Affordable Care Act and Medicaid Expansion The Patient Protection and Affordable Care Act (ACA) legislation passed in 2010 supported changes to private and public market places for patients, providers and health insurers most noticeably through expanded health insurance availability. A key piece of the legislation included a significant expansion to the Medicaid program to include all individuals with incomes below 138 percent of the Federal Poverty Level (FPL) (Hahn & Sheingold, 2013). Initially, if accepted within the state, the expansion is fully paid for by the federal government and progressively through 2020, 10 percent of the Medicaid spending is a responsibility for the state to fund. As part of continuing to receive any federal …show more content…
A final edict was delivered by the Supreme Court in 2012, ruling the mandates to be a tax and Medicaid expansion at the discretion of the state. As of February 2015, 22 states have elected not to expand Medicaid, 23 states have expanded eligibility within their existing programs and six states are using alternative programs (Custer, 2015). Unfortunately, Georgia chose not to accept the additional funding for Medicaid expansion, a heated topic often discussed by impacted Georgia residents and healthcare providers. The result of not expanding Georgia Medicaid leaves many in the coverage gap and uninsured. Research conducted by The Kaiser Family Foundation in 2016 reports that 309,000 Georgians are in the coverage gap and unable to qualify for Medicaid or subsidies for the health exchange, thus remaining with no health insurance …show more content…
DCH contracts with private insurers, referred to as Care Management Organizations (CMOs), to administer healthcare for these and other state employee groups. The DCH establishes and monitors specific criteria for quality of care, access and provider quality delivered by the CMO’s to Georgia’s participants. The current three CMO’s supporting the Georgia Medicaid and PeachCare Kids market are Wellcare, Anthem (Amerigroup) and Centene Corporation; with the potential for others to enter the market as the state negotiates future contracts. These three insurers cover six regions within the state, with a minimum of two insurers in each region and all three CMOs covering the greatest concentration of population in the Atlanta market. In 2015, the DCH supported 1.966 million participants in Medicaid and PeachCare Kids, with a cost to the state of $9 billion (XXXXX Website –gvt
With the passage of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) has initiated reimbursement based off of patient satisfaction scores (Murphy, 2014). In fact, “CMS plans to base 30% of hospitals ' scores under the value-based purchasing initiative on patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems survey, or HCAHPS, which measures patient satisfaction” (Daly, 2011, p. 30). Consequently, a hospital’s HCAHPS score could influence 1% of a Medicare’s hospital reimbursement, which could cost between $500,000 and $850,000, depending on the organization (Murphy, 2014).
Eligibility for Medicaid programs in Michigan is based on either income only or income and assets. In addition, many of the programs available have age restrictions and/or require applicants to have certain health conditions (e.g. pregnancy). Eligibility requirements for Medicaid in Indiana are similar to those of Michigan. The two programs, however, do contrast in three substantial ways. Two out of three of these ways indicates that Indiana has the better program.
To guarantee that its members receive appropriate, high level quality care in a cost-effective manner, each managed care organization (MCO) tailors its networks according to the characteristics of the providers, consumers, and competitors in a specific market. Other considerations for creating the network are the managed care organization's own goals for quality, accessibility, cost savings, and member satisfaction. Strategic planning for networks is a continuing process. In addition to an initial evaluation of its markets and goals, the managed care organization must periodically reevaluate its target markets and objectives. After reviewing the markets, then the organization must modify its network strategies accordingly to remain competitive in the rapidly changing healthcare industry. Coventry Health Care, Inc and its affiliated companies recognize the importance of developing and managing an adequate network of qualified providers to serve the need of customers and enrolled members (Coventry Health Care Intranet, Creasy and Spath, http://cvtynet/ ). "A central goal of managed care is containing the costs of delivering care, but the wide variety of organizations typically lumped together under the umbrella of managed care pursue this goal using combination of numerous strategies that vary from market to market and from organization to organization" (Baker , 2000, p.2).
Zaleski, G. (2014, April 1). South Carolina’s health costs continue to rise following decision not to expand Medicaid. Retrieved May 17, 2014, from MEDCITY News: http://medcitynews.com/2014/04/south-carolinas-health-costs-continue-rise-following-decision-expand-medicaid/
For decades, one of the many externalities that the government is trying to solve is the rising costs of healthcare. "Rising healthcare costs have hurt American competitiveness, forced too many families into bankruptcy to get their families the care they need, and driven up our nation's long-term deficit" ("Deficit-Reducing Healthcare Reform," 2014). The United States national government plays a major role in organizing, overseeing, financing, and more so than ever delivering health care (Jaffe, 2009). Though the government does not provide healthcare directly, it serves as a financing agent for publicly funded healthcare programs through the taxation of citizens. The total share of the national publicly funded health spending by various governments amounts to 4 percent of the nation's gross domestic product, GDP (Jaffe, 2009). By 2019, government spending on Medicare and Medicaid is expected to rise to 6 percent and 12 percent by 2050 (Jaffe, 2009). The percentages, documented from the Health Policy Brief (2009) by Jaffe, are from Medicare and Medicaid alone. The rapid rates are not due to increase of enrollment but growth in per capita costs for providing healthcare, especially via Medicare.
As part of the Affordable Care Act, beginning this year Medicaid will expand eligibility to include all uninsured individuals under the age of 65 whose incomes fall at or below 138 percent of the Federal Poverty Level, or about $32,500 for a family of four. However, the 2012 Supreme Court ruling that upheld the law also allowed states more flexibility concerning what parts of the ACA they can implement and said that those same states would not lose federal funding for their existing programs. This result would leave the decision to opt out of the law's provision into the hands of state legislators. While twenty-six states have chosen to expand healthcare coverage, twenty-one states have not and four have yet to make a decision. The state of Florida is among those not seeking to expand coverage and that decision alone could cost Florida millions of dollars a year in tax penalties. As conservative and liberal state lawmakers square off into a maelstrom of debate over whether Medicaid should cover more people, thousands of uninsured Floridians will be caught in the crossfire.
Formed in 1998, the Managed Care Executive Group (MCEG) is a national organization of U.S. senior health executives who provide an open exchange of shared resources by discussing issues which are currently faced by health care organizations. In the fall of 2011, 61 organizations, which represented 90 responders, ranked the top ten strategic issues for 2012. Although the issues were ranked according to their priority, this report discusses the top three issues which I believe to be the most significant due to the need for competitive and inter-related products, quality care and cost containment.
...ty to all individuals and families below the 138% federal poverty line. As of right now, twenty five states have rejected this idea of medicaid expansion. By rejecting this proposal, this will leave many Americans uninsured and up the cost of private insurance and taxes.
In 1965 President Johnson signed both Medicare and Medicaid programs into law (Nile, 2011). According to Medical news today, “Medicare is a social insurance program that serves more than 44 million enrollees as of 2008” (MediLexicon International Ltd, 2011, para2). It cost about $432 billion or 3.2% of GDP, as of 2007(par2).Medicare is broken down into parts, Part A is hospital Insurance Part B is medical Insurance, and Part D is Medicare prescription drug coverage (medicare.gov). Like we previously stated Medicare is a health insurance for people who are 65 and older, people under 65 with certain disabilities, and people of any age with End- Stage Renal Disease. Medicaid is a joint federal-state program of medical assistance for low income persons (Benefit.gov). It is administered by the Illinois Department of Human Services (DHS) and Illinois Department of Public Aid (IDPA). Medicaid serves about 40 million people as of 2007; it cost $330 billion, or 2.4% of GDP, in 2007.(par.2) “In Illinois you may be eligible for Medicaid if you are a child, pre...
In March 2010, under the Obama administration, the United States enacted major health-care reform. The Affordable Care Act (ACA) of 2010 expands coverage to the majority of uninsured Americans, through: (a) subsidies aimed at lower-income individuals and families to purchase coverage, (b) a mandate that most Americans obtain insurance or face a penalty,
The author also believes that the Medicaid expansion extends beyond the politics, and has an aim to impact the life, health, and financial stability for the state and individuals. Medicaid expansion can be beneficial to many countries that have a large proportion of low-income people that are uninsured and or with disabilities. This can aid in saving the state money because much of the cost is provided and covered by the federal government, that encourages healthier behavior and results to a reduction in chronic disease due to lower health care costs. Although Texas opted out in adopting the expansion, legislators should decide on the advantage and disadvantage of participating in the Medicaid expansion to improve the welfare of the state. The expansion of Medicaid coverage will give low-income pregnant women the chance to reduce the rate in infant mortality and provide an opportunity for those that were unable to get coverage to be
...while bearing a portion of the costs, and the states’ ability to manipulate the program to obtain federal funds (Weil, 2003). The overwhelming increase in Medicaid costs are born by the states individually and reflect actual costs associated with growing eligible population that requires the services offered by Medicaid.
It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed One being the Health Maintenance Organizations (HMO), which was first proposed in the 1960s by Dr. Paul Elwood in the "Health Maintenance Strategy”. The HMO concept was created to decrease increasing health care costs and was set in law as the Health Maintenance Organization Act of 1973, after promotion from the Nixon Administration. HMO would, in exchange for a fee, allow members access to employed physicians and facilities. In return, the HMO received market access and could earn federal development funds.
A federally mandated program, Medicaid is run by state and local governments under the established federal guidelines. Income and resource levels are the primary means for each state to determine eligibility with the level varying from state to state. Eligibility is also affected by other factors such as age, whether you are pregnant, if you are blind or have other disabilities, and U.S. citizenship or lawful immigration status. Some states req... ...
Another article that caught my eye is improving the management of care. It has been a challenge to Medicaid and Medicare when it comes to overutilization of services. If one looks at the demographics of the issue, it would indicate that these are individuals with high cost occurrence and those whose social and personal environment is quite unfavorable.