John Q

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.

Patients with long-term, chronic illnesses like Mr. Davis’s, care can be very costly, especially when the patient is unable to maintain routine medical care or visits and medications. Without routine medical care and maintenance medications, patients like Mr. Davis tend to have more frequent emergency room visits and hospitalizations; increasing costs for state and local government as well as tax payers. Though Mr. Davis is able to receive care during an emergency room visit, the providers are not fully aware of his health history and are only able to provide a temporary fix of his symptoms and not address his health care needs.

In today’s society, there is still a great struggle with health care disparities and many lives are affected by the lack of this fundamental program in our society. There are millions of people who die each year because they are unable to afford quality healthcare. The debate still continues about healthcare inequalities, what causes this disparity and who are affected by it. Health care is more of a necessity rather than a luxury and even though skeptics may argue to the latter, it only underlines the importance of the need for the wellbeing and care of individuals. There are several factors that could contribute to the lack of health care in the United States which ranges from but not limited to race, gender, socio- economic status, and lack of insurance coverage. The truth is there is a great disproportion between who can really afford quality healthcare as appose to individuals who have it. One would imagine that an employed individual would easily afford quality healthcare but we could be no further from the truth, since one’s economic status is an essential determinant to its affordability.

The CMS.gov website provides information about Medicaid, Medicare and related government programs ("Cms.gov centers for”) to beneficiaries and other interested parties. It is a federal government website, created by the Freedom of Information Act (FOIA), which made government information to the public. All information provided must meet government standards for content and accuracy. The information is kept current and is clearly labeled with publication or modification dates. The government agencies are clearly identified and in-text references are available when appropriate.

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

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).

‘Some counties don't have certain types of doctors” (Leonard 2). If an individual only has one insurer that supports that area, that insurer may not cover that doctor or hospital in that area, which can result to that individual driving far out of their area, just so they can see a doctor or get their medical treatment for a reasonable price. Individuals are also being limited with options because their insurers may see them as costly, and they could force the individual to go to under resourced hospitals (Goodnough 3). This shows that even if an individual does not live in a rural area and has plenty of options to choose from, they can still be limited in location because their medical treatment can be seen as too expensive, and the insurance company has to figure out a way to save money.

In the current U.S. system the free market prevails and companies, in this case, major insurance providers “compete” for business. This competitive business approach should in theory drive costs down. For some reason, however, an argument can be made that it has produced the opposite result in profiteering. The nation’s largest insurer, UnitedHealth, boasted over a 10 percent revenue increase in 2013 according to Forbes (2013). Health insurance affordability contributes to the disparity in access to health care, as evidenced by the fact that there are millions that are still uncovered. A greater majority of certain minorities lack both health insurance and the financial resource to seek out either health care or insurance. While insurance companies reap huge profits the percent of private sector companies offering health insurance has dropped to less than 50 percent (Kaiser, 2013). There is decidedly a lack of coordination of care for this at risk population as well, since treatment is rendered sporadically and with continuously changing providers. The last major challenge is that of improving the quality of health care. According to a 2010 report by the U.S. Department of Health and Human Services, Office of Inspector General (OIG), an estimated 13.5 percent of Medicare beneficiaries experienced adverse events during their hospital stay and an additional 13.5 percent experienced a temporary

In 1965, President Johnson signed Title XIX of the Social Security Amendments, which enacted Medicare and Medicaid (CMS, n.d.). Now, Medicaid is the single largest publically funded health coverage in the United States. The Medicaid program is federally and state funded. Currently, Medicaid covers 70 million Americans. Over 33 million children, 19 million low-income adults, and 16 million elderly or disabled persons are insured through the program. Medicaid also provides assistance to select Medicare beneficiaries, which is currently about 10 million individuals. Long-term care assistance is also a role of Medicaid, with 1.5 million institutional and 2.9 million community-based residents assisted. As visualized in Figure 1, of the almost 70

Health care reform and access to insurance have been staples of the American political agenda ever since the end of World War II. From President Truman’s call for universal coverage in the late 1940’s to the creation of Medicaid and Medicare to the Affordable Care Act, both parties have debated how to lower the rate of uninsured Americans. After nearly 70 years of debate in Washington and beyond, the number of Americans with health insurance has certainly grown (Miller, 2014). However, the number of people in the United States without coverage is still unacceptably high and a problem that should be addressed with a great deal of urgency and care.

Medicaid-focused managed care has become progressively imperative to state Medicaid organizations. With healthcare reform and the enactment of the Patient Protection & Affordable Care Act (ACA) in 2010, Medicaid will possibly be the main insurer for increasing coverage to millions of low-income, uninsured Americans. Medicaid, a government funded health insurance plan overseen by the state, has supplied coverage for people with disabilities, children, pregnant women, seniors, and the indigent. Managed care plans have aimed to contract with healthcare providers and provide coverage at reduced costs (Smith & Coustasse, 2014). The ACA has helped people become eligible for Medicaid who otherwise would not be able to afford health insurance. There will be more equality between genders, before ACA, the majority of beneficiaries were female. Even though ACA has helped more people become eligible for Medicaid, there are also challenges that have risen due to this as well. The focus of this paper is on the challenges regarding Medicaid managed care and how they can be resolved. The first area discussed will be the history behind Medicaid. Then move on to the challenges of the Medicaid Managed Care Program and how they can be resolved as well as the possible solutions.

Within the previous four years, the number of uninsured Americans has jumped to forty five million people. Beginning in the 1980’s, the American Academy of Family Physicians (AAFP) has been trying to fix this problem of health insurance coverage for everyone with a basic reform. The AAFP’s plan imagined every American with insured coverage for necessary improved services that fall between the crucial health benefits and the surprising costs. (Sweeney) They expect by fostering prevention, and early prevention, with early diagnosis with treatment, the program would result in decreased health system costs and increased productivity through healthier lives. The way to achieve health care coverage

Financial or health problems may result in loss of a home, social status or independence in adults. Patients should be asked about primary source of income, living arrangements and with whom they live as well as family dynamic and whether he or she is the primary income producer for the family. According to Barkley, the economic profile of many elderly is poor accounting one in every six elderly live below the poverty line in U. S. (2014). If the patient has to pay out of pocket over the amount they can afford, it is more likely that he or she will not follow up with treatment regiment or future appointments. Obtaining such information early will help practitioners to develop plan of care accordingly and provide additional resource referrals that patients may

Lack of doctors is only one facet to this multifaceted problem. Accessibility in terms of having the financial resources to obtain care is another. “Individuals in lower social status groups have the highest rates

Too poor to afford private health care insurance coverage, but lucky enough to qualify for Medicaid John Q faces yet another challenge. John’s father recently suffered a heart attack which brought into question his own mortality. John like many Americans is a working class man who works full time but still under the poverty level and into a substandard and overworked Medicaid system. He like many others has high blood pressure and with his father recent heart attack he would like to be checked out. Due to John’s low income he qualifies for Medicaid coverage, but also has work within his restraints. John lives in