Major Differences Between The Medicaid And Medicare Programs

Major Differences Between The Medicaid And Medicare Programs
ion 1: Describe the major differences between the Medicaid and Medicare programs.
Answer: Medicare and Medicaid both represent federal healthcare initiatives, still some major
differences exist between those programs. The existing differences largely pertain to a number of
factors such as overall mission & goals; authorities administering & implementing the programs;
sources of program funding; eligible populations; range of services covered by the programs; and
costs on the part of the program user (patient).
Medicare represents a social insurance initiative with uniform, national rules. It is administered by
federal officials and a number of insurance companies employed to manage particular tasks (e.g.
part C & part D of the Medicare). ... Show more content on Helpwriting.net ...
Medicaid, in its turn, has a much more extensive range of benefits, with Federal Government
mandating coverage for certain services which are deemed as medically necessary.
Question 2: Describe the Medicare Part D "Donut Hole". Give details.
Answer: The "Donut Hole", or coverage gap, represents one of the most controversial aspects of the
Medicare Part D prescription drug plan and has been of concern to many Medicaid beneficiaries
who have opted for the plan. A coverage gap, contained within the plan, obliges beneficiaries to pay
for the full cost of their prescription drugs, despite beneficiaries continuing to pay their monthly
plan contributions. To illustrate, in 2010, when Medicare patients ' out–of–pocket prescription drug
expenses exceeded $2,840, they entered the "Donut Hole". Coverage for medications resumed when
expenditures totaled $4,550. These annual out–of–pocket expense amounts included yearly
deductible, copayment, and coinsurance payments associated with the plan.
The ACA of March 23, 2010 initiated several improvements to Medicare Part D, in order to reduce
out–of–pocket expenses of beneficiaries when they reached the "Donut Hole". In 2010, if
beneficiary has expenditures in the coverage gap, he/she should be eligible for a $250 rebate from
Medicare. In 2011, if beneficiary reaches the "Donut Hole", he/she should be given a 50%
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Decision Making; Medicaid Cuts
Decision Making: Medicaid budget cuts
An emergency manager's meeting was called this morning to announce the 2009 fiscal budget cut's
starting June 1, 2009. The North Carolina Department of Health and Hospitals has cut Medicaid
payments for hospital services by 15 % to reduce the state 's budget deficit.These budget changes
will directly affect private insurers with significant focus on the Medicaid recipients in the rural low
income population located in Eastern North Carolina. During this called meeting a manager
mentioned the Informed Decision Toolbox, she read about in an article for her graduate program.
This article mentions steps or processes to help decide which services could be eliminated or
introduced to continue to provide ... Show more content on Helpwriting.net ...
Evaluate the decisions and outcomes by continuously reviewing the data and develop measureable
goals. Since implementing the services provided by the clinic the organizational budget should be
reduced by 15 % before the next fiscal year. Having buy in from the community to support services
the clinic has eliminated from the operating budget will be a win–win situation for all involve.
In step 4, applying the Informed Decision toolkit to the changes implemented during the adjustment
to the budget. Steps three and four are similar in the approach of evaluating the progress of the
decision and measuring the goals. An option to assistance with budget changes is allowing
healthcare providers to practice in clinic; service for space option. The idea of this option, is
allowing medical providers practice clinic which is fully operational while caring for Medicaid
patients with simple needs. Medicaid recipients will receive health screening such as a diabetes and
hypertension. Another win –win situation, decrease emergency room visit for Medicaid patients and
medical provider will eliminate healthcare facility overhead cost due to service for space agreement.
Determining if the progress will work or if more research in the validity is needed is the next step of
the IDT.
Putting the decision to work for the manager or the policymaker is step 5. Rundall states,
"Actionability questions include whether

Medicaid Administrative Cost
Medicaid Administrative Costs – It is possible to obtain reimbursement for administrative activities
directly related to Medicaid for either obtaining Medicaid coverage or assisting beneficiaries in
obtaining care. To begin the process, there will need to be a discussion with the state Medicaid
office and completion of several pieces of documentation before billing for costs can occur. It will
require a written plan and documentation of time spent on the administrative activities. The two
specific types of reimbursement are Medicaid Administrative Claiming (MAC) and Targeted Case
Management (TCM).
Documentation of time spent on the administrative activities will require either a perpetual time
study or random moment time study. Both of these require records of types and time each activity
has taken. This will determine how much staff time is used to complete the administrative activities.
There may be more than one staff member who would be included in any time study. The goal is to
establish how much staff time could be included for billing purposes. If an agency is only
completing one activity, then it could be done using direct billing while maintaining the records of
the time spent on the activity. Accurate accounting for activities will be essential for successful
billing. a. ... Show more content on Helpwriting.net ...
They may not understand the criminal justice system and how it is organized. Providing an overview
of the entire system may be very useful as a baseline for developing potential solutions for
implementing health care reform strategies. Remember to include information about the different
levels of court system, how they are connected and the differences between city, county and regional
jail and the prison system. At a minimum, discussion would also include community supervision
including probation, parole and community corrections (half way

Expansion Of Medicaid Expansion : The Affordable Care Act
Expansion of Medicaid
The Affordable Care Act was put in place by President Obama in 2010, providing Americans access
to affordable health insurance. But South Carolina's governor, the republican Nikki Haley is still
rejecting the Medicaid expansion. My paper has detailed information on why Governor Haley and
republicans made their decision to opt out of the expansion. Also, alternate approaches to expanding
access to care and implementing or reconsidering the state's decision of opting out of the expansion.
Finally, recommendations to the state legislature to convey opting out of Medicaid expansion.
South Carolina without Medicaid Expansion
In the state of South Carolina, Governor Nikki Haley opposes the Medicaid expansion, and the
majority of republican rejected the Medicaid expansion. In 2014, Governor Haley opposed the
Medicaid expansion, but 500 million was added to the Medicaid program. The federal government
will "inject $13.34 billion into the economy and 92.75 to 7.5 will be matched.
The Medicaid program has impacted our hospitals and the economy of the state of South Carolina.
There are a lot of pressures for most of the hospitals in the state dealing with bad credit, pay cuts,
and financial pressure. According to U.S. News (2012), "the Supreme Court upheld the President,
Patient Protection, and Affordable Care Act because it was the big key to a health care law
expansion of Medicaid." This program is based on lower–income individuals and children that are
below

Medicaid Expansion
In the article, "Report: Medicaid enrollment, costs swell under ObamaCare expansion," Brooke
Singman informs us about the future ObamaCare's Medicaid will bring to the country. The cost for
ObamaCare's Medicaid is increasing which is causing budget problems to the states. Enrollments
from able–bodied adults are increasing making the cost of Medicaid is a big issue. Singman explains
the cause and effect that come with Medicaid. Singman uses good diction or word choice to connect
her audience to the information that is being given in her article. The techniques she uses, help the
audience grasp onto the content being given and make her argument clear. According to The
Foundation for Government Accountability, ObamaCare's Medicaid has expanded ... Show more
content on Helpwriting.net ...
It is very important for the audience to have an understanding of the message the writer is trying to
say. Singman's article is full of different techniques which make her article intelligible for a majority
of her audience. The techniques being used make the argument of the article more effective After
writing this essay it has helped me to view writing differently. The way we put words together can
make a huge difference to your audience. This is the reason why we need to be for careful with our
word choice, depending on what we want our audience to take from our writing. We also need to
understand that not everyone will be able to understand if we do not put it in a format that is clear to
the

The Cost Of Medicaid Funding
The costs associated with Medicaid have continued to increase over the years, consuming a larger
amount of both federal and state budgets throughout the country. There are now worries about
Medicaid eating up state budgets throughout several states. In Kaiser Health News, Rau (2013)
reported that "health spending will rise faster than economic growth." With such a significant
increase in Medicaid costs, there is the danger of notable shortfalls within the Medicaid spending at
the state level. Without adequate reforms, the costs associated with Medicaid threaten to consume a
larger portion of state budgets, which could sequentially affect other budget items. An increase in
the number of enrollees, growth in provider payments, and an increase in healthcare costs are some
of the main reasons for an increase in Medicaid costs. The intricacy of the Medicaid costs problem
within the United States is made worse by a decrease in state funds.
Medicaid financing has become an increasing issue for most states throughout the years. The
Government Accountability Office (2010) reported that forty–seven of the states as well as the
District of Columbia had concerns regarding the sustainability of their program. Around 16% of the
state budgets go towards Medicaid each year, totaling around $183 billion (Center on Budget and
Policy Priorities, 2015). A significant share of vulnerable populations relies on Medicaid for medical
coverage. Rocco, Gellad, & Donohue (2015) estimated that of the

Differences And Similarities Between Healthcare And Medicaid
Medicare is a federal funded health care program for anyone 65 and older or anyone who has a
disability; whereas, Medicaid is a state and federal funded health care program for anyone who is
considered low income. Both Medicaid and Medicare has forms that each person must fill out to
determine eligibility. The eligibility for Medicare is that you must be 65, or determined disable by
Social Security Administration (in most cases cannot work, this includes anyone under the age of
65). At the age of 65, you have the option to retire, and are entitled to benefits such as Medicare.
Once Social Security Administration approves the person for Medicare they are issued a Red, White
and Blue insurance card that can be presented, and used in conjunction

Medicare, Medicaid
Introduction
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.
Medicaid
Medicaid is a joi8nt federal and state program. It provides health coverage to nearly 60 million
Americans including children, pregnant women, seniors, and individuals with disabilities. As well as
those people who are eligible to receive federally assisted income. Eligibility does however vary
state to state.
Medicaid may help pay for: Doctor bills, hospital bills, prescriptions, vision care, dental care, ...
Show more content on Helpwriting.net ...
Medicare Part C is Medicare Advantage Plan. This a Medicare health plans that is offered by a
private company. It contracts with Medicare and provides all the benefits of Part A and B. Medicare
Advantage Plans include: Health Manteca Organizations, Preferred Provider Organizations, Private
Fee for Service Plans, Special Needs Plans, and Medicare medical Savings Account Plans. Most
plans offer prescription drug coverage
Medicare Part D is prescription drug coverage. It's the newest part in Medicare. It adds prescription
drug coverage to original Medicare, some Medicare cost plans, some Medicare PPS plans, and
Medicare Medical Savings plans. Beneficiaries choose the drug plan and pay a monthly premium.
Medicare doesn't pay the largest part of Long Term Care services or personal care. Medicare will
pay for a short stay at a Skilled Nursing Facility, hospice care, or home health if an individual meets
these conditions: * Prior hospital stay of at least three days * Admitted to a Medicare certified
nursing facility 30 day prior to hospital stay * If skilled care is needed
Medicare will pay for some of the cost for 100 days. First 20 days they pay the full amount and from
21 days to 100 the individual pays $140 of expenses.
Medicare covers hospice if you have a terminal illness and aren't expected to live more than six
months. However it doesn't cover grief counseling.
Conclusion
In conclusion, Medicare and

Medicaid Program : A National Health Insurance Program For...
The Medicaid program is a federal health insurance program for the under–privileged and
incapacitated. The plan is managed by states within comprehensive limits instituted by the federal
government. Together the federal and state governments finance the program, with the federal share
ranging from 50 percent to 74 percent. Now Medicaid currently makes up 7 percent of the federal
budget and 23.7 percent of all state expenses. Approximately sixty million people are enrolled in the
Medicaid program and 400 million is spent annually.
History of Medicaid In 1965 president Lyndon Johnson authorized regulation that established the
Medicaid program. The program has since grown from its origins as a health coverage program for
welfare recipients ... Show more content on Helpwriting.net ...
111–148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111–152),
collectively referred to as the Affordable Care Act. The Affordable Care Act increases access to care,
makes health insurance more affordable, strengthens Medicare, and ensures that Americans have
more rights and protections – and more security that health insurance coverage will be available
when it is needed. The Affordable Care Act has given states the option to expand access to Medicaid
for low–income adults and families. The federal government will pay for 100% of the costs of
covering newly eligible adults for three years beginning in 2014. The federal amount decreases
gradually and becomes 90% of the costs in 2020 and subsequent years (ASPE, 2016)
The ultimate goal of expanded Medicaid is to make coverage more secure for those who have
insurance, and extend affordable coverage to the uninsured.
The Affordable Care Act was passed by Congress and then signed into law by the President on
March 23, 2010. On June 28, 2012 the Supreme Court rendered a final decision to uphold the health
care law.
The Objectives are to:
Improve health care quality and patient safety
Emphasize primary and preventive care, linked with community prevention services
Reduce the growth of health care costs while promoting high–value, effective care
Ensure access to quality, culturally competent care, including long–term services and supports, for
vulnerable

Medicaid Case Study
On June 28, 2012, the United States Supreme Court issued a decision that made the enforcement
mechanism for the ACA Medicaid expansion optional for states. Regardless of that decision, the
Affordable Care Act (ACA) has reduced the uninsured rate since its complete implementation in
2014. The original intent and projections were that all states were expected to expand Medicaid.
However, after that Supreme Court decision, some states chose not to expand Medicaid.
The central goal of the ACA remains to make affordable health insurance available to more people,
Expand the Medicaid program to cover all adults with income below 138% of the federal poverty
level, and Support innovative medical care delivery methods designed to lower the costs ... Show
more content on Helpwriting.net ...
Seiber and Berman (2017) conclude that the Medicaid expansion helped the vast majority of
enrollees, and there would be no pathway for them to obtain private–sector insurance if the ACA
were repealed. Tarazi et al. (2016) believes that if there were no expansion of Medicaid, many
cancer survivors would have limited access to routine care. Call et al. (2015) state that there is a
clear evidence that the ACA has led to significant health insurance coverage gains. Pickett, Stephen,
et al. (2016) analyze the uninsured rate in Texas (one of the highest in the nation) and conclude that
Texas health care providers would face grave financial consequences if the 2017 session of the
Texas legislature had not pass legislation to expand Medicaid under the ACA. Flint (2014) finds that
States that refuse the Medicaid expansions are creating a problem for themselves as we are all
beneficiaries of the Medicaid program.
Other authors, however, have a different views and argued against Medicaid expansion. Baker and
Hunt (2016) have argued that the expansion policies are rooted in ideology that favors personal
responsibility over society's responsibility in caring for the public's health. They are more political
than logical. Conover, Christopher J. (2017) argues that in the long run Medicaid Expansion is
unaffordable and financing it encourages fiscal irresponsibility. Wright et al. (2016) analyze the
Iowa

Medicare and Medicaid Essay
COMPARE AND CONTRAST MEDICAID AND MEDICARE
Medicaid and Medicare are two different government programs. Both programs were created in
1965 to help older and low–income families be able to buy their own private health insurance. These
programs were part of President Lyndon Johnson's "Great Society" plan, a commitment to helping
meet the needs of individual health care. They are social insurance programs, which allow the
financial load of patient's illnesses to be shared by other healthy, sick, wealthy, and lower income
individuals and families.
Medicaid insurance covers approximately 60 million Americans, according to their income.
Medicaid is larger than any other single private health insurance program. The criteria for
participating ... Show more content on Helpwriting.net ...
Hospice became a permanent benefit in 1984. The next big change came in 1997 when Medicare
added a Part C, Medicare Plus Choice which translates as health insurance programs offered by
private companies but approved by Medicare.
When Medicare first went into effect the monthly premium for Part B, medical insurance, was three
dollars. As it stands today in year 2010, Part A, hospital premium, is $254 to $461 per month. Part
B, the medical insurance portion, is $96.40 for those individuals whose income does not exceed a
certain amount. There are also multiple co–pays and carve–outs, which further increase the cost to
the patient. The ceiling restrictions put on various costs, such as the daily allotment for hospital
stays and skilled nursing facilities, often do not fully cover the patient's expenses.
Today, Medicare recipients must carefully review their Medicare benefits and compare and contrast
them with their private insurance. Some providers do not take new Medicare patients. There are
benefits that are the responsibility of the Federal government, and others that belong to the State
government. It is a challenge for elderly patients to even understand their benefits.
Medicaid and Medicare both play important parts in paying for health care for seniors. They are,
however, very different. There are many details, but here are three big differences.
Variability: First, Medicare is more or less the same in every state, but Medicaid rules vary widely
state

Medicaid : An Important And Costly Government Program
Jesse Smith
Policy Brief
Econ 471
11/24/2015
Dear Congressman Duncan, Medicaid is both an extremely important and costly government
program. The program provides medical care for those who cannot afford it and also for the elderly
and the disabled. Over 69 million people were provided medical assistance through Medicaid in the
fiscal year of 2011 (Herz). Medical attention is very expensive but is also something that every
human being needs. Some people are individually wealthy enough to afford medical insurance. Most
people are provided medical insurance through their employer. So what are those people who are
unemployed and not independently wealthy supposed to do? If you have no job you have no
insurance through your employer ... Show more content on Helpwriting.net ...
Essentially they give states funding for something such as community development and the money
must be spent in that general policy area but the allocation of funds is up to the states. Block grants
are the better system for funding Medicaid for a lot of reasons, but the two biggest are the massive
flaws of the current system, and the increased efficiency that would result from block grant funding
that would decrease the crowding out of spending on other government responsibilities. Education
and health are supposed to be the two largest drivers of development. Medicaid is currently the
largest expenditure for almost every single state, which in turn crowds out funding for things like
education, transportation, and other government funded activities. Around 2009 government
expenditure on Medicaid passed up expenditure on K–12 education. Unfortunately spending didn't
just become so extreme for Medicaid that it passed education at its highest level, we see the
increased spending on Medicaid goes hand in had with decreased spending on education (Howard).
Medicaid spending is rising faster than tax revenues. The money has to come from somewhere, and
since increased taxes are not always an option because of political and other pressures spending
must be reduced in other areas. Federal government currently funds Medicaid on a matching system.
There is no limit on how much aid the government will

Medicaid Intervention In Health Care
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).
Medicaid Expansion The individual mandate, a shared responsibility in the Affordable Care Act,
requires all Americans to have health insurance. (42 U.S.C., 2010) This new law highlighted a gap
in the Medicaid coverage leaving ... Show more content on Helpwriting.net ...
Newly eligible beneficiaries, those under 21, and the medically frail have been provided NEMT
services as a result ("Medicaid Expansion in Iowa", 2015).
Iowa has covered 148,000 newly eligible citizens since its Medicaid expansion (Norris, 2016) and
costs with the waiver are predicted to be $213 million in 2016, $221 million in 2017, and $230
million in 2018 ("Medicaid Expansion in Iowa", 2015).
Michigan expansion. The "Healthy Michigan Plan" is the Section 1115 waiver that was approved by
CMS in December 2013 for Michigan to implement the ACA's Medicaid expansion. This plan uses
Medicaid funds to provide coverage for all newly eligible adults with income up to 138% of the FPL
(Norris, 2017).
Monthly payments into health savings accounts, based on their average six–month usage cost, are
required by all beneficiaries. Individuals that fall between the 100%–138% FPL are required to
make an additional contribution totaling 2% of their income, although, payments can be reduced by
following specified healthy behaviors. Regardless of payment status, beneficiaries cannot lose their
eligibility or be denied services ("Medicaid Expansion in Michigan",

Medicaid Expansion Of The United States
One of the states that have not participated in the Medicaid expansion is Florida. States that are
opting out in the Medicaid expansion can leave several citizens uninsured and their health will be at
risk. Currently, since the America's Supreme Court has given the states more flexibility relating to
the Affordable Care Act, some states are opting out of the Medicaid expansion plan that is intended
to give low–income citizens in the state dependable healthcare. To reasons the state of Florida
opting out the Medicaid expansion, the governor of Florida stated, that Floridians are more
interested in economic growth and employment, better quality of education for their children, and
that they keep the cost of their living low. Florida State is ... Show more content on Helpwriting.net
...
Hence, these people will continue suffering when sick and will jeopardize their health that's lead to
death. It is ridiculous, that some of the state's governors have to opt out because the federal
government covers the majority of the health care cost; it's the taxes that the citizens are paying,
regardless of if the state opted in or out the plan. If a governor opts out, it means that he or she will
be walking away from billion or millions of money that could have helped the citizens, thus leaving
some the citizens without health care. Citizens with incomes that are above the federal poverty line
will be eligible for the tax credits from the government for them to get insured, but the people who
are below the poverty line would be the state's responsibility.
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

History And History Of Medicaid Program
History of Medicaid In 1965 president Lyndon Johnson authorized regulation that established the
Medicaid program. The program has since grown from its origins as a health coverage program for
welfare recipients into a public health insurance program for the nation's low–income population
covering millions of additional children and adults in added categories living in or near poverty.
Medicaid is administered by states, according to federal requirements. (Medicaid.gov, 2015) States
and the federal government fund the program jointly. Although the Federal government establishes
certain parameters for all states to adhere, each state administers their Medicaid program differently,
resulting in differences in Medicaid coverage across the ... Show more content on Helpwriting.net ...
111–148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111–152), jointly
known as the Affordable Care Act. This law was created to upsurge availability to healthcare, make
health insurance more affordable, strengthen the Medicare program and ensures that Americans have
more rights and privileges to insurance coverage when it is needed most. The Affordable Care Act
provides states with the opportunity to increase admittance to Medicaid program for low–income
individuals and families. The federal government will cover 100% of the costs of new applicants for
three years then decrease it gradually to 90% of the costs in subsequent years (HHS.gov, 2016)
Policy Goals and Objectives
The ultimate goal of expanded Medicaid is to provide more security for those with insurance
coverage and offer equitable coverage to those that are not insured.
The Affordable Care Act was passed by Congress and then signed into law by the President on
March 23, 2010. On June 28, 2012 the Supreme Court rendered a final decision to uphold the health
care law.
The Objectives are to:
Improve health care quality and patient safety
Emphasize primary and preventive care, linked with community prevention services
Reduce the growth of health care costs while promoting high–value, effective care
Ensure access to quality, culturally competent care, including long–term services and supports, for
vulnerable populations
Improve health care and population health through

Current State Of Medicare Medicaid
Current State of Medicare
Medicare enrollees in Utah have saved about $78 million on prescription drugs due to the ACA.
Coverage for both brand name and generic drugs will continue to increase until the coverage gap is
closed. The ACA also allows Medicare beneficiaries to seek preventive services without worrying
about cost, due to the lack of deductibles and copays. This aids in detecting and treating health
problems early on. In Utah in 2014, 220,972 individuals with Medicare used free preventive
services. In addition to that, fraud is at a minimum due to tougher screening procedures, penalties,
and technology developments.
Current State of Medicaid
Medicaid has gaps in coverage for adults because eligibility was restricted to specific categories of
low–income individuals such as children and their parents, pregnant women, the elderly, and the
disabled. As of 2014, coverage gaps existed in the following areas in Utah: 0% FPL to 100% FPL
for childless adults, and 46% FPL and 100% FPL for parents. In Utah, 58,000 uninsured adults who
would have been eligible for Medicaid under expansion, fall through the cracks. These individuals
are all below the poverty line and have very limited incomes.
Medicaid Expansion
The amount of money the state is leaving on the table over the next decade due to the lack of
expansion is $5.3 billion. Medicaid is available for pregnant women with incomes 139% of FPL,
children with incomes up to 200% of FPL, and parents with incomes up to 51% of

The For Medicare And Medicaid Services
Introduction
In 2009, The Recovery Act was passed by congress and signed into law by President Obama. This
act was designed to jump start the economy and to create and save jobs. Its long term investment
goals included computerization of medical records to reduce errors and health care costs. Under the
direction of the US Department of Health and Human Services, health care providers had access to
$27 billion dollars in economic stimulus money by utilizing Electronic Medical Records (EMR's)
and meaningful use. (Centers For Medicare and Medicaid Services, 2014) "Meaningful use" as
defined by HealthIT.gov consists of using digital health records to improve quality, safety,
efficiency, and reduce health disparities. Its purpose is to ... Show more content on Helpwriting.net
...
As of January 1, 2014 all public and private health providers must have adopted and demonstrated
"meaningful use" in order to maintain their existing Medicare and Medicaid reimbursement levels
(Centers For Medicare and Medicaid Services, 2014). The year 2014 is also significant in that from
2015 onwards, penalties are likely to be levied on entities that are non–compliant with the ability to
upgrade to electronic record technologies. The proposed penalty is 1% and likely to increase
incrementally to 5%. In order to meet the requirements set forth by the Federal Government many
health care institutions began the painstaking process of seeking out an electronic program. These
institutions sought to purchase a system that would have the capacity to interact with other
programs, and the flexibility to allow all clinical personnel easy access to pertinent medical
information such as labs, diagnostic test results and past medical history.
Statement of the Problem Adcare hospital is a small privately owned facility located in Worcester
County. Adcare offers nationally recognized inpatient treatment for people and families who
struggle with substance abuse addictions. (Adcare Hospital of Worcester, Inc., 2007) Many of these
patients rely on state funded health insurance and fall under the Medicare guidelines. The hospital
first opened in 1984 after converting from a

Medicaid Research Paper
4401089
Medicaid and Its effects in America
PBHE112
Professor R. Vargas
August 2014 Medicaid and Its Effects in America
In this essay my intentions are not to describe in full the features of the Medicaid as an insurance
program or to make standing revision of its budgetary or galenic form. Instead, I will compel a short
recount on its original characteristics when it first started and the positive or negative performance
the program provides its recipients in the United States population. Furthermore, I will move bases
on how Medicaid is affecting our budgetary systems and its upcoming sustainability. Nevertheless,
this paper will contour how the Medicaid program has grown as a major framework of the United
States and the unique ... Show more content on Helpwriting.net ...
There are also greater problems faced by those outside of Medicaid. Those who surpass the revenue
requirements for Medicaid but do not have enough funds for private insurance get stuck and (since
they are uninsured) are hurried to attend the emergency room, one the most costly medical services
handy. Another question is faced not by patients, but physicians. Though there is moderate
administrative charge for patients on Medicaid, physicians are constrained to accept Medicaid
patients and accept a lower pay–for–service comparison to patients who are not on Medicaid.
States commonly have clear discretion inbound which groups their Medicaid programs will shelter
and the financial criteria for Medicaid eligibility. To be suitable for federal funds, however, states
are directed to supply Medicaid coverage for certain individuals who take federally assisted
income– allowance payments, as well as for combined bunch not receiving cash payments. In
consequent to their Medicaid programs, most states have added "state–only" programs to supply
medical aid for indicate underprivileged persons who do not qualify for Medicaid.
Medicaid Services
The Medicaid program has an extensive health service package for those who enlist and qualified
for the service. It is claimed by the federal government absolute coverage of almost thirteen
services, which includes items such as inpatient

Medicaid Liability Report
Good morning, as you requested I have analyzed the qualifications for Medicaid. However, by the
information that I was provided, it is unclear whether or not the patient is eligible for their services. I
need additional information such as the patient's income, family size, age, proof of citizenship, and
if he is part of certain programs to determine whether the patient qualifies for Medicaid. If the
patient does qualify for Medicaid, then he has the choice of filling out an application either online,
by mail, or by going to his County Social Services office. Below, I have stated in depth, the
requirements that the patient needs in order to be eligible for Medicaid. (Include why is it important)
Discussion
Medicaid is federal and state government ... Show more content on Helpwriting.net ...
Medi–Cal enrollment is year around, therefore the patient can apply at any time. The patient has
many choices in which he could apply for Medi–Cal. The patient can apply by completely filling out
an application and mailing it to his nearest county social office. The application is provided in
English and other languages. If the patient prefers to apply to Medi–Cal in person, then the patient
can go his nearest county office and get personal assistance. If the patient lives in Alameda County,
the county office is located in 8477 Enterprise Way, Oakland, CA 94621. The patient can also apply
by phone. The number for the Alameda Social Services Agency is 1 (888) 999–4772 Toll Free and
(510)

Expansion of Medicaid Essay
Expansion of Medicaid
Name
School
Abstract
On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law, allowing all
Americans access to affordable health care. Despite the urgent need to provide health care to all
Americans some Governors and elected Congressmen continue to debate over the necessity to
expand Medicaid and the ACA. The Supreme Court on June 28, 2012 ruled in support of the ACA
by upholding the individual mandate which require Americans to have health care insurance.
Americans without health care insurance, because of this new health care policy will be able to
either purchase insurance through the exchange market or through the expansion of Medicaid. Some
states are against the expansion of ... Show more content on Helpwriting.net ...
Ironically, Texas has the highest number of uninsured citizens in the nation, 6.2 million to be exact.
The majority of these citizens are children. According to Goodwyn (2013), "by Texas refusing to
participate in the Medicaid expansion, which is part of the ACA, the state will leave on the table an
estimated 100 billion dollars over the next decade. It is sad to know many citizens in this state will
be denied health care by those who already have the best insurance and will never have to worry
about being uninsured. In addition, the Texas politicians fail to recognize the need for health care for
neither its most vulnerable citizens nor the burden on the Emergency room as well as the rise in
healthcare premiums for citizens who maintain health insurance. Landers (2013) reports, "whether
they have a good income or a lower one, Texas lag behind much of the nation in access to and
quality health care." States who fail to expand Medicaid will see their funds distributed to states on
board with expanding Medicaid.
Background
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,

Medicaid Fraud
Medicaid Fraud
HCS/545
July 9, 2012
Medicaid fraud comes in many forms. A provider who bills Medicaid for services that he or she does
not provide is committing fraud. Overstating the level of care provided to patients and altering
patient records to conceal the deception is fraud. Recipients also commit fraud by failing to report or
misrepresenting income, household members, residence, or private health insurance. Facilities have
also been known to commit Medicaid fraud through false billing. The Medicare and Medicaid fraud
and abuse statute provides that an individual who knowingly and willfully offers, pays, solicits, or
receives any remuneration in exchange for referring an individual for the furnishing of any item or
service ... Show more content on Helpwriting.net ...
To compensate for such fraud, states must either raise taxes or decrease services in other areas.
Those who most need Medicaid services may not be able to obtain benefits because resources are
not available. For patients, Medicaid fraud could mean tampering with their medical records, which
could put their health at risk. People can get hurt when doctors or other providers give less or more
care than needed just to make more money. Also the public is more skeptical about social service
programs as more incidents of Medicaid fraud occur every day. Providers and facilities who commit
Medicaid fraud can face penalties from state and federal governments.
Federal or state authorities may investigate allegations of fraud depending on where the fraud was
reported, the laws broken, and the amount of money involved. The strictness of penalties levied by
state governments varies from state to state. Federal laws such as The False Claims Act, Anti–
Kickback Statute, and Social Security Act are laws that address fraud and abuse. Title XI of the
Social Security Act contains Medicaid program–related anti–fraud provisions, which impose civil
penalties, criminal penalties, and exclusions from federal health care programs on persons who
engage in certain types of misconduct (Staman, 2010). Under federal regulations, providers
convicted of fraud are excluded for a minimum of five years from receiving funds from any
federally

Health Insurance Plan For Medicaid Care
Introduction 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.
Background of Medicaid Managed Care Medicaid was signed into law by President Lyndon B.
Johnson on July 30, 1965 (History, 2015). Medicaid covers people who are low income, pregnant,
disabled, and

Case Study: Medicaid Managed Care
The Basic Health program could be structure in several ways. It could expand programs such as
Medicaid and CHIP and contract with managed care plans on behalf of its Medicaid and CHIP
beneficiaries outside the private insurance market. These changes would allow both programs to
continue as a "separate program with a separate financing mechanism and risk pool from that of
Medicaid and CHIP, but would leverage the state's existing infrastructure for information
technology, contracting, rate setting, and other function" (Angeles, 2012). Alternatively, a state
could expand the Medicaid managed care by increasing the number and types of service through
different network of providers, other than those that serve Medicaid and CHIP beneficiaries
(Angeles, ... Show more content on Helpwriting.net ...
Part A covers inpatient hospital care as well as hospice care, Part B pays a portion of your outpatient
care, medical equipment expenses, health care provider services and some preventive care like flu
shots, Part C is a Medicare Advantage plan that is offer by a private insurer and approved by
Medicare and Part D covers prescription drugs (Lewis, 2012).
Medicaid is government–sponsored for low income families with dependent children and people
with disabilities under 65 years old. The coverage, as well as qualification for coverage may, vary by
state. Individual can qualify based on family size and income level (Lewis, 2012). If a individual is
denied Medicaid because of excess income, he or she may qualify for "Medicaid spend down,"
which pays medical bills over the excess amount (Lewis, 2012).
The baby boomer generation will need more Medicaid services which would place a large financial
burden on the program. Compared with previous generations, the baby boomers generation has a
higher rate of "diabetes, hypertension, high cholesterol, and obesity" (Barr, 2014). People with
multiple chronic conditions are hospitalized more than those with fall or cold. They are more
vulnerable and therefore, are more expensive. As a result, a two–fold problem is created. First, there
will be a shortage in health care professionals, because baby boomer makeup such a large part of the
healthcare field. The second part of the problem is

Health Policy : Medicaid Expansion Of The Ppaca
Health Policy: Medicaid Expansion of the PPACA:
In the United States, there is an inequitable distribution of power, money, and resources that create
health disparities among the different socioeconomic classes (WHO, 2014). The PPACA was created
to affect the social determinants of health through the Expansion of Medicaid via the PPACA. An
example of health disparities can be seen with life expectancy across the difference levels of social
economical levels. In the United States, the upper class individuals live on average 20 years longer
than those in the poorer classes (Marmot, 2005).
The federal government has created rules to expand Medicaid that include offering Medicaid
medical insurance to all non–Medicare eligible individuals whom are under the age of 65 with
incomes up to 133% of the federal poverty level which is based on the modified adjusted gross
income (MAGI) (KFF, 2013).
Social Problem:
There is expected to be roughly 17 million individuals becoming newly insured through the
Medicaid Expansion of the PPACA by 2019 (Carrier, Yee, & Stark, 2011). The expansion of
Medicaid will create a major supply and demand issue within the health care services. Simply put,
the demand for primary care services will exceed the capacity of the current primary care
infrastructure. This will only add to health care spending because the newly insured individuals will
not have many options to obtain primary care services and they may be forced to use inappropriate
services such

Medical Insurance and Medicaid
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).

Statistics Of Medicaid Fraud That Will Shock You
Statistics of Medicaid Fraud That Will Shock You
1. In May of 2014, some 107 healthcare providers including doctors and nurses were arrested in
several cities. These ones were charged with cheating the programs out of some $452 million in
funds.
2. In 2010 federal officials arrested some 94 people who had filed false claims through Medicare
and Medicaid, for a total of $251 million in fraudulent claims.
3. The Medicare Fraud Strike Force was formed by federal officials in 2007. The group visited some
1600 businesses in Miami at random, following up on billing to Medicare for durable medical
equipment. Of those businesses, nearly one–third did not exist although they had billed Medicare for
$237 million in the past year.
4. It was reported ... Show more content on Helpwriting.net ...
This is the practice of routinely paying out every claim as it comes in and then only pursuing those
that seem blatantly fraudulent, such as a dentist filing 991 claims in one day.
13. The Department's Secretary Kathleen Sebelius has stated that they are planning on pursuing pre–
claim adjudication to analyze patterns in claims before they are paid out, and are looking to abandon
the "pay and chase" model within the next few years.
14. Some estimate that private insurers lose 1% to 1.5% of their revenue to fraud alone and credit
card fraud is estimated to be at around 0.05%, while Medicaid and Medicare numbers are closer to
10% to 15%. One reason for this discrepancy is that private insurers and businesses like credit card
providers may be more willing to invest in software and other technology that allows them to spot
fraud much more quickly than government programs, and to do so before those claims and charges
are paid.
15. Spending for healthcare is estimated to reach some $3 trillion in the U.S. in 2014 alone, although
this amount does not currently keep up with the rate of inflation.
16. Claims pursued by the federal government in 2012 included unlawful pricing by drug
manufacturers, illegal marketing of products and medical devices that have not been approved of by
the Food and Drug Administration, and violations of law in regards to kickbacks and self–referrals.
17. The year 2012

Government Health Insurance Medicaid and Medicare
Government Health Insurance Medicaid and Medicare
HCS/531
03–16–2013
Dr. Dorothy Cucinelli
Government Health insurance Medicaid and Medicare
In today's society concerning health care there are many aspects. These aspects are not limited to the
provider, the patient, and the financial aspect. The aspect that is found quite interesting is the
financial aspect. To be more specific about the financial aspect, this paper will cover the healthcare
insurance. Healthcare insurance comes in different forms whether it is private, employee–based or
government insurance, A significant event that has brought among change in the Healthcare system
is ... Show more content on Helpwriting.net ...
1966–Medicare was implemented on July 1, serving more than 19 million individuals. Medicaid
funding was available to states starting January 1, 1966; the program was phased –in by states over a
several year period.
1967–An Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) comprehensive health
services benefit for all Medicaid children under age 21 was established.
1972–Medicare eligibility was extended to 2 million individuals under age 65 with long–term
disabilities and to individuals with end–stage renal disease (ESRD). Medicare was given the
authority to conduct demonstration programs (Healthcare Finance... 2005). Medicaid and Medicare
today Every year the number of beneficiaries increases. The pressure to gain control of Medicaid
program spending, which has consumed an ever–larger share of state budgets, increased during the
recent economic downturn. Nearly a quarter of the U.S. population, or 77.5 million people, were
enrolled in Medicaid or the Children's Health Insurance Plan at some point in 2011, according to the
March 2012 report of the Medicaid and CHIP Payment and Access Commission.(modern healthcare,
2005)
Conclusion
In conclusion this government–based health insurance has only been around almost 50 years. The
time before this must have been very difficult on society when it came to their

The Affordable Care Act, Medicaid Expansion, And The...
The Affordable Care Act, Medicaid Expansion, and the Effect on Advanced Practice Nursing In
2010, the President of the United States signed the Patient Protection and Affordable Care Act
(PPACA) into law (Luther & Hart, 2014). As written, the PPACA will be the most extensive change
in the financing and provision of healthcare in 50 years (Luther & Hart, 2014). The stated purposes
of the legislation are to decrease the number of medically uninsured people as well as decrease the
cost of insurance and healthcare for those already insured (Shi & Singh, 2015). Medicaid expansion
is significant element of the PPACA and is designed to provide health insurance to the lower income
population (Vincent & Reed, 2014). The purpose of this paper ... Show more content on
Helpwriting.net ...
The PPACA was structured to accomplish insurance reform through several avenues (Vincent &
Reed, 2014). Medicaid program expansion and the individual mandate are two of the primary
elements of healthcare insurance and finance reform (Vincent & Reed, 2014). Additionally
preventative health services delivered without cost, removal of health insurance exclusions for
preexisting conditions, allowing children under the age of 26 to remain on their parent's healthcare
insurance, and gradually decreasing the out of pocket costs for Medicare Part D participants are
mandated by the provisions of the PPACA (Vincent & Reed, 2014).
Medicaid Expansion Expansion of the Medicaid program is an important part of the PPACA
(Vincent & Reed, 2014). To decrease the number of Americans without health insurance coverage,
the Medicaid expansion is designed to provide coverage for individuals with incomes of up to 138%
of the federal poverty level (FPL). Individuals with incomes of 100% to 400% of the FPL, who did
not qualify for Medicaid, would be eligible for subsidies in the Insurance Marketplaces mandated by
the passage of the PPACA (Sommers, 2015) . In the states that do not expand Medicaid, Sommers
(2015) notes that individuals who do not qualify for Medicaid and have incomes below the criteria
to receive insurance subsidies in the healthcare marketplace will remain uninsured. The Medicaid
program is jointly funded by the federal

Medicaid and Medicare
According to Barton (2010) Long–term Care "emphasized continuous care over a period of at least
90 days for a range of acute and chronic conditions. Regardless of the length of time (i.e., from
weeks to years), LTC is an array of services provided in a range of settings to people who have lost
some capacity for independence because of an injury, a chronic illness, or a condition" (pg. 349).
This is the description of someone who may have been in a debilitating car accident, an elderly
person with Alzheimer's and dementia, a person diagnosed with chronic mental illness, and
individuals who are developmentally delayed or "disabled." People who are placed in these type of
long–term care facilities are usually screened using two different ... Show more content on
Helpwriting.net ...
As I previously stated, there are a number of people who can provide LTC services. For those
individuals who receive these services, but who are receiving them within their home or in home
services, they are usually provided these services by certified nursing assistants or personal care
aides. They can even be provided by family or friends. The latter usually does not receive pay.
Hospice services are also provided be nursing assistants due to the nature of the work. Sometimes
family members do not want to go into hospice so they are care for by their loved ones. Nursing
homes are staffed with nurses, medication technicians, and nursing assistants as well. The delivery
of these services can be affected by various policies and payment mechanisms. All of these services
cost money as do medical insurance. Unfortunately for those people who cannot afford services,
they are left with nothing or either poor care, which is unjust and just shouldn't be. There are major
challenges faced by policy makers such as trying to control the cost of Medicaid spending because
Medicaid is the biggest payer of these services. Policy makers must ensure that they are also
keeping the individual served front and foremost in their decisions. Ensuring that quality services
are met is one piece of the puzzle. As stated, unfortunately it seems that those who have lesser
insurance or who cannot afford these services are provided with less than

A Brief Note On Cost And Effectiveness Of Medicaid
Examining the Cost and Effectiveness of Medicaid
Medicaid is a government initiative that is aimed at facilitating access to health care for
beneficiaries. Studies shows that this option is cheaper compared to other health insurance schemes
especially those sponsored by employers, otherwise known as employer–sponsored insurance (ESI).
Several studies have been conducted on the difference that Medicaid makes. Studies show that there
is a huge number of Americans without insurance. This number mostly comprises the poor
population who cannot afford insurance. The government came up with this insurance scheme as a
way of helping out the poor population, and the unemployed who cannot afford or access employer
sponsored insurance.
Studies show ... Show more content on Helpwriting.net ...
A Review of Medicaid Insurance
Medicaid is a government insurance initiative that was started in 1965. The objective of the scheme
is to provide health insurance to low–income citizens, as well as their families. Medicaid places
more emphasis on covering people with disabilities, parents, children, pregnant women and the
elderly from low–income families (CBPP, 2014). Both the state and federal governments are
responsible for funding the program. Each state has its own independent Medicaid program that
operates within the set federal guidelines. These guidelines are broad and give states some sort of
flexibility in the design and administration of the programs.
According to CBPP (2014), Medicaid has an eligibility criterion that is used to determine who
qualifies for program, and who does not. Anybody who meets this criterion can enroll in the
program. The following is the criterion for eligibility into the Medicaid program.
1. Children below the age of 18 years, coming from families whose incomes fall below 133% of the
poverty line determined by the federal government.
2. Low–income pregnant women falling below 133% of the poverty line
3. Parents from families whose income falls within the eligibility limit that attracts cash assistance
from the state.
4. People with disabilities and the elderly who receive cash assistance from the state.
States

The Gap Between Medicaid And Medicaid Essay
We all have this confusion between Medicaid and Medicare some people don't know the difference
between the two or don't even know what either of them are. The Federal government has two
different programs to provide health insurance coverage to citizens in the United States, which are
Medicare and Medicaid. The two programs, while helpful to those individuals who qualify, are not
available to everyone. I'm here to briefly explain and discuss the two programs, their similarities,
and their differences and hopefully get people to understand each program. This become important
in our lives because once we reach the age limit of where we can't provide or take care of our
illnesses these programs come into play on your health care options. This topic I choose has a big
connection into our class because this is something we need to be aware of when it our time to retire
and know that we have some type of insurance to support with our health. Once we get to the age
where we can pay for things we need the Medicare or Medicaid program to help us get the care that
we worked hard for and most importantly deserve. First, I would like to start off with Medicare.
President Johnson signed the Title XVIII of the Social Security Act, known as Medicare, into a law
on July 30, 1965 with full coverage in the beginning of 1966. To qualify for Medicare you have to
be 65 and older, people who are under the age of 65 with certain disabilities, and people of all ages
with End–Stage Renal Disease,

Medicare and Medicaid are programs that have been developed to assist Americans in attainment of
quality health care. Both programs were established in 1965 and are federally supported to provide
health care coverage to vulnerable populations such as the elderly, the disabled, and people with low
incomes. Both Medicare and Medicaid are federally mandated and determine coverage under each
program; both are run by the Centers for Medicare & Medicaid Services, a federal agency ("What is
Medicare? What is Medicaid?" 2008).
Distinguishing between Medicare and Medicaid
Medicare is a federally governed insurance program, primarily serving Americans over the age of
65, younger disabled meeting specific disability criteria, and dialysis ... Show more content on
Helpwriting.net ...
The Evolution of Medicare based on the Needs of Society Since its establishment in 1965 we have
seen Medicare change as people's needs change however being a federal program these changes do
have an incredible amount of lag time. One of the first major changes to Medicare occurred in 1972
when President Nixon signed the Social Security Amendments of 1972 which extended coverage to
individuals under age 65 with long–term disabilities, expanded benefits to include some chiropractic
services and speech and physical therapy. During this time we see the American public growing
tired of the Vietnam Conflict and lack of support and care for those returning Marines and soldiers
with severe disabilities. As the protests escalate and the peace initiatives fail a key piece of
legislation is signed showing government support and a willingness to extend health care benefits to
this growing and vocal population of veterans (The Vietnam War, 1999). Also included in this
Amendment is the encouragement of the use of Health Maintenance Organizations, President
Nixon's administration caught in the scandal of Watergate and pending hearings appeased the left
and proposed the HMO Act, which Congress passed in 1973 (Phillips, 2003).
Conte & Karr (2001) report the economic growth of the 1980's in the United States sees President
Regan cutting taxes and slashing social programs. President Reagan also

Medicaid Expansion Pros And Cons
Medicaid Expansion Debate
Medicaid is one of the states' mandated health insurance program that is operated and financed by
the federal and state government. It is the predominant source of funding for hospitals, community
health centers, physicians and nursing home that provides for more than 74 million low–income
children, pregnant women, adults, elderly, and people with disabilities in the nation (Kaiser Family
Foundation, 2017). As of January 7, 1965, former President Johnson provided his first legislative
message to the 89th Congress, about advancing the Nation's Health through the Social Security
Amendment that accommodates for seniors over the age of 65, children under the age of 19, and to
the unfortunate (Kaiser Family Foundation, 2015).
In 1972, the Social Security Act was recognized to provide programs of cash such as the
Supplemental Security Income (SSI) to assist the elderly and individuals with disabilities and
allowed states to link SSI and Medicaid eligibility for these people. For people to receive Medicaid,
one must meet the state and federal criteria such as residency, citizen, and immigration status. The
federal government has ... Show more content on Helpwriting.net ...
States can select to expand coverage with the Federal support or choose to opt out of the expansion.
As of January 2017, 19 states decide not to adopt the Medicaid Expansion now, and Texas is listed
as one of the states to opt out in the expansion. As a result of Texas opting out of the Medicaid
expansion; the decision has caused a constant battle between the two political parties. The
Democrats who are supporters of the welfare system do not support the cause of Texas not
participating in the Medicaid expansion. On the other hand, the Republicans believe that not
involved in the expansion will save Texas billions of dollars and would prefer certain reforms to the

A Brief Note On Medicare And Medicaid Services
Both Medicare and Medicaid are managed by the Centers for Medicare and Medicaid Services
(CMS), which is a division of the U.S. Department of Health and Human Services. Medicare was
created in 1965 when people of over 65 found it impossible to get private health insurance coverage.
Medicare is a Federal health insurance program that pays for hospital and medical care for elderly
and certain individual with disabilities. The program consists of two main parts for hospital and
medical insurance (Part A and Part B), and two additional parts the provide flexibility and
prescription drugs (Part C and Part D). Medicaid is a health and medical service program for certain
individuals and families with low incomes and few resources. Primary oversight is handle at the
federal level, but each state establishes its own standards, determines the type, amount, duration and
scope of services, sets the rate of payment for services, and administers its own Medicaid program.
Reimbursement to providers are through a fee–for–service model or through various prepaid
arrangements, such as a HMO plan. ACOs create incentives for health care providers to work
together to treat an individual patient across healthcare settings, which includes doctor's offices,
hospitals, and long–term care facilities. There are several factors, in my opinion, for ACOs to be
successful. Buy–in from all involved with physician leadership, hiring the right professionals who
are interested in having the mindset

Statement of Problem
Medicare and Medicaid are two of the United States largest broken systems, which must sustain
themselves in order to provide care to their beneficiaries. Both Medicare and Medicaid are funding
by a joint effort between the federal government and the local state government. If and when these
governments choose to cut funding or reduce spending, Medicare and Medicaid take the biggest hit.
Most people see these two benefits as one in the same, two benefits the government takes out of
their pay check to help fund health care. While the government does deduct a sum from paychecks
everywhere, Medicare and Medicaid are very two very different programs. Medicare was designed
for beneficiaries sixty five years and ... Show more content on Helpwriting.net ...
Medicare and Medicaid's sustainability relies greatly on funding in order to provide health care.
Managed care has been adopted into the government funded care organizations. Medicare managed
care plans provide all coverage themselves, including basic Medicare coverage. Managed care plans
cover above and beyond the basic benefits of Medicare, the size of premiums and copayments, and
the decisions about paying for treatment are controlled by the managed care plan. The basic premise
of managed care is that the member/patient agrees to receive care from only a specific doctors and
hospitals, in exchange for reduced healthcare costs. Medicare, like other insurance companies offer
plans that give Medicare beneficiaries more choices in coverage, like HMO or PPO. Managed care
has been used since the mid 1990's in order to provide healthcare to beneficiaries with serious or life
long illnesses. Today, managed care has become a way for states to provide quality care to both
Medicaid and Medicare patients.
Analysis of Medicaid Funding
Medicaid provides a comprehensive benefit package for those who enroll. The federal government
requires coverage of thirteen services, including inpatient and outpatient hospital services, nursing
home and home health care, and for children under the age of twenty–one. The benefits do not end
there, Medicaid offers a

Historical Legislation Medicare and Medicaid
Historical Legislation from 1965: Medicare and Medicaid Liliana Martinez
Dr. Smith
Grand Canyon University: HCA–460
3/7/13
Historical Legislation from 1965: Medicare and Medicaid The Medicare and Medicaid programs
were signed into law on July 30, 1965 by President Lyndon Johnson ("Centers for Medicare," 2012).
Before this decision was even taken into consideration, many other healthcare reforms had
previously been introduced by earlier presidents, but failed to pass the Senate. Healthcare issues
have always been on board for the United States, but during this time the elderly and the poor were
desperately screaming for help. The government had no choice but to come up with a solution to
their healthcare needs; these two ... Show more content on Helpwriting.net ...
Each states administrates the program according to their guidelines, laws, and financial status
(Wesissman, Zaslavsky, Wolf, & Ayanian, 2008).
In order to qualify for Medicaid individuals must meet certain regulations. Eligibility depends on
each state, age and whether the individual is a U.S. Citizen, blind, pregnant, single parent, or suffers
from any disabilities; all of this plays a huge role in the Medicaid eligibility criteria. Although, some
immigrants may be able to benefit from this program, if the immigrant is a woman whose labor and
delivery of child is taken care of inside the U.S. that is enough to make them eligible for Medicaid
(Medicaid, 2012). Even though the states are allowed to provide their own regulation guidelines
along with other decisions for this health program, there are certain mandatory federal requirements
that must be met by each state in order to receive funding. Some of those requirements include;
inpatient hospital service, prenatal care, vaccines for children, rural health clinic services,
transportation services and many others that according to the federal government are extremely
essential for the management of this program ("What is medicare/medicaid?," 2012).
Considering the fact that millions of Americans have greatly benefited from these two health
programs, the ones who are not really getting much out of this are hospitals and other health care
facilities around the country. Reimbursement from these health

Medicaid History
Medicaid's History, Growth and Development
Tolejela Tucker
Southeastern Institute
Ms. Knox EMBC
Abstract
Title XIX of the Social Security Act Provides for a program of medical assistance for certain low
income individuals and families. The program is known as Medicaid in 49 states and Medi–Cal in
California. Medicaid was established to assist individuals in certain categories such as low income,
disabled, pregnant, and the blind whose income levels are 200% below the federal poverty level or
those families with income 50% higher than the state's Medicaid eligibility threshold. The Medicaid
programs are funded by federal and state contributions. The state has 3 options in the design of their
programs. (1) Use the State Children's Health Insurance ... Show more content on Helpwriting.net ...
In Mecklenburg County Medicaid cost are being controlled by programs like Community Care
Partners. Their access care program serves 23 counties in the state of N.C. This program was
established in July of 1998 and is a member owned not–for–profit organization of 23 practices.
Access Care has a statewide network of over 300 primary care practices with 1,000 providers caring
for over 260,000 Medicaid enrollees. This program has changed Medicaid drastically here in N.C.
The main focus of Community Care Partners is to provide quality services to the Medicaid
recipients with a focus on improvement. The program has quality control, special projects,
population management, provider tools and many other features and services to make Medicaid a
better health plan. Community Care of North Carolina (CCNC) received the Wellness Frontiers
Award from the Healthcare Leadership Council (HLC) on April 3, 2013. The Healthcare Leadership
Council is a coalition of chief executives from the nation's leading healthcare companies and
organizations. The HLC award recognizes companies that successfully implement an evidence–
based wellness program that prevents disease and improves the well–being of a population.

Managing Medicaid For Children
Managing Medicaid for Children in the Behavioral Mental Health Systems
When describing an adequate system of care for children in the behavioral mental health field, the
first thing I think of is good access to care, care that is not expensive and care that is valuable and
need. However, today, this is still not the case; we are currently, still transitioning into trying to
achieve these. In fact, children 's needs for mental health services are not being met by the current
delivery system and minority children are particularly likely to lack appropriate care (Mennen &
Trickett, 2007). However, although managed behavioral health care under parity is expected to
narrow the gap between need for and use of services, some fear that the ... Show more content on
Helpwriting.net ...
Also, it increased accountability and increased focus on outcome and quality measurement as an
opportunity related to Managed Care, and it looked to improve the efficiency and cost–effectiveness
of services (Stroul, 1998). However, the question still is, how did managing Medicaid dollars
increase access to services for children in mental health systems. One of the biggest criticisms that
Managed Mental health has received is that because of the way the managed care system works in
regards to reducing cost utilization, then Managed mental health care could limit access (Boyle &
Callahan.1995). However, in reality, there is a belief and some empirical evidence that Medicaid
managed behavioral health care for children enhances access to care and that patients are more
likely to obtain services in a timely and appropriate manner than under financially restrictive,
traditional fee–for–service care (Boyle & Callahan, 1995). Regardless of this, the Surgeon General 's
1999 comprehensive report on mental health noted the seriousness of the problem and estimated that
70% of children needing mental health services do not receive those (Mennen & Trickett, 2007).
Therefore, focusing on

Impacts of Medicare and Medicaid
As we become older, issues with our health begin to take affect and finding ways to fund for that
care is becoming even more difficult. In the article "Some Elders Must Take Drastic Measures to
Obtain Long–term Care", national magazine journalist Mary A. Fischer (2011) states that many
Americans must face demeaning and disempowering choices in order to qualify for Medicaid or
Medicare–federal funded health insurance programs– such as refusing to pay for a spouses
institutionalization, divorce, and spending down assets. The author argues that these choices leave
the healthy spouse with decreased funds to plan for their own retirement expense (Fisher, 2011).
Working in the health care field for 4 years, along with my family's own personal experiences I can
relate to this article, since I have seen a variety of ways that federal funded health insurances have
been unable to meet the expectations and demands of its beneficiaries.
Consequently, to qualify for Medicaid, which is designed for beneficiaries with low income, one
must receive a monthly income below the average poverty level, which is around $2,000 per month
and have no cash assets, in order for Medicaid to cover long–term care facilities. When applicants
spend down his or her assets, Medicaid will look at any "financial gifts" made within the past 5
years; this could result in the denial of benefits depending on the number of months the gift could
have paid for a long–term care facility (Fischer, 2011).
Medicare, was

Major Differences Between The Medicaid And Medicare Programs

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