Medicare and Medicaid-SLP - Essay Example

Summary of the Medicaid Eligibility Program for Illinois The Medicaid Plan in Illinois is a health pharmaceutical public insurance program aimed to help individuals access drugs when required. It covers all drugs prescribed by doctors. It also covers some over-the-counter (OTC) products in regular use by patients, provided that the manufacturers have a signed rebate agreement with the federal Centers for Medicare and Medicaid Services (CMS). Such rebate ensures that the drugs are paid for at a fee below the normal market price.

Naturally, over-the-counter drugs that do not meet this criterion are not included. Even some prescription drugs require approval from the department to facilitate reimbursements, (www.hfs.illinois.gov, 2009). Apart from Pharmaceutical labelers that refer to drug prior approval information supplied with the drug by the CMS, the Automated Voice Response System (AVRS) is used to reinforce the Drug Prior Approval process. Through AVRS pharmacy providers can inquire about or enter a request for a drug prior approval via either a touch-tone or rotary dial phone, (www.hfs.illinois.

gov/avrs, 2009). The Illinois State All Kids Insurance ProgramThe State of Illinois has the All Kids medical insurance program. Under this program, children who have no medical cover because their parents cannot afford insurance premiums are covered at rates their parents can afford. The aim of the program is to ensure that all children benefit from medical coverage no matter what their ascribed social status. They are covered under comprehensive, affordable health insurance, regardless of family income, immigration status or health condition, (www.allkids.com, 2009).

Under the program children can access hospitals, medicine and physicians when the need arises. The program recognizes the fact that every child deserves to grow up healthy without any medical discrimination. It covers doctor calls, hospitalization, prescribed drugs, optician visits, dental check-ups, eyeglasses, regular check-ups and immunization shots. Other services like medical equipment, speech therapy and physical therapy are also covered for the children in need. Anyone 18 years and below living in Illinois is a potential candidate for All Kids, provided that they are not in a position to afford regular health care from conventional programs.

There is no income limit since all uninsured kids can qualify for All Kids regardless of what their parents earn. All Kids is different from the State’s Comprehensive Health Insurance Plan (Chip). CHIP is funded partly by participant premiums and partly by appropriations of the state’s General Revenue Fund. Premiums are calculated at 125% to 150% of normal premiums payable to traditional insurance companies. Children to whom this program is applicable are generally covered via their guardians’ contributions.

Previous programs such as KidCare and Medicaid have been incorporated into All Kids. Subsequently children who were covered under the two programs previously are now automatic members of All Kids. In other words, All Kids is a one-stop comprehensive package that is designed to cover the medical needs of all children left out of conventional insurance coverof the Blue Cross Blue Shield of Illinois providers. Individuals who have been turned away from individual health insurance due to pre-existing medical conditions or already have a substantially expensive medical cover that costs them a lot can apply for Kid Care for their children.

In the case of children whose parents are divorced, only the custodial parent can apply for the medical cover. And where guardians are not there or not able to contribute for them, they generally benefit from state coverage. However, there is a lot of red tape involved in determining whether they qualify as beneficiaries, which at times makes the process cumbersome and frustrating. ReferencesIllinois Healthcare and Family Services. www.hfs.illinois.gov, retrieved June 21, 2009State of Illinois - All Kids. www.allkids.

com, retrieved June 21, 2009The Automated Voice Response System. www.hfs.illinois.gov/avrs, retrieved June 21, 2009).