Medicare and Medicaid
Medicare is a federal governed program that pays for hospital and medical care for elderly and certain disabled Americans while Medicaid is a means tested health and medical services program for certain individuals and families with less resources. The populations that are served with the Medicaid are the American citizens and those people who may not necessarily be of American origin but have a legal and permanent residence in America. It also covers adults with extremely low income and their children, and people with certain disabilities.
Medicare is a predominantly federal government program and sponsored while on the other hand, Medicaid is a state governed program in collaboration with the federal government.
Medicare deals with people of age 65 and over, people of any age who may be having kidney failure and long-term kidney diseases, permanently disabled people who cannot work and it is applied for at the local social…...
mlaReferences
Centers for Medicare and Medicaid services (2011). Medical Eligibility; Overview. Retrieved October 7, 2011 from https://www.cms.gov/medicaideligibility/
Unlike Medicare, Medicaid is not a purely federally-funded program. Every state has a Medicaid budget, which the federal government 'matches' based upon a formula, despite the fact that Medicaid is considered an entitlement, implying that enrollees are entitled to benefits regardless of where they live. Because federal funding is 'matched' that means that states that spend more on Medicaid -- usually wealthier states -- tend to receive more federal funds (Villarreal 2006). The reason for the 'matched' funding is partially due to the highly variable costs of living from state to state -- it is far more expensive to reside in New York City than Wyoming, for example -- and also to honor the principles of federalism, allowing the states to determine additional categories eligible for care. Although states must provide Medicaid for persons with income below a certain level, they do have a great deal of discretion in covering…...
mlaReferences
Luhby, Tami. (200). Medicaid busts state budgets.
CNN.com. Retrieved June 24, 2011 at http://money.cnn.com/2011/02/28/news/economy/medicaid_funding_states/index.htm
Medicare and Medicaid: What is the difference? (2011). Nolo. Retrieved June 24, 2011
Medicare and Medicaid
These two terms are government programs meant to assist specific groups of in the United States regarding health matters and are both managed by the Centers for Medicare and Medicaid Services, a division of the U.S. Department of Health and Human Services.
Medicare is a social insurance program that pays for hospital and medical care for elderly and certain disabled Americans. The program consists of hospital insurance which pays the bill of the patient including meals, supplies, testing, and a semi-private room. The hospital insurance also has home extension healthcare provision such as physical, occupational, and speech therapy as medic may deem it necessary. Medicare also covers supplementary medical insurance that makes and settles medical bills relating to physician visits, outpatient hospital visits, home health care costs and other service costs for the aged and disabled. (MediLexicon International, 2011).
On the other hand Medicaid refers to health and medical services…...
mlaReferences
SNM,(2011).Physician Certification and Licensure. Retrieved Nov 15, 2011 from http://www.snm.org/index.cfm?PageID=1089
MediLexicon International Ltd., (2011).Medical News Today. Retrieved Nov 15, 2011 from http://www.medicalnewstoday.com/info/medicare-medicaid/
Public Health Institute,(2011). Public Health. Retrieved on Nov 15, 2011 from http://www.phi.org/public_health_101/
S.E. Smith,(2011).Ambulatory care. Retrieved on Nov 15, 2011 from http://www.wisegeek.com/what-is-ambulatory-care.htm
Medicare and Medicaid
An important part of health care delivery within the state of Pennsylvania involves access to services such as Medicaid and children's insurance programs. These programs help families in need to obtain health services in order to maintain a high level of health and well-being. There are certain strengths and weaknesses exhibited by the population of Pennsylvania that may influence the consumption of insurance services.
According to the United Health Foundation (2012), Pennsylvania demonstrates strengths such as a low rate of uninsured population, high availability of physicians involved in primary care, as well as a high rate of high school graduation. In regard to weaknesses, the state of Pennsylvania has exhibited high air pollution levels, low funding for public health per capita, as well as a high prevalence of diabetes (United Health Foundation, 2012). Also, obesity as increased dramatically in the past decade, from 21.2% to 29.2% of the adult…...
mlaReferences
CHIP: Pennsylvania's Children's Health Insurance Program (2012). Eligibility & Benefits. Retrieved 18 March 2012 from http://www.chipcoverspakids/eligibility-and-requirements.
Pennsylvania Department of Public Welfare (2012). Medical Assistance General Eligibility Requirements. Retrieved 18 March 2012 from http://www.dpw.state.pa.us/foradults/healthcaremedicalassistance/index.htm.
United Health Foundations (2012). The rankings: Pennsylvania. America's Health Rankings. Retrieved 18 March 2012 from http://www.americashealthrankings.org/PA/2011 .
The fears of the elderly were rooted in the fact that the reforms would eliminate "the tax deductibility of the 28% federal subsidy, known as the retiree drug subsidy (DS), for employers who provide creditable prescription drug coverage to Medicare beneficiaries, effective in 2013" (KFF, 2010). Thus, the 'gutting' feared by elderly Americans is the end of subsidies to private programs of elderly individuals with health coverage in addition to Medicare. The 2010 Healthcare Law also increases the Medicare payroll tax for individuals earning above $200,000 a year and establishes a new office within the Centers for Medicare & Medicaid Services (CMS) and the Federal Coordinated Health Care Office to "reduce annual market basket updates for inpatient hospital, home health, skilled nursing facility, hospice and other Medicare providers" (KFF, 2010).
Supporters of the 2010 Healthcare eform Law point out the number of Americans with no health coverage at all. The end…...
mlaReferences
FAQ. (2010). The New York Times. Retrieved November 17, 2010 at http://prescriptions.blogs.nytimes.com/faq-health-care/
Focus on health reform. (2010). Kaiser Family Forum (KFF). Retrieved November 17, 2010 at http://www.kff.org/healthreform/upload/7948-02.pdf
Medicare and the Republicans. (2010, November 5) the New York Times. Retrieved November
17, 2010 at http://www.nytimes.com/2010/11/05/opinion/05fri2.html?scp=6&sq=Medicare&st=cse
Medicare and Medicaid are government-sponsored programs whose objective is to provide patients with health assistance upon meeting specific criteria. Medicare is the federal program that provides insurance for elderly patients aged 65 and over, and approximately 40 million people are enrolled in this program. Medicaid is an insurance program that is available for disadvantaged persons, including the elderly, who cannot afford health benefits because of low incomes or other factors. Both programs are subsidized by government funds and in many instances, will cover the costs of basic medical care as well as specialized testing and supplies. However, as time progresses and the elderly population increases and requires additional medical care, it is evident that Medicare and Medicaid are assuming less responsibility for healthcare costs, leaving the majority of the costs to be assumed by the patient. Furthermore, the necessity for prescription drugs is on the rise, yet pharmaceuticals are only…...
mlaWorks Cited
Ettner, S. "Medicaid Participation Among the Eligible Elderly." Journal of Policy Analysis and Management 16.2 (1997): 237-255.
Economist. "Say Yes to Drugs." Economist 363.8279 (2002): 28-29.
Korcok, M. "U.S. MDs Respond to Pay Cuts by Turning Backs on Medicare."
Canadian Medical Association Journal 166.10 (2002): 1322.
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 serves to negate the whole purpose of the CMS health care services.
In order to cover the above mentioned areas that the CMS leaves out, there is the Medicare part C which is also referred to as Medicare + Choice program which allows the beneficiary to select a private health plan provider such as the Health Maintenance Organization (HMO) who will then contract with the Medicare in order to provide all the covered health services. This is the other undoing of…...
mlaReferences
Congressional Budget Office (2011). Technological Change and the Growth of Health Care
Spending. Retrieved November 10, 2011 from http://www.cbo.gov/ftpdocs/89xx/doc8947/MainText.3.1.shtml
Steven J. Lonchyna, (2011). The Evolution of Medicare and Medicaid Services. Retrieved November 10, 2011 from http://www.cwru.edu/med/epidbio/mphp439/Medicare_Medicaid.htm
Techtarget, (2011). Centers for Medicare & Medicaid Services (CMS). Retrieved November 10,
However, it presented the major problems of covering only half of the workers of the labor force and the undercutting of political support for public health insurance (erkowitz).
The 50s
As social security became popular and Congress passed bills raising social security benefits in that decade, reformers were inclined to extend health insurance to social security beneficiaries, mostly elderly persons (erkowitz 2001). Most of them had stopped paying for their employer-based health insurance and had high morbidity rates. The federal government could then come in as a health provider through what came to be Medicare. The concept of limiting federally financed national health insurance for the elderly received congressional attention in 1957 (erkowitz).
In 1961, President John F. Kennedy endorsed a Medicare bill, followed by a long campaign for its passage (erkowitz 2001). The concept of national health insurance underwent another transformation or major change of sharing common grounds with private health…...
mlaBibliography
Berkowitz, E. (2005). The past as prologue. 15 pages. Health Care Financing Review: U.S. Department of Health and Human Services
Edwards, D.J. (2005). The Medicare/Medicaid slowdown. 2 pages. Nursing Homes: Medquest Communications LLC
Sherman, M. (2004). U.S. health-care spending surges. 2 pages. Deseret News: Deseret News Publishing
Shumaker, R. (2001). Medicaid, Medicare: the differences. 4 pages. Topeka Capital Journal: Proquest Information and Learning Company
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 a value chain until a product is ready to bring to market includes chain segments such as uphill and downhill, and the effective supervision and analysis of its value chains is paramount to a corporation's ability to grow and thrive. The center of gravity along any value chain is defined as "the part of the chain that is most important to the company and the point where its greatest expertise and core competencies lie" (Wheelen & Hunger, 2009). Speaking of…...
mlaReferences
Burns, L.R., Degraaff, R.A., Danzon, P.M., Kimberly, J.R., Kissick, W.L. & Pauly, M.V. (2002). 'The Wharton School study of the health care value chain.' In: Burns, L.R. (Ed.), The healthcare value chain: Producers, purchasers, and providers. New York: John Wiley and Sons.
Wheelen, T., & Hunger, J.D. (2009). Internal scanning: Organizational analysis. In Strategic Management and Business Policy (12th ed.). New York, NY: Prentice Hall.
Preventing 30 Day eadmission on Medicare and Medicaid Patients
One of the most costly and common phenomenon in the modern healthcare system is the increased rates of readmission to hospital of Medicare and Medicaid patients within a short period after discharge i.e. usually within the first 30 days. These readmissions are usually caused by progression of chronic diseases among these patients as well as insufficient post-discharge care. Actually, insufficient post-discharge care is the major factor contributing to these preventable re-hospitalizations. Therefore, reducing the rates of readmissions to hospital of Medicare and Medicaid patients requires developing and implementing a new or enhanced plan for patients' follow-up after discharge. According to the findings of a recent survey, 22% of patients admitted to hospitals are either re-hospitalized or visit an emergency department within the first month after discharge (Harrison et al., 2011, p.27). This plan focuses on preventing readmission of these patients through…...
mlaReferences
Costantino, M. E., Frey, B., Hall, B., & Painter, P. (2013, November 5). The Influence of a Post
Discharge Intervention on Reducing Hospital Readmissions in a Medicare Population. Population Health Management, 16(5), 310-316.
With four out of every ten hospital stays covered by Medicare, and almost half of hospitals’ overall revenue, Medicare cost strategies are critical for healthcare financial management (Herman, 2012). In “7 Strategies to Help Hospitals Break Even on Medicare,” Herman (2012) discusses ways hospital administrators can better manage their Medicare strategy. Hospitals do not break even on Medicare unless they implement proactive strategies for addressing potential shortfalls. Short of advocating for political reform of Medicare policies and programs, Herman (2012) claims that hospital CFOs can actually develop methods of financial management that minimize losses and ensure solvency. Herman (2012) offers seven suggestions to hospital administrators and CFOs, the most important of which is forming strategic alliances and partnerships. Strategic partnerships are important to hospitals not just for Medicare cost structuring but for overall cost-effectiveness. Pooling resources allows all partners to benefit from their relationships, while also improving the quality of healthcare…...
mlaReferences
Herman, B. (2012). 7 Strategies to Help Hospitals Break Even on Medicare.
Kivlahan, C., Orlowski, J. M., Pearce, J., Walradt, J., Baker, M. & Kirch, D. (2016). Taking Risk: Early Results From Teaching Hospitals’ Participation in the Center for Medicare and Medicaid Innovation Bundled Payments for Care Improvement Initiative. Academic Medicine 91(7): 936-942.
The CDC has provided almost $7 million in funding to establish DPPs for research purposes, which means the number of pre-diabetes individuals helped by these programs will be very limited (CDC, 2012). While these programs will probably provide free or nearly-free diabetes preventive services to a large number of individuals, most underserved patients will not benefit from these programs.
S. 452 is worded in such a way that establishing DPPs under Medicaid will be optional for states (Sebelius, 2010). As of 2010, 43 states covered the expense of screening Medicaid patients for diabetes, but only 13 states provided reimbursement for obesity preventive services. This suggests that states are willing to pay for screening, but not preventive services like lifestyle interventions; however, if only a few states implement DPPs for Medicaid recipients, this will provide a proof-of-principle experiment in a real-world setting and establish the overall healthcare savings such programs can…...
mlaReferences
CDC (Centers for Disease Control and Prevention). (2012). National Diabetes Prevention Program. Funded Organizations. CDC.gov. Retrieved 17 Apr. 2013 from http://www.cdc.gov/diabetes/prevention/foa/index.htm .
Civic Impulse, LLC. (2013). S. 452: Medicare Diabetes Prevention Act of 2013. GovTrack.U.S.. Retrieved 17 Apr. 2013 from http://www.govtrack.us/congress/bills/113/s452 .
DPPRG (Diabetes Prevention Program Research Group). (2003). Costs associated with the primary prevention of type 2 diabetes mellitus in the diabetes prevention program. Diabetes Care, 26, 36-47.
Green, Lawrence W., Brancati, Frederick L., Albright, Ann, and PPDWG (Primary Prevention of Diabetes Working Group). (2012). Primary prevention of type 2 diabetes: Integrative public health and primary care opportunities, challenges and strategies. Family Practice, 29, i13-i23.
On April 16, 2015 an Act called the Medicare Access and CHIP Reauthorization Act (MACRA) was passed, which is a piece of history of bipartisan legislation. Eventually, on October 14, 2016 the Centers for Medicare & Medicaid Services, the department of Health and Human Services, and the regulatory agency which takes care implementing and putting into practice MACRA, gave out an ultimate rule with a comment duration putting into practice the provisions of MACRA. MACRA revokes the highly denounced Sustainable Growth Rate Formula together with its schedule for Medicare Physician Fee (MPF) cuts, substituting it with the Quality Payment Program, which is a new model that focuses on cost measurement and quality, as well as payment and reporting adjustments. Physicians and their assistants, clinical nurse specialists, nurse practitioners, and certified registered nurse anesthetics are all part of the eligible clinicians indicated in Medicare Part B and their QPP includes the…...
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 serves people aged 65 years or more or those under 65 years and have a disability. This program provides health insurance coverage to these individuals regardless of their incomes. Medical bills under this program are paid from trust funds paid into by those covered (Digital Communications Division, 2015). As a federal program, Medicare is primarily similar across the country and run by the Centers for Medicare & Medicaid Services. On the contrary, Medicaid is an assistance program that serves low-income…...
mlaReferencesDigital Communications Division. (2015, October 2). What is the Difference Between Medicare and Medicaid? Retrieved from U.S. Department of Health and Human Services website: D.A., Hurley, R.E. & Short, A.C. (2004, March 1). Medicaid Managed Care: The Last Bastion of the HMO? Health Affairs, 23(2), 155-167. Retrieved from https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.23.2.155Mitchell, J., Potter, D. & Amin, S. (2019, December 10). Medicare vs. Medicaid. Retrieved November 10, 2020, from https://www.healthline.com/health/medicare/medicare-vs-medicaidhttps://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html Draper,
Further, in order to be covered by Medicare, the stay at the nursing home must include care that requires skilled nursing. In other words, Medicare will not cover custodial, non-skilled or long-term care that includes activities of daily living, such as cooking, cleaning and hygiene. A stay at a skilled nursing facility under Medicare is limited to one-hundred days per ailment. Medicare will pay for the first twenty days in full. The remaining eighty days requires the patient to pay a co-payment of approximately $124.00 per day.
Under Medicare Part , Medicare will provide medical insurance to a qualified individual. This coverage includes physician and nursing services, x-rays, laboratory and diagnostic testing, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital treatment, some ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments and other outpatient medical care treatments as administered in a physician's office. However, medication administration…...
mlaBibliography
Marrelli, Tina M. (2001): Handbook of Home Health Standards and Documentation Guidelines for Reimbursement. Elsevier Health Sciences.
Matthews, Joseph L., Dorothy Matthews Berman. (2007): Social Security, Medicare and Government Pensions: Get the Most out of Your Retirement and Medical Benefits. New York: NOLO.
Vogel, Ronald J. (1999): Medicare. Anne Arbor: University of Michigan Press.
1. The impact of the Affordable Care Act (Obamacare) on access to healthcare in the United States
2. The effectiveness of Medicare and Medicaid in providing affordable healthcare to low-income and elderly populations
3. The future of universal healthcare in the United States
4. The role of pharmaceutical companies in rising healthcare costs
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Analyze the ethical implications of using technology in health care and the potential for data privacy and algorithmic bias.
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Identify the root causes of health disparities based on race, ethnicity, socioeconomic status, and geographic location.
Evaluate the effectiveness of existing policy interventions aimed at reducing disparities, such as Medicaid expansion and community health centers.
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2. Specificity: Diagnostic codes should be as specific as possible to accurately describe the patient's medical condition. Healthcare professionals should use the most detailed diagnostic codes available to accurately capture the patient's medical history, symptoms, and conditions.
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