Medicaid Managed Care: A Case Study

To attract Medicare patients, hospital must be contracted with Medicare. Hospital must also be contracted with private health insurance companies that provide Medicare Part A or Part B benefits. As per Kaiser Family Foundation, there are more than 55.5 million Medicare beneficiaries in the U.S. and Texas has more than 3 million. Hospital should have regular contact with senior citizens and can be made attractive to Medicare patients by offering sessions about healthy life style choices. Also offer regular disease management sessions, exercise group and organize social activities such as trips to mall, museums. Seniors should also be encouraged to take tour of the hospital.

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).

Managed Care for Everyone Managed care has become so popular because of its capabilities to deliver health care at

Conclusion: The Obamacare has its very good points it does benefit the economy in ways that are meant to take the economy out of debt. But they do cause side effects that may not have been thought of.

Despite such challenges, a growing number of health plans and hospitals have begun collecting race/ethnicity data and have detected disparities among commercially

Robbie’s accuracy affect the reimbursements the facility receives from Medicare and Medicaid reimbursement decides by and large give that the correct Medicare bearer to pay doctor cases is the Medicare transporter for the area in which the doctor or work on giving the administration is found as opposed to the

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.

The Affordable Care Act (ACA) caused some of the issues central to the expansion of Medicaid. Some of the major challenges in Affordable Care Act (ACA) the improved access to more individuals. According to Levitt, Claxton, and Damico (2013), the Affordable Care Act expansion increase limitation to families under 65 whose income is at or below 133% of federal poverty guidelines. This leads into significant growth in eligibility of newly coverage populations. Medicaid provide an opportunity to identify successful enrollment and renewal practices, strategies to ensure access to care, effective models of person-centered and coordinated care, and payment systems that align financial incentives with goals for quality and cost. (Paradise, 2015). Especially

Medicaid care plans struggle to provide mental health services and with the expansion of Medicaid under the Affordable Care Act many individuals will gain access to healthcare and also to behavioral health coverage. Though the Affordable Care Act outlined changes to make access to mental health service easy, it is

Since the passing of the Affordable Care Act (ACA) in 2010, the healthcare revenue cycle has significantly change. Physicians and managed care organization saw a spike in the number of patients. iThe health care also law created initiatives to transition from the traditional fee-for-service (FFS) system to a payment-for-value delivery system, with key attention to cost containment and quality improvement. Managed care organizations are restructuring how they deliver care and receive reimbursement in a value-based system to maximize their profit.

In chapter 4, I learned about managed care organizations (MCOs), preferred provider organization (PPOs), and health maintenance organizations (HMOs). In PPO there is a list of in-network providers that patients are allowed to see but pay a lot more if they see a physician that is not on the list. In a HMO patients are only allowed to see physicians that are employed by them and may not see anyone else. There are a variety of methods to pay providers for healthcare services. Two of them are widely known as capitation and per diagnosis. Under capitation, organizations receive a fixed amount of money each month regardless of use. In per diagnosis, organizations are paid based on the diagnosis of the patient. The chapter also explained cost shifting

Medicare for All The intention for universal coverage has been on the government agenda for several decades now. With differing opinions and oppositions, the idea of national insurance was repeatedly dismissed until the neglected health needs of the elderly population became apparent. Thus, in 1965, Nickitas, Middaugh, and Aries (2016) narrated

QMHP called the client to informed her that she is not eligible for case management due to (1) living in Independence and (1) has inactive Medicaid. QMHP informed Ms. Anderson that she could receive services at Swope as an outpatient. Ms. Anderson asked if she could get her medications and other services (Imani House, vision, dental) without having Medicaid. QMHP told Ms. Anderson that she could. Ms. Anderson stated she will apply for her Medicaid. QMHP apologized to Ms. Anderson two times because at the intake, QMHP had informed Ms. Anderson that he was eligible for CSS. QMHP told Ms. Anderson that after she her Medicaid is active, she could request for a CSS. QMHP thanked Ms. Anderson for her understanding and hang up the

Today I got a glimpse of how difficult it is to get approval from Medicaid for services that were absolutely necessary. This patient was seen in the ER the previous night and was sent to our office for possible obstruction of a ureter and kidney stones. With Medicaid, the family

As established in the preceding sections, the congress was largely involved in the health care reform involving Medicare. To some extent, the congress members have acted indifferently with the aim of pursuing their own political interests rather than addressing the real issues facing the society. Eventually, this may influence the