and beneficial medicines because they cannot afford them. They may be working in part time jobs, seasonal jobs or other unskilled labor jobs and lack affordable health insurance. They are the poor people below the 138% federal poverty level (FDP). According to Chris Kelly, a former Representative of the Missouri House for district 24, the West Plains hospital Ozark Medical Center’s (OMC) service area includes more than 9,000 uninsured adults (p1). So, what do you do when you are poor and sick and can’t afford a doctor’s visit? You go to the emergency room of a local hospital and the hospital absorbs that

The Affordable Care Act (ACA) highlighted the importance Medicaid played in insuring every American receive healthcare coverage. (42 U.S.C., 2010) Medicaid provides health benefits to over 71 million across the country. While involvement is optional, all 50 states participate in the program and requirements differ across the nation. The flexibility given to each state has allowed them to make their own decisions to work towards improvements that they believe would best benefit their region (Feldstein, 2015, p. 125-126).