Medicaid has long been an issue of debate throughout the country. Healthcare is a critical need and many Americans do not have any healthcare. Therefore, Medicaid is vitally important because it provides healthcare to the poor. For many years, both federal and state governments have attempted to reduce the cost associated with Medicare. Some states have resorted to allowing HMO's to take responsibility for some of the recipients of Medicaid. This is particularly true is Georgia with the passage of House Bill 392. According to Goggin (2002) "the shift to managed care has been evident in both the private and public sectors ... Today, over 85% receive health care through some type of "managed delivery." Similarly, growth in managed care coverage of Medicaid clients has grown from 14% in 1993 to 56% in 2000 (Goggin 2002)."
For the purposes of this discussion we will focus on the implications of this bill and explain why such a bill is necessary in the state of Georgia. Medicaid costs are currently outpacing the growth of Georgia's budget. For this reason, many people including state legislators have advocated that healthcare be moved away from state funded programs and placed in the hands of the HMO's. In addition, the research will present an opposing view of Medicaid being outsourced to HMO's.
Proponents for the Outsourcing of Medicaid to HMO's
According to an article released by the Medical Association of Georgia (MAG) entitled "Georgia Medicaid Managed Care RFP Review" the program that will remove 1 million people in Georgia from Medicaid and place them in HMO's has long been under consideration. The article asserts that in the early part of 2005 MAG presented the Department of Community Health's release of a "Request for Proposal," RFP, on January 8, 2005 (Georgia Medicaid Managed Care RFP Review). This RFP was directed at Care Management Organizations systems to function in six regions of the state for numerous Medicaid patients, instead of the current Medicaid program (Georgia Medicaid Managed Care RFP Review). According to the article the proposals were due on April 4, 2005 and the program is supposed to be implemented by January 1 of 2006 in the Atlanta and Central Regions. The implementation of the program in the Eastern and Northern regions were to begin by July 1, 2006 and in other regions by December, 2006 (Georgia Medicaid Managed Care RFP Review).
In addition, the initial contract term will be from July 1, 2005 through June 30, 2006, the Contract will include six annual options for renewal (Georgia Medicaid Managed Care RFP Review).
The review also goes on to reveal several points about the program that reiterate the feasibility of the plan. One of the chief concerns for patients is that they will loose the ability to choose their own primary care physicians (Georgia Medicaid Managed Care RFP Review). However, the article points out that patients can request their physicians and may change their physicians. In addition, the review explains that patient can opt out of the program (Georgia Medicaid Managed Care RFP Review). The article asserts that members can request disenrollment from the program without cause within 90 days of initial enrollment (Georgia Medicaid Managed Care RFP Review). After the initial ninety days member can request disenrollment once per year without cause (Georgia Medicaid Managed Care RFP Review). The article further states that
"A member may request Disenrollment from a CMO plan for cause at any time. Cause my include: member moving out of CMO region, the CMO plan does not, provide the covered service sought;because of moral or religious objections, the member needs related services performed at the same time and not all are available in the network or because of unnecessary risk; the member requests to be assigned to the same CMO plan as family members: the member's eligibility category changes; other reasons related to poor quality of care, access, lack of providers experienced in need area (Georgia Medicaid Managed Care RFP Review)."
The main reason why the passage of this House bill 392 was so important to legislators is that the bill actually establishes the monies needed to place 1 million PeachCare children and Medicaid recipients with privately run HMO's and remove them from the health plan run by the state of Georgia (Tax on HMOs Passes State Senate, 2005). This plan is essential to the reduction of Medicaid cost in the state of Georgia, which have been on the increase by 10 to 12% each year (Tax on HMOs Passes State Senate, 2005). The reduction of these costs is essential because the state budget is only growing by about 5% each year. Last year alone the state spent $2.5 billion on Medicaid expenses (Tax...
Medicaid and MedicareMedicaid and Medicare are two health programs that sound very similar and usually confused and used interchangeably despite being very different. Each of these government health insurance programs is regulated by a set of its own policies and laws (Mitchell, Potter & Amin, 2019). In addition, the programs differ on the premise that they designed for different sets of individuals. Medicare is a federal health insurance program that
S.A. It is worth noting that some of these parts that are left out can be very expensive at times particularly when the beneficiary has to pay the out-of-pocket premiums and deductibles as well, and these services could be inevitable like seeking medical services outside the U.S.A. Some of the services left out by the cover at times can be more expensive and life threatening that those covered hence this
H's claim with an HMO plan is the need for individuals to remain within the network to receive care. Initially, Mr. H was denied coverage because he did not get a referral from his primary physician to see a specialist. The original treatment to which Mr. H's primary care physician was subjecting Mr. H was 1. not effective and 2. The physician suggested a radical amputation for his condition
In 2003, President Bush expanded Medicare, by subsidizing prescription drug costs under Part D. There are further changes to Medicare and Medicaid in the Affordable Care Act. There were expansions in the number of preventative health care services offered for free (such as colorectal screening), and by closing gaps in prior coverage (HHS, 2012). Berenson (2010) notes that the ACA pays for this expanded coverage by decreasing Medicare spending by
Ordinary insurance companies were not willing to extend insurance services to older citizens since it was considered a losing proposition. With the enactment of Medicare, 99% of older people in the country have health insurance and poverty among this group has dropped significantly. With this program, people now have access to better healthcare services which has resulted in increased life expectancy. The reason we can say with some degree of
Medicaid and Medicare Value-Based Purchasing A value chain is defined as "a linked set of value creating activities that begin with basic raw materials coming from suppliers, moving on to a series of value-added activities involved in producing and marking a product or service, and ending with distributors getting the final goods into the hands of the ultimate consumer" (Wheelen & Hunger, 2009). The process of improving raw goods along
Our semester plans gives you unlimited, unrestricted access to our entire library of resources —writing tools, guides, example essays, tutorials, class notes, and more.
Get Started Now