Medicaid APA Essay Example

Medicaid APA Essay Example Medicaid APA Paper Medicaid APA Paper According to the New York State Department, Medicaid is a program created by the government to assist the New York working class, particularly those who could not afford to pay for their health care and medical needs. Accordingly, this benefit poses a few requisites before a person could avail. Among them includes; the very high medical bills that no ordinary employee can afford; a supplemental security income or (SSI), as well as age, disability and income requirements that falls within certain bracket identified as fit to be considered beneficiary. The scope of Medicaid is so vast that it caters to almost all kinds of health care needs, from ordinary illness, to maternity and childcare benefits and even to those critical in nature, such as cancer and chemotherapy. It began as a program that pays off health care benefits for disabled, unemployed as well as the elderly. In 1996, The Michigan Department of Health was created along with a portion of the Department of Public; Mental and the Medical Services Administration; and is responsible for the collection of information of a wide range of health related information. The purpose of this collection is the baseline monitoring of the well being of its citizen and is mainly responsible for health policy and management of the population. It set goals to maintain and to execute to strive for healthier conditions; promote access to the broadest possible range of quality services and supports; prevent disease, promote wellness and improve the quality of life. The Medicaid health care coverage for people with limited incomes, mental health services for those with mental illness or disabilities, health promotion, disease prevention, drug enforcements, treatment and education are among its basic duties. In order for Michigan to accomplish these goals, funding for health services comes from the Federal Government in the form of operating grants. The rest comes from taxes paid by its citizens. Medicaid uses utilization review, which is the process of evaluating the appropriateness of services provided. The main objective is to review each case and determine the most appropriate level of service and the setting in which it should be delivered, the most cost-efficient methods for care delivery, and the need to plan subsequent care. It is divided into three categories which are prospective, concurrent, and retrospective. One example of prospective care is preventing unnecessary or inappropriate institutionalization. It notifies the concurrent review system that a case will be occurring and allows them to prepare for discharge planning. Concurrent utilization review occurs when decisions regarding appropriateness are made during the course of health care utilization. An example of this would involve monitoring the length of inpatient stays and discharge planning. Retrospective utilization is managing utilization after the services have been delivered. The review is based on an examination of medical records to access the appropriateness of care. This can be helpful for taking corrective action and for monitoring subsequent progress. Utilization control is about is practice profiling, a method that refers to the development of provider-specific practice patterns and the comparison of individual practice patterns to some norm. The profiles are basically used to identify which physicians, compared to other physicians in their category, are using surgery, tests, or hospitalization excessively. The profile reports are used to give feedback to providers so that they can modify their behavior of medical practice. They can also help detect fraud and abuse. Medicaid provides many programs that help families in need with assistance for medical, nutritional, food, day care or other expenses. It encompasses a wide array of the public and includes: adults, children and teens, senior citizens, pregnant women or persons with disabilities, some of which are broken down according to specific guidelines. The up-to-date health care coverage and the promotion of quality of care are made possible through the maintenance of agency regulatory control. One of which is CMS, that plays a key role in the overall direction of the healthcare services and serves approximately 90 million beneficiaries (US Department of Health. 2005). It anticipates accomplishing the mission by continuing to transform and modernize the health care system. They set standards and guidelines for organizations to follow and adhere to in order to provide the best possible care. Another important regulatory system is called the Health Plan Employer Data and Information Set which is a set of performance data developed and maintained by the National Committee for Quality Assurance. It is most widely used to standardize performance measure in the managed care industry. HEDIS establishes accountability in managed care and assure that employers, regulators and consumers have the information the need. In a home health care situation the primary care giver is usually not the physician. The physician is communicated with by phone and with documentation from the caregivers. The primary caregivers are usually the nurses and other team members who are involved directly with the patients care. Although, the original order to begin home care must be initiated by the physician if skilled care is to be obtained. According to the 1995 Guide to Health Insurance for People with Medicare pays the full cost of medically necessary home health visits by a Medicare-approved home health agency. This coverage must meet specific criteria, but it can be a relief to family members to know that their loved ones can be taken care of at home without worrying about the expenses. Unfortunately, if the care to be given within the home is termed not medically necessary the expense is not covered. This can include items such as meal and medication delivery, a percentage of necessary durable medical equipment, personal care and homemaker services. Health care services that are not included can become quite numerous. It is often difficult for family members to understand why specific services are not covered especially when they appear to be necessary for the care of the patient. These costs can add up quite quickly and the impact of the cost can become quite distressing for family members and patients on a limited budget. In these cases a Social Worker is usually provided to help the patient and family explore other avenues which may enable them to cover their health care costs. Assisted living is an arrangement to residents of a facility that enables them to complete certain daily activities while remaining independent. The services provided enable the resident to achieve maximum function of their activities of daily living. These services help assist the aged, blind, disabled, and other functionally limited individuals with necessary daily activities which they require help with or are unable to perform on their own. Personal care does not include specific health oriented services which would require the services of a certified or licensed professional. The goal of an assisted living facility is to have the residents feel independent. Reference Page Department of Health (2007). Medicaid in New York City. Retrieved online on 16 March 2007 from: health. state. ny. us/health_care/medicaid/#definitionCare. US Department of Health: on Center for Medicare and Medical Services. USA. gov, page last updated on 07 July 2005, and retrieved on 16 March 2007 from: cms. hhs. gov/History/