Medicaid Case Study

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).

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

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 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).

As Congress considers potential options to reform Medicaid, it is important to keep in mind patient access to prescription drugs and other healthcare services. Retail community pharmacies believe that Medicaid prescription drug benefit reform efforts should be focused on maintaining a Medicaid prescription drug benefit, maintaining patient access to adequate provider networks, fair and appropriate cost-based provider payments, and facilitating patient access to pharmacist-provided health care services.

The article summarizes on how the Medicaid has expanded to the state that it wasn’t non-existent such as New York through the provision of the statistics of the beneficiaries. The author focuses on the measurement of the quality of the Medicaid which deteriorates at an alarming rate leading to a greater future concern on the medical coverage on the patients in the Medicaid program. The article also emphasizes on the reports by Centers for Medicare and Medicaid services which presented poor quality of the services offered as a result of the Medicaid. For instance, the existence of low- birth weight babies, patient’s satisfaction and body mass indexes. The authors further states that, for the future success of the Medicaid on the poor and the sick, there should be a balance on the quality and financial savings and the close monitor of the adverse impacts which can arise as a result of lack of proper procedures in the Medicaid program. Therefore,

Medicaid expansion is seen as a huge problem in this case it takes place among the 50 states. The environment includes the 50 states such as California, Texas, New York and New Jersey. Medicaid expansion offers financial protection. It also addresses the uncompensated care problem which involves paying and reimbursement for service rendered. Medicaid expansion also provides customers access to affordable coverage, as well as customers taking up that cover, which is a moral duty of the government. Medicaid also supports politically powerful interest groups who support expansion. The expansion of Medicaid helps rural hospitals stay afloat in states like Colorado, which added 400,000 people to the health insurance program under

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.

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.

Toward the end of the 1920s, in a little town in South Texas named Cotulla, a junior high teacher saw the injustice and poverty among his Mexican-American students (Del Bosque, 2013). After decades passed, that same man became the U.S. President; Lyndon B. Johnson signed the bill that constructed Medicaid in 1965, which is a program that is funded by the state and the federal government to provide health insurance to low-income Americans (2013). Johnson had an idea to create a “Great Society” which he defined as “a society where no child will go unfed, and no youngster will go unschooled” (2013) . Now even in 2015, we see that President Obama is still fighting for this dream of Johnson’s (Ura & Walters, 2014). President Obama’s Affordable Care

Prior to the enactment of the Affordable Care Act, many Americans did not have access to health care. According to Shi and Singh, assess is an individual’s ability to obtain health services when necessary (Shi &Singh, 2010). “After implementation of the ACA, the proportion of the U.S. population that was uninsured dropped from approximately 16% to roughly 12% in 2014 (Shi & Singh, 2010, p 11). More low to middle income American are eligible for health care services through the Affordable Care Act. Advancements in health information technology have helped to improve and streamline medical services and have helped with the lower cost of health care. “Essential insurance benefits required by the ACA include preventative and wellness services,

In today’s world, the one item that is constantly brought up between State and Federal Governments is the expansion of Medicaid in response to Obamacare. Many states are willing to accept the expansion of their Medicaid programs, while others turn the expansion down. In fact in 2010 when the healthcare reform law, commonly known as Obamacare, came forth only 18 states opted to accept the Medicaid expansion, along with other federal initiatives, while 14 completely refused all of the Medicaid expansions, and federal initiatives (Posner & Conlan 2014, 7). So in response to this theme that has been read about, and brought up in this class within the last few weeks, I chose a survey question on whether or not people think their state should accept the expansion of their states Medicaid program.

Issue: 4.6 million Texans are currently uninsured without access to affordable healthcare due to the state’s refusal to expand Medicaid or provide additional public health coverage options. Section 1115 of the Social Security Act gives the Secretary of Health and Human Services the authority to approve states’ experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs.

Part A (Hospital Insurance program) covers inpatient hospital stays, home health service, and skilled nursing facility. In addition to this, Medicare pays for 100 days of care in Medicare-certified skilled nursing facilities as well as for the patients staying in Medicare certified hospice. Some people do not pay any premium for part A due to the taxes paid by them or their spouse during their working years. Moreover, contribution comes to Medicare through payroll taxes paid by individuals which make them eligible for the benefits. In order to become eligible for this premium free Part A program, individuals or their spouse must have forty credits after working at least 10 years. However, people, who do not have forty credits, will pay a monthly

The Centers for Medicare and Medicaid Services is the government body in charge of managing Medicare and Medicaid programs. CMS likewise runs the State Children's Health Insurance Program (SCHIP), which is mutually financed by the Federal and State governments and managed by individual States. ACA created major change in CMS's implementation responsibilities.