Medicare and Medicaid - Coursework Example

Medicare and Medicaid Medicare and Medicaid The government of United s is charged with healthcare provision to all citizens. The efforts have seen the establishment of state and federal initiatives namely Medicaid and Medicare. Major historical milestones have shaped Medicaid and Medicare over the years as the country continues to debate on the administration of Accountable Care Act and Obama Care. The following is a discussion of the transformation of healthcare initiatives over the past 50 years. Historical Milestones in the History of Medicare Medicare provides health care for American populations, and at least 49 million citizens received coverage by 2014. The healthcare program has undergone key milestones that have impacted the overall cost and plans for healthcare. On July 1965, Medicare was signed into law through presidential assent. President Lyndon Johnson signed HR 6675 during Independence ceremony in Missouri. The government allocated a budget of $10 billion for Medicare program. The program saw 19 million people sign up within the first year. Medicare coverage took effect in 1966 where elderly and senior Americans were enrolled (Commonwealthfund.org, 2015). The first major change in the law came in 1972 through President Richard Nixon’s assent. The change included coverage for citizens under the age of 65 years. The individuals with long-term disabilities and End-Stage Renal Disease were included in the new coverage plan. Omnibus Reconciliation Act of 1980 expanded Medicare to include home health services, Medigap (Commonwealthfund.org, 2015). The program was a supplement insurance plan under the supervision of the federal government. Congress also approved hospice services in 1982 to benefit patients with terminal illnesses. In the 1990s, Medicare incorporated new legislations that included Low-Income Medicare Beneficiary group. The federal government saw it wise to provide cover premiums of income earners of between 100 and 120 percent of pervert level. Medicare also welcomed participants from the private market under Part C and Medicare Advantage under the tag ‘Medicare+Choice’. The private options offer benefits such as prescription drug cover for individuals. Significant changes in Medicare health program have occurred in the 2000s. The Obama government introduced Patient Protection and Affordable Care Act in 2010 (Commonwealthfund.org, 2015). The intention was to bring reforms that would reduce the overall costs of Medicare and increase revenue from the enrollment plans. The streamlining plan targeted private and public sectors to improve delivery and the scope of services in the Medicare program. According to Kaiser Family Foundation, at least 49 million individuals had enrolled in Medicare program by the end of 2014. Description of Medicare Parts A, B, D Part A entails Medicare services and supplies to treat conditions and diseases for all enrollees (WebMD, 2015). The services include lab tests, doctor visits, and surgeries. Part A includes supplies such as wheelchairs and walkers depending on the disease and condition. The programs covered under part A include skilled nursing facility care, nursing home care, hospice, hospital care, home health services, and hospice. Hospital care includes inpatient and long-term care hospitals. The Medicare coverage in Part A is dependent on federal and state laws, national coverage decisions, and local companies. The decisions approve the medical conditions and treatment required within a particular area. Part B covers the services defined under Medicare plan, and they vary from one area to another (WebMD, 2015). The section provides coverage for services that are medically necessary. The medically necessary services encompass supplies and services to conduct diagnosis and treatment of medical conditions or diseases that are within the limits of the medical standards practice. Part B also includes preventive services to inhibit prevalence of illnesses such as flu. The services also help in early detection of diseases during early stages and ensure that the treatment works best for the patients covered under Part B. The services include partial, outpatient and inpatient hospitalization for mental health, ambulance services, durable medical equipment, clinical research, and right to second opinion before surgery. Part D covers eligible enrollees who want to receive prescription drug coverage from public and private insurance companies. The costs of drug coverage vary by carriers and location. Medicare part D entails Prescription Drug and Medicare Advantage Prescription Drug plans. The formulary includes the specific generic and brand-name drugs but differs with the plan and insurance company. Companies set monthly premiums in addition to Part B premiums. Beneficiaries should also pay yearly deductible, co-payments, coinsurance, and coverage gap premiums depending with the medication schedule. Medicare Advantage Plan Medicare-approved private companies offer Medicare Advantage Plans. The plan also includes medical and hospital insurance for part A and B (WebMD, 2015). The services and costs paid to the plan vary with the company but the Medicare rules required a monthly payment of a fixed amount. Medicare Advantage provides Prescription Drug coverage to all enrollees. The plan substitutes Original Medicare in Part A and B. Introduction of Patient Protection, and Affordable Care Act came in to reduce payment in the plan. The reduction of payment has helped to reduce the costs under the traditional Medicare program. There are different domains for MA plans together with Five-Star Quality Rating System to assess the quality of the healthcare plan. Part 2: Medicaid Historical Milestones in the History of Medicaid The amendment of Social Security Act in 1965 initiated the creation of Medicaid. President Johnson delivered advancing the Nation’s Health legislative message to initiate hospital insurance for age children and elderly Americans (Kff.org, 2015). The Medicaid program also includes persons with disabilities, caretaker relatives, and the blind. Medicaid became Title 19 of Social Security Act when H.R 6675 was signed into law. The healthcare program became a federal-state program partnership in 1967 where voluntary states began to grant eligible residents long-term benefits. Children of up to 21 years were included under Early and Periodic Screening, Diagnosis and Treatment. In 1971, intermediate care facilities (ICFs) and Mental Retardation for elderly, disabled, and mentally disturbed individuals were introduced in nursing care facilities. The amendment of Social Security Act of 1972 established Supplemental Security Income to help elderly and patients with disabilities (Kff.org, 2015). Medicaid achieved a major milestone in 1981 when Joe Califano created Health Care Financing Administration (HCFA). HCFA’s duty was to administer Medicare and Medicaid programs for at least 1500 employees (Kff.org, 2015). Omnibus Reconciliation Act (ORA) established Freedom of Choice waivers, Home, and Community Based Services in the same year up to 1985 when the program opened doors for pregnant women. ORA empowered Medicaid to cover emergency cases, pregnant women, infants, and low-income earners in 1986. Medicare and Medicaid Patient and Program Protection act was signed into law in 1987 to prevent fraud increase benefits in the protection programs. President Bill Clinton vetoed Block Grant in January 1995 to allow Medicaid program to block grants to all states (Medicaid.gov, 2015). The connection between cash assistance and eligibility for Medicaid came in 1996 when Congress passed Personal Responsibility and Work opportunity Reconciliation Act. Medicaid started to cover uninsured children in 1997 through provisions of Balanced Budget Act. Medicaid coverage expanded in 1999 to include income earners above 250% FPL and disabled individuals. Medicaid began to cover uninsured women in 2000 when breast cancer cases sparked concerns. Establishment of Center for Medicare and Medicaid Services replaced HCFA in 2001 and prepared beneficiaries for an impending economic downturn (Medicaid.gov, 2015). The response to economic downturn came in 2009 when President Obama signed American Recovery and Reinvestment Act. The government wanted to introduce health information technology and increase funding by 2010. The same year came when PPACA was implemented to expand Medicaid eligibility. The set Medicaid expansions have taken effect in 28 states as at January 2015. Eligibility Requirements for Medicaid An amalgamation of financial and categorical eligibility requirements determine Medicaid eligibility. The resource standards and low-income brackets for beneficiaries must be put into consideration. Health Care Financing Administration provides data used to determine income and resource thresholds for individuals. The thresholds vary by the state and group of people within the American population. Income upholding programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income help determine payments (Medicaid.gov, 2015). Family members with children and pregnant women, persons with disabilities and specific low-income individuals are eligible for Medicaid assistance (Cms.gov, 2015). The statutes within the Medicare laws require states to provide coverage for chosen populations. The states decide the people who are eligible for coverage. However, the choice should be limited to certain groups that include poverty related groups such as pregnant women and children from low-income families. The groups must have a 133% FDL while considering all income and resources. The children must be below the age of 6 years. Second, Medicaid should cover individuals who have satisfied AFDC requirements. The requirements have taken effect from July 1996 and varied from one state to another. Third, children born after September 1983 are entitled to Medicaid coverage. The children should also satisfy incomes of up to 100% FPL. Foster care and adoption assistance beneficiaries under Social Security Act. Lastly, optional groups such as higher income pregnant women and children, medically needy, individuals not covered under SSI and persons residing in medical institutions. The Financial Support for Medicaid The federal and state governments provide joint funds for the Medicaid program (Medicaid.gov, 2015). The federal government administers Federal Medical Assistance Percentage (FMAP) to each state based on the per capita income. FMAP ranges from 50-75% but not beyond 82% depending on the wealth level of each state under Medicaid program. The percentage is also adjusted every three years to respond to prevailing economic fluctuations. The state sources funds from certified public expenditures, permissible taxes and provider donations, intergovernmental transfers, and legislative appropriations. The Center for Medicaid Services must approve state plan amendment based on the set statutory and regulatory conditions. The approval paves the way for federal financial participation for the stipulated services under Medicaid. Each state comes up with a payment rate schedules regulated by the federal requirements. Summary As the United States continues to debate on the best method of addressing healthcare dilemma among individuals across diverse financial divides, Medicare and Medicaid changes have improved health care delivery and payment. The goal has been to improve overall delivery, quality, and cost of healthcare to all individuals. The eligibility varies from one group of individuals to another with income and resource standards for participants are given high priority. The joint funding from state and federal government has given the programs a firm footing. References Cms.gov,. (2015). CMS Quality Strategy - Centers for Medicare & Medicaid Services. Retrieved from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/CMS-Quality-Strategy.html Commonwealthfund.org,. (2015). 50 Years Of Medicare: How Did We Get Here?. Retrieved from http://www.commonwealthfund.org/medicare-timeline/ Kff.org,. (2015). Medicaid and CHIP Health Reform Implementation Timeline. Retrieved from http://kff.org/health-reform/issue-brief/medicaid-and-chip-health-reform-implementation-timeline/ Medicaid.gov,. (2015). Financing & Reimbursement | Medicaid.gov. Retrieved from http://www.medicaid.gov/medicaid-chip-program-information/by-topics/financing-and-reimbursement/financing-and-reimbursement.html WebMD,. (2015). Changes to Medicare With the Affordable Care Act. Retrieved from http://www.webmd.com/health-insurance/insurance-basics/medicare-and-affordable-care-act Read More