This small fraction of enrollees disproportionately impacted spending, representing a whopping 42% of the total spending Medicaid nationwide ("Medicaid Facts: Medicaid Spending by Enrollment Group ", 2011). The statistic for the state of California was worse yet, with disabled beneficiaries representing just 9% of all beneficiaries, nevertheless constituting 41% of the spending ("Medicaid Facts: Distribution of Medicaid Enrollees by Enrollment Group," 2011; "Medicaid Facts: Medicaid Spending by Enrollment Group ", 2011). The trends in spending are hardly news though, as the proportion of expenditures on disabled beneficiaries has only increased in the last decades (Vladeck, 2003). Naturally, cost cutting methods have been a topic of interest among providers, payers and policy makers. California, on the heels of the Patient Protection and Affordable Care Act (ACA), was one of the first states to plan reform through submission of the Medicaid 1115 waiver in 2010. Notably, one component of this Bridge to Reform is a transition of Seniors and Persons of Disabilities (SPD) from traditional Fee For Service (FFS) to managed care in an effort to promote coordinated systems of care more cost efficiently. Another major component is the support for reform of
Despite higher spending on health care, the U.S. health care system ranked last on patient safety, efficiency and equity according to the Commonwealth Fund survey. Our aim should be reduction of high healthcare costs without decreasing people access to health care or sacrificing quality. A collaborative effort is required to work on above recommendations to solve the problems besetting our health care system.
This is where one type of plan will explain what is to be expected for users. Explaining the benefits is practically as important as the application itself: for determining the value of the health care may be "service dependent" ("Medicaid", 2015). Another important term that should be well known is clean claims. Clean claims identify the health professional, health facility, home health care provider or durable medical equipment provider that has given service to verify affiliation status. In short, it identifies a lot of the medical information to make it more transparent. It is not to be mistaken as being part of the medical billing process like balance billing, which is the practice of a provider to bill a client the difference between what the insurance will reimburse and what the provider chooses to charge ("Medicare", 2015). While both are incredibly useful, they are indeed different (2015).
3. The meaning and importance of the “spend down” provision in Medicaid as it relates to long term care is the spending assets.
“Managed Care is a health care delivery system organized to manage cost, utilization, and quality (Medicaid, n.d).” Managed care is set up for easy affordable access to healthcare, the care is regulated so that needed procedures are performed on the patients within the limits of network providers available. There are many undesirable and helpful aspects of managed care. For example, a managed care system provides lower costs, quality service, employer opportunities to make available insurance for their employees, in network provider connections allowing for easy finds of doctors for the patient’s specific plan (Cyrene, n.d). There are however many disadvantages, those include not having the accurate provider or lack of provider for the required
Just yesterday, the presidential candidates, Democratic Congressman Matthew Santos and Republican Senator Arnold Vinick squared off in a live debate moderated by Forrest Soyer. During Vinick’s opening statement, the candidates decide to forgo the negotiated rules in favor of a less constricting debate format. The two address multiple current topics, some of which include: gun control, illegal immigration, tax cuts, health care, and foreign debt relief.
Some people view Medicare and Medicaid as people getting over on the government and not taking care of their responsibilities. There are many different things that Medicare and Medicaid provide to an enormous amount of people in the United States. Some of these people who receive these services are not lazy, they may have gotten laid off of a job that provided health care insurance and now they do not have insurance or employment.
In 1987, the Nursing Home Reform Act was introduced and has started a great leap (post Medicare and Medicaid) into the realm of quality of care for the elderly. The main objective of this Act was to make sure that residents in nursing homes received the quality of care that would ultimately maintain or achieve their highest level of mental, social and physical well being. However, since it was introduced, it has been difficult to make a collective agreement on what is considered acceptable quality of life for someone who needs LTC. This is based on regulators and policymakers simply losing track of various ailments and sudden outcomes through time. So the clear issue falls back on the idea that for the most part, LTC is inevitably in their
There has been an extensive change in the U.S. demographics within last 50 years. According to Center for Health Workforce Studies (2006), in 2020, there will be about 54 million Americans above the age of 65 years as compared to 35 million in 2000. This number is expected to rise further at the rate of 12.5% to 20%, which means by 2050 every 1 in 5 American will be above 65 years (p. 2). This exhibits how baby boomer generation will have a significant impact on the current long-term care system.
California Medicaid program, also known as Medi-Cal is the largest Medicaid program in the nation. With the rollout of Medicaid expansion in 2014, the Medi-Cal is suffering an unsustainable high ED use rate. The identification of a model of care to direct patients to the appropriate setting for care has emerged as a top priority for the state’s health policy.
Western countries had been massive growth in the elderly population, long-term care from the minority poor social problem into a number of common problems. For long-term care policies have to reflect on how to improve the quality of long-term care services,
The Centers for Medicare and Medicaid Services is according to Briesacher et al (2009), is thought to be the principal consumer of nursing home services.
Some of these issues include funding, Medicare coverage and a lack of effective communication and understanding. Funding is the greatest barrier to the Australian healthcare system. Government health spending has increased 74% over the last decade (Kretowicz, 2013). According to The Australian Law Reform Commission, “new medical technologies have the potential to strain the capacity of the healthcare system to afford them” (n.d.). They also state that many experts believe that these new technologies could be a factor driving the increase of healthcare spending. Research funding often favors “safe” investments rather than projects that explore new ideas and does not cover the entire cost of research (Campbell & Brendan, 1978). Researchers must provide a portion of the funding themselves, resulting in wasted time and effort to seek funding elsewhere (Campbell & Brendan, 1978). Healthcare is often divided into those who can afford it and those who cannot (Kretowicz, 2013). Carol Bennett, the chief executive of the Consumers Health Forum of Australia, states that the average Australian spends $1000 per year on out-of-pocket medical expenses (Kretowicz, 2013). This causes the people who are most likely to require healthcare to not be able to afford it (Kretowicz, 2013). Although funding is an important issue in Australia’s healthcare system, Medicare also has multiple flaws.
Under direct contracting, providers must go beyond their traditional roles as suppliers of care to owners of integrated financing and delivery systems. This transition can be difficult for employers to compile and manage actuarial and legal mandates. A physician group can be presented as a threat to health plans, as it does business by obtaining an insurance license. This is because the subcontractor is a competitor. Providers must become active managed care partners with employers, instead of being reactive adversaries of managed care organizations on a contractual basis.
Feder, Judith, and William Scanlon. “The Underused Benefit: Medicare 's Coverage of Nursing Home Care.” Health and Society, vol. 60, no. 4, 1982, pp. 604–632. JSTOR, www.jstor.org/stable/3349693.