Presumptive Eligibility Case Study

Critically analyze the implications of the state’s decision to opt out of Medicaid expansion on the citizens of the state.

First of all, keeping track of a monthly spend down of an elderly, disabled patient is ridiculous. In Mrs. Jackson’s case, she needed Medicaid to cover her transportation needs. Its close to impossible to schedule appointments and procedures if you are not sure how you are going to get there. Other patients use Medicaid for numerous reasons. A better option for Medicaid would be to take an average of a few months expenses and use that to determine eligibility for longer than a month at a time. It is common for patients to spend the same amount on medication each month. They also try to visit doctors on a regular basis. Knowing they are covered by Medicaid for longer than a month, would be a huge relief. The patients could keep their appointments without worrying about transportation costs. Also, medicine could be taken as directed instead of trying to make it last longer in fear of losing coverage the next month. Another area which needs addressing is in the area of medically necessary items. Who determines if adult diapers is necessary or a convenience? For an elderly person who does not want to walk to the wash room after going to the bathroom, I can see how diapers would be convenient. But what about the person with no legs and not adequate enough help to lift them out of bed? I would definitely say adult diapers is medically necessary for this person.

One important health disparity is the lack of prenatal care amongst women in socially disadvantaged populations. These predominately include women of minorities, women who have a low income, and the location these women live in. This health disparity is important to address because research has shown that women who receive prenatal care are more likely to conceive babies of a healthy birth weight and have low infant mortality rates than those women who do not receive this prenatal care ("Putting Women 's Health Disparities on the Map," 2009). Therefore, health disparities amongst women in need of prenatal care have lead to preventable infant mortalities amongst women in vulnerable populations. Three reasons why this health disparity is important to address include the following: health disparities in prenatal care lead to lack of access to prenatal care to women in vulnerable populations, there are increased adverse health outcomes for both the infant and mother, and there are excess medical expenses that could otherwise have been prevented. Because “prematurity is the leading cause of newborn death in the United States” (“Healthy Mothers and Healthy babies,” 2013), finding and developing a solution will be extremely beneficial and needs to begin with addressing prenatal care.

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

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

There are some problems that must be addressed in the expansion of the Medicaid policy to include; social, economic, ethical, legal and political. First, the social impact of having health insurance removes the burden off of parents, people with chronic diseases, children and the disabled. If access to health insurance is unavailable our nation’s health care costs will continue to rise,

PMG receive billing pool message that the prenatal is not more longer under the prenatal care for any of these follow reasons:

This program would cut about 43 percent or equivalent to 40,000 enrollment participants’ slots. The program, at the time, housed or serviced 104,000 enrollees and after the reduction it would bring that number down to 64,000 enrolled (Renz, 2011). The reason this was a more serious issue for administrators to resolve, was the demographics of the participants; Low Income Families. Families that are, at the time, in a disadvantage state and needed means to provide for basic necessities when it came to health coverage.

The health care reform debate between 2008 and 2010 led to the passage of Patient Protection and Affordable Act. It was reminiscent of opportunities for reform that have occurred on a cyclical basis throughout American history. These opportunities occurred most notably in the presidential administrations of Franklin Roosevelt, Harry S. Truman, John F. Kennedy, Lyndon B. Johnson, Richard Nixon, and William J. Clinton. (Rich, Cheung, Lurvey, 79). We have to look at recent opportunities that have expanded today.

Chris and his brother Kevin arrived at the Woodman Center for the DD Waiver intake. Kevin provided conservators documentation. verifying Kevin and their parents, Alice and George as the limited conservators; to date both parents are deceased.

I would like to formally start gathering more information for the Pre-Gateway program. We want to start off with forming a committee to get the ball rolling in a more progressive manor. If you would like to be a part of this committee our first meeting will be on 04-06-2016 from 2 -3. I value your expertise, experience, and input to make this program a success.

In order to target the majority of participants in the 2-year span of the program, qualifying participants will be broken into 6 groups. A new group will start after the initiation of the program. Qualifying participants include pregnant mothers that are at least 6 months pregnant and mothers that are up to 12 months postpartum.

In order to accomplish the program’s specified mission, the HRPP/NICP developed goals which include: (1) early identification of women and children at risk of mortality and morbidity, (2) education for health professionals, families, and communities, (3) linkage of infant, toddlers, and pregnant women to risk appropriate services, and (4) establishment of standards of care (ADHS, 2009). As a result, the program has provided a safety net for Arizona families and a method for ensuring availability and accessibility of risk appropriate care to critically ill newborns and high-risk pregnant women, regardless of their ability to pay (ADHS,

E-verify is a internet-based system that compares information for employee's Form I-9, Employment Eligibility Verification, to data from U.S. Department of Homeland Security and Social Security Administration records to confirm employment eligibility.