The State Health Insurance Assistance Program (SHIP) and the Children's Health Insurance Program (CHIP) help Americans navigate Medicare and obtain health insurance coverage. SHIP provides free assistance to people with Medicare, while CHIP provides coverage to children from low-income families. Both programs are administered at the state level but receive funding from federal and state governments. SHIP counselors can help choose coverage and address claims, while CHIP covers services like checkups, prescriptions, and hospital care. Government legislation has affected CHIP eligibility and funding over time.
THE BIDEN PLAN TO PROTECT & BUILD ON THE AFFORDABLE CARE ACTDr Matthew Boente MD
From the time right before the Affordable Care Act’s key coverage-related policies went into effect to the last full year of the Obama-Biden Administration, 2016, the number of Americans lacking health insurance fell from 44 million to 27 million – an almost 40% drop. But President Trump’s persistent efforts to sabotage Obamacare through executive action, after failing in his efforts to repeal it through Congress, have started to reverse this progress. Since 2016, the number of uninsured Americans has increased by roughly 1.4 million
THE BIDEN PLAN TO PROTECT & BUILD ON THE AFFORDABLE CARE ACTDr Matthew Boente MD
From the time right before the Affordable Care Act’s key coverage-related policies went into effect to the last full year of the Obama-Biden Administration, 2016, the number of Americans lacking health insurance fell from 44 million to 27 million – an almost 40% drop. But President Trump’s persistent efforts to sabotage Obamacare through executive action, after failing in his efforts to repeal it through Congress, have started to reverse this progress. Since 2016, the number of uninsured Americans has increased by roughly 1.4 million
This presentation will help you understand the strategies for patient enrollment & navigation and there by reduce the risk of caring for the uninsured.
http://www.symbiusmedical.com/ - This article can help you navigate the often misunderstood new world of healthcare - the Affordable Care Act. As of 2014 non-grandfathered individual and small group health plans must provide the essential health benefits (EHBs). EHBs will include items & services in 10 statutory benefit categories. Individuals are able to shop for insurance coverage on state health insurance exchanges, called “marketplaces.” The article is written by Symbius Medical Corporate Compliance Manager, Natalie Franklin.
A Guide To Medicare Eligibility And Open EnrollmentAllsup
Find out if you are eligible to receive Medicare, and how to apply for Medicare. Learn about the different types of Medicare and what you may be eligible to receive.
Helping Job Hunters Navigate Their Health Insurance Optionsdpomer99
These PowerPoint slides are from a workshop I conducted at The Career Place in Woburn, Massachusetts on October 13, 2009: www.careerplacejobs.com/aboutUs.htm
1) Discuss what seems to be the current posture of the Trump Administration and Republican Party leadership relative to expected health care policy changes.
2) Identify key distinctions between the Affordable Care Act (ACA aka ObamaCare) and the American Health Care Act (AHCA aka TrumpCare).
3) Recognize key strategies for future success regardless of changes to US healthcare policy and law.
This presentation will help you understand the strategies for patient enrollment & navigation and there by reduce the risk of caring for the uninsured.
http://www.symbiusmedical.com/ - This article can help you navigate the often misunderstood new world of healthcare - the Affordable Care Act. As of 2014 non-grandfathered individual and small group health plans must provide the essential health benefits (EHBs). EHBs will include items & services in 10 statutory benefit categories. Individuals are able to shop for insurance coverage on state health insurance exchanges, called “marketplaces.” The article is written by Symbius Medical Corporate Compliance Manager, Natalie Franklin.
A Guide To Medicare Eligibility And Open EnrollmentAllsup
Find out if you are eligible to receive Medicare, and how to apply for Medicare. Learn about the different types of Medicare and what you may be eligible to receive.
Helping Job Hunters Navigate Their Health Insurance Optionsdpomer99
These PowerPoint slides are from a workshop I conducted at The Career Place in Woburn, Massachusetts on October 13, 2009: www.careerplacejobs.com/aboutUs.htm
1) Discuss what seems to be the current posture of the Trump Administration and Republican Party leadership relative to expected health care policy changes.
2) Identify key distinctions between the Affordable Care Act (ACA aka ObamaCare) and the American Health Care Act (AHCA aka TrumpCare).
3) Recognize key strategies for future success regardless of changes to US healthcare policy and law.
The healthcare industry offers many opportunities to work and establish a career. Aside from health care services, these establishments offer jobs in administration and finance. Gather facts about the US health care system and who are qualified.
Week 5 DBMedicaid EligibilityImagine a close friend asked for .docxcockekeshia
Week 5 DB:Medicaid Eligibility
Imagine a close friend asked for your help. You are to research information about health insurance for this close friend. She is 62 years old and her husband is 72 years old. He is in a rehab hospital following what she calls a "mild stroke". Your friend is employed on a part-time basis as a waitress at a local coffee shop. Determine if they qualify for Medicaid in your state.
Locate an official government on-line source of information for the state you consider “home” (you might live there or it might be home to your family members). Find an additional source of insurance information from an advocacy or resource group for your state. To help determine eligibility, take a look at the current Federal Poverty (FPL) Guidelines. (Remember to identify your home state and include a link to your resource sites.)
A. 1. a.What are the eligibility requirements for Medicaid in your state? Are they both eligible for Medicaid in your state?
b. How much income (Social Security, wages, pension, interest, etc.) is allowed each month (as a Medicaid beneficiary)?
c. How much assets are they allowed? Which possessions count as assets?
2. Assuming eligibility, what benefits are available? Provide an overview of the assistance programs specific to their needs. She is considering home care services, an adult day health program, or the possibility of nursing home care.
B. Share your thoughts:
1. Are the sites user-friendly? Consider health care literacy standards. Also contemplate getting the information if you had an age-related limitation such as poor vision, limited hand function due to arthritis, or short term memory loss.
Medi-Cal
According to the California Department of Health Care Services (DHHS) Medi-Cal qualification website, a family of two can qualify for Medi-Cal if their annual income is below 138% of the federal poverty level which is $22,108 (California Department of Health Care Services, 2016). An individual can also qualify for Medi-Cal if they are: 65 or older; blind; disabled; under 21; pregnant; in a skilled nursing or intermediate care home; on refugee status for a limited time, depending on how long they have been in the United States; breast cancer cervical cancer patients who qualify under the Breast and Cervical Cancer Treatment Program (California Department of Health Care Services, 2016); and/or a parent or caretaker relative of a child under 21 if the child's parent is deceased or doesn't live with the child, or the child's parent is incapacitated, or the child's parent is under employed or unemployed. Medi-Cal is also available to individuals who are enrolled in CalFresh, SSI/SSP, CalWorks (AFDC), Refugee Assistance, and/or the Foster Care or Adoption Assistance Program.
Applications for Medi-Cal can be made on the Covered California website (Covered California, 2016). Applications may also be filed in person at local county human services agencies (Calif.
LECTUREUnit ObjectivesAfter completing this unit, you should b.docxgauthierleppington
LECTURE
Unit Objectives
After completing this unit, you should be able to
define
moral hazard
,
adverse selection
, and
cost-shifting
identify the major public programs for the financing of health care
compare and contrast Medicare and Medicaid
list and describe the four sub-programs of Medicare
describe different reimbursement approaches for health services
Unit Lecture
When asked how health care services are paid for, many of us think immediately of health insurance. However, we typically don't think about the dynamics behind health insurance or the various types of programs through which it is delivered. At its most basic level,
health insurance
is a tool for mitigating risk. An individual purchases health insurance to mitigate the risk of having to pay an enormous medical bill in the event of sickness or injury.
Those who provide health insurance—insurance companies—also work to mitigate risk, albeit from the other side. They attempt to create a risk pool containing a large number of healthy people to offset the expenses accrued by those who do get sick or injured.
Premiums
, the fees paid for ownership of health insurance, are used to subsidize the cost of the health care provided to those who use the insurance.
Factors that insurance companies need to be mindful of include
moral hazard
, whereby an insured individual is more prone to seek care than if he or she were paying the medical bill him- or herself; and
adverse selection
, whereby insurance is mainly purchased by those most in need of it. As with any financial enterprise, if the costs of providing the product or service exceed the revenue, the company goes out of business.
There are several types of insurance programs, both public and private. Together, these programs cover not only individual health services, but public health services, research, and the administration of the delivery and financing of health care in the United States. The majority of public and private expenditures—approximately 81 percent—are directed toward hospital care, provider and clinical services, long-term care, and prescription drug provision (Kovner & Knickman, 2011).
As mentioned in the week 4 lecture, health insurance is a relatively new mechanism for financing health services, and it has grown substantially since the mid-1900s, when only 9 percent of the US population had health insurance (Blumberg & Davidson, 2009). Health insurance can be broken down into private and public insurance.
Private health insurance
is primarily employment-based, meaning that individuals receive coverage through commercial health insurance plans for which their employers either pay the premiums or subsidize them, with the employee paying the balance.
Some larger employers choose to self-insure, which means that they administer their own plans and accept the financial risk of doing so. In essence, they act as the insurer of their employees.
Some individuals, either through necessity or choice, opt to purchase t.
Medi-Cal According to the California Department of Health Care.docxARIV4
Medi-Cal
According to the California Department of Health Care Services (DHHS) Medi-Cal qualification website, a family of two can qualify for Medi-Cal if their annual income is below 138% of the federal poverty level which is $22,108 (California Department of Health Care Services, 2016). An individual can also qualify for Medi-Cal if they are: 65 or older; blind; disabled; under 21; pregnant; in a skilled nursing or intermediate care home; on refugee status for a limited time, depending on how long they have been in the United States; breast cancer cervical cancer patients who qualify under the Breast and Cervical Cancer Treatment Program (California Department of Health Care Services, 2016); and/or a parent or caretaker relative of a child under 21 if the child's parent is deceased or doesn't live with the child, or the child's parent is incapacitated, or the child's parent is under employed or unemployed. Medi-Cal is also available to individuals who are enrolled in CalFresh, SSI/SSP, CalWorks (AFDC), Refugee Assistance, and/or the Foster Care or Adoption Assistance Program.
Applications for Medi-Cal can be made on the Covered California website (Covered California, 2016). Applications may also be filed in person at local county human services agencies (California Department of Health Care Services, 2016). Covered California gives a description of who’s eligible for Medi-Cal on their website that concisely summarizes the verbiage on the DHHS site: “Medi-Cal covers low-income adults, families with children, seniors, persons with disabilities, children in foster care as well as former foster youth up to age 26, and pregnant women” (Covered California, 2016).
According to California Health Advocates, the male spouse in the case would be considered for Medi-Cal under the Medi-Cal for individuals with Medicare program known as “dual eligibles” or “Medi-Medis” because he is 72 years of age (California Health Advocates, 2016). For a couple, the asset limitation is $3000 excluding the primary home, one vehicle, household goods and personal belongings, a life-insurance policy with a face value of $1,500 per person, a prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot. Various Medi-Cal programs are available to Medicare eligible individuals as shown in the table below from California Health Advocates (California Health Advocates, 2016).
Medi-Cal Programs – Qualification at a Glance
(Asset limits are the same for all programs: Single: $2,000; Couple: $3,000)
Program / Requirements
Your Monthly Income
Supplemental Security Income (SSI)
· 65 or older, blind or disabled
Single: up to $889.40/mo.
Couple: up to $1,496.20/mo.
Note: Higher income levels apply for individuals who are blind.
Aged & Disabled Federal Poverty Level (A&D FPL) Program
· 65 or older, blind or disabled
Single: up to $1,220/mo.
Couple: up to $1,645/mo.
Medi-Cal with a Share of Cost (SOC)
· 65 or older, blind or disabled
Single: over $1 ...
Heritage Health Insurance: Eligibility, Renewal, & BenefitsTech Good Health
In this article, we will cover the basics of heritage health insurance and Nebraska's Medicaid expansion program. Renew the heritage health insurance easily.
A Guide to Supplemental Security Income (SSI) for Groups and Organizations Julie Wilson
This booklet explains the SSI program to help institutions, groups, and organizations that have contact with people who get, or may be able to get, SSI.
Although the Affordable Care Act has benefited the health insurance consumer in many respects, it has also added to the confusion. This presentation, Given by Wanda Stephens in Raleigh, North Carolina, details some of the many facets to Obamacare in NC.
for more information visit http://www.hisonc.com/obamacare-north-carolina/
1. Overview: Health Care System
Section 1: U.S. Government Health Programs
Title: State Health Insurance Assistance Program (SHIP) / State Children's Health
Insurance Program (CHIP)
What Are the State Health Insurance Assistance Program (SHIP) and the
Children’s Health Insurance Program (CHIP)?
Since 1965, the United States federal government has helped Americans pay for their
medical needs through the Medicare and Medicaid programs. Traditionally, Medicare
pays medical expenses for Americans who are older or have disabilities or certain
medical conditions, while Medicaid pays medical expenses for poorer Americans. Yet
what these programs offer and how they operate is more complex. Both Medicare and
Medicaid have relationships with a host of federal and state programs.
One of these programs is the Children’s Health Insurance Program, or CHIP. CHIP is
similar to Medicaid since it is a program that provides health insurance coverage for
children and pregnant women who cannot afford private insurance coverage. Since the
1990s, state governments have administered their own programs under CHIP. Funded by
the federal government and state governments, CHIP plans provide health insurance for
free or for a limited cost to eligible people. To qualify for a CHIP plan, you must have an
annual income that falls within certain poverty limits, the upper limit of which are
different in different states.
Other programs help Americans navigate the complex Medicare and Medicaid systems.
One such program is the State Health Insurance Assistance Program, or SHIP, a federal
program that began in 1990. SHIP gives monetary grants to state agencies to operate
different programs that provide free assistance to people receiving Medicare or thinking
about enrolling in Medicare.
How are SHIPs and CHIPs Funded and Administered?
The United States Department of Health and Human Services is a federal government
agency that gives grants to state government agencies that offer different state SHIPs.
These grants pay to train and support the SHIP’s counselors, many of whom are
volunteers. While the federal government pays for SHIP, state governments manage
SHIP. State government agencies operate SHIP programs and services through different
agencies. SHIP exists in all fifty states as well as the District of Columbia (Washington,
DC), Puerto Rico, Guam, and the United States Virgin Islands.
State governments administer their CHIP plans with guidance from the federal Centers
for Medicare & Medicaid Services. The operation of CHIP health plans varies by state.
Some states manage CHIP plans separately from the Medicaid system. Other states
manage their state CHIP plans as part of the Medicaid system. Still other states offer a
combination of the two and offer state CHIP plans that have affiliations to Medicaid.
2. Regardless of how states operate their CHIP plans, these plans receive funding from
federal and state governments. The federal government gives each state a certain amount
of money to fund children’s health insurance programs. States must match the federal
amount to receive this federal funding. The federal government also gives states
additional funding as bonuses if states improve their enrollment procedures and enroll
and retain more people in CHIP programs.
How Do I Search for SHIPs and CHIPs in Different States?
Different states administer SHIP programs through different state offices, generally
offices on aging or insurance. For example, the Nebraska Department of Insurance
administers its SHIP program, which it calls the Nebraska Senior Health Insurance
Information Program (SHIIP). Meanwhile, the California Department of Aging
administers California’s SHIP program, which is known in that state as the Health
Insurance Counseling and Advocacy Program (HICAP).
As you can see, states use different names for their SHIP programs. Some of these names
can be quite different from the term SHIP, such as GeorgiaCares, the state of Georgia’s
SHIP. Despite all of these different terms, finding your state’s SHIP is easy if you use the
Internet. Go to an online Internet search engine and enter terms such as “State Health
Insurance Assistance Program” or “SHIP program” and the name of your state, and you
should be able to find the SHIP for your state. You can also look for web sites devoted to
SHIPs, such as SHIPtalk, since these web sites have information about SHIPs and often
allow you to search for the SHIP in your state.
Other informative web sites will teach you about CHIP plans and Medicaid coverage in
your state. You can learn about Medicaid and CHIP plans by visiting the online site
Medicaid.gov. The home page of this site has a number of links relating to CHIP plans,
including links that feature maps of the United States. These maps allow you to click on a
picture of your home state to help you learn about CHIP plans and other health care
programs in your state.
Using a site such as Medicaid.gov is also a quick and accurate way to give you the names
of state CHIP plans. This is because state CHIP plans do not always have the name CHIP,
just as state SHIPs are often not known by the name SHIP. Some states incorporate their
state name or nickname into their CHIP plans, such as Louisiana’s LaCHIP and
BadgerCare Plus, a CHIP plan covering Wisconsin, the Badger State. Other states use
more generic names for such plans, such as Illinois’s All Kids program.
Why Should I Use a State SHIP and How Do I Find a SHIP Office?
You could use SHIP services if you will be turning sixty-five years old soon. When you
reach that birthday, you will be eligible to receive Medicare benefits if you do not receive
3. them already for a disability or medical condition. You might have some questions
relating to health insurance and Medicare, though. You might wonder if you should keep
your private health insurance instead of enrolling in Medicare. Or you might decide you
want to enroll in Medicare, but do not know which Medicare plan to choose, since there
are multiple Medicare plans.
If you are thinking about enrolling in a Medicare program but do not know how to start
the process, you can turn to SHIP. Go online to find a web site devoted to SHIPs, such as
SHIPtalk. This site will help you find web pages for the SHIP of your home state. If you
live in the state of New York, for example, you will find a great deal of information about
Medicare through the Internet pages of that state’s SHIP, the Health Insurance
Information, Counseling and Assistance Program (HIICAP).
New York’s HIICAP web site has links to the SHIP services and programs it offers. It
also has a link to HIICAP’s offices throughout the state. Clicking on this link reveals a
list of HIICAP offices in different New York counties as well as their street addresses,
phone numbers, and e-mail addresses. You can use this contact list to visit or call a
HIICAP office to speak with a counselor.
What Kinds of Services Do SHIPs and CHIPs Offer?
Talking with a SHIP counselor could help you choose the right Medicare program for
you. A SHIP counselor could tell you whether Medicare pays for certain types of medical
expenses, teach you about other insurance plans that offer additional coverage, and
explain insurance plans that could help you pay for your prescriptions. If you are already
a Medicare recipient, this counselor could help you file a Medicare claim or help you
with insurance problems. SHIP counselors could also help you find additional resources,
since SHIP offices are often affiliated with agencies that help older adults. Some SHIP
offices sponsor events known as Medicare Mondays, events where SHIP counselors
discuss Medicare with members of the community at different locations.
You also can use the Internet to access some of SHIP’s resources. HIICAP, the state of
New York’s SHIP, has web pages with a number of informative links. One page alone
has links to overviews of different Medicare plans, the state of New York’s Medicare
drug plan and other drug plan information, an online handbook about Medicare,
guidelines about reporting Medicare abuse and fraud, and an online notebook for HIICAP
counselors. You can even access information on HIICAP’s home page in more than
seventy languages, although the information on the linked pages appears in English.
Going online can also help you learn more about CHIP plans. Visit the Internet site
Medicaid.gov to find links about CHIP. The links include information about CHIP plans
in your home state. They allow you to check your state’s eligibility requirements to learn
whether you or your children qualify for CHIP plans. They tell you if your state offers
more than one health care plan and allow you to compare multiple plans to find the right
4. health care solution for you. Perhaps most importantly, you can use the links to help you
apply for CHIP benefits and check the status of your benefits.
If you or your children belong to a CHIP plan, you can access a wide range of services.
Most state CHIP plans pay for costs associated with routine types of medical care, such
as children’s checkups, doctors’ visits, immunizations, hospital care, emergency care,
prescriptions, X-rays and laboratory services, immunizations, and dental care. If you are
pregnant, CHIP plans could pay for prenatal care, labor, and postdelivery medical care
for you and your baby. There are differences in different state CHIP plans, however. This
means that some state CHIP plans might pay entirely for your medical services while
other state CHIP plans might charge you some fees for the medical services you receive.
How Have Legislation and Government Involvement Affected CHIPs?
Researching CHIP and state plans is a good idea because health insurance is a complex
topic. Legislation has made government-funded heath insurance even more complicated.
This legislation has included the Children's Health Insurance Program Reauthorization
Act of 2009 (CHIPRA). This act allowed the U.S. federal government to give more
funding, guidance, and standards to state CHIP plans. This act included provisions that
allowed states to enroll people more easily in CHIP plans and Medicaid programs.
Other legislation of the 2000s affected CHIP. In 2010, President Barack Obama signed
The Patient Protection and Affordable Care Act, an act commonly known as the
Affordable Care Act or ObamaCare. This act required most Americans to find health
insurance coverage and helped people who were not able to afford such coverage to
obtain it. This act established federal and state health insurance marketplaces (the state
marketplaces were also known as state exchanges).
You could learn about the federal health insurance marketplace by visiting the Internet
site HealthCare.gov. Visiting this site allows you compare different insurance plans,
learn about eligibility requirements for programs such as Medicaid and CHIP, and ask
questions about insurance coverage. This site also allows you to complete a Marketplace
application that will enroll you in an insurance plan during specific periods of time
known as open enrollment periods. If you are eligible to enroll in a Medicaid or CHIP
plan, you can complete a Marketplace application and enroll in these programs at any
time. As you can see, researching your options on your own or a through SHIP can help
you make effective choices relating to health insurance.
Sources (save for cluster bibliography)
Books
5. "Medicaid." Gale Encyclopedia of Everyday Law. Ed. Donna Batten. 3rd ed. Vol. 2:
Health Care to Travel. Detroit: Gale, 2013. 845-850.
Web sites
Children's Health Insurance Program (CHIP). Medicaid.gov.
http://www.medicaid.gov/CHIP/CHIP-Program-Information.html (accessed October 1,
2014).
“Children's Health Insurance Program Financing.” Medicaid.gov.
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Financing-
and-Reimbursement/Childrens-Health-Insurance-Program-Financing.html (accessed
October 1, 2014).
“Children's Health Insurance Program Reauthorization Act (CHIPRA).” Medicaid.gov.
http://www.medicaid.gov/medicaid-chip-program-information/by-topics/childrens-
health-insurance-program-chip/chipra.html (accessed October 3, 2014).
“CHIPRA Performance Bonuses.” InsureKidsNow.gov.
http://www.insurekidsnow.gov/professionals/eligibility/performance_bonuses.html
(accessed October 4, 2014).
“Health Insurance Information, Counseling and Assistance—HIICAP.” New York State
Office for the Aging. http://www.aging.ny.gov/HealthBenefits/ (accessed October 2,
2014).
“Health Insurance Marketplace.” HHS.gov/HeathCare.
http://www.hhs.gov/healthcare/insurance/index.html (accessed October 3, 2014).
“HHS FY2015 Budget in Brief.” HHS.gov. http://www.hhs.gov/budget/fy2015-hhs-
budget-in-brief/hhs-fy2015budget-in-brief-cms-program-management.html (accessed
October 3, 2014).
“Programs and Services.” New York State Office for the Aging.
http://www.aging.ny.gov/NYSOFA/Services/Index.cfm?id=HIICAP,#HIICAP (accessed
October 2, 2014).
“Questions & Answers.” InsureKidsNow.gov.
http://www.insurekidsnow.gov/qa/index.html#Covered Services (accessed October 3,
2014).
“State Health Insurance Assistance Program National Technical Assistance Center.”
HHS Grants Forecast. http://www.acf.hhs.gov/hhsgrantsforecast/index.cfm?
switch=grant.view&gff_grants_forecastInfoID=70300 (accessed October 1, 2014).
6. “State Health Insurance Programs.” National Association of States United for Aging and
Disabilities. http://www.nasuad.org/initiatives/state-health-insurance-programs (accessed
October 1, 2014).
“Welcome to SHIPtalk!” SHIPtalk. https://www.shiptalk.org/default.aspx?ReturnUrl=
%2f&AspxAutoDetectCookieSupport=1 (accessed October 1, 2014).
#
7. “State Health Insurance Programs.” National Association of States United for Aging and
Disabilities. http://www.nasuad.org/initiatives/state-health-insurance-programs (accessed
October 1, 2014).
“Welcome to SHIPtalk!” SHIPtalk. https://www.shiptalk.org/default.aspx?ReturnUrl=
%2f&AspxAutoDetectCookieSupport=1 (accessed October 1, 2014).
#
