Kentucky Medicaid Case Study

The Arkansas Health Care Payment Improvement Initiative (“AHCPII”) is one part of the health care innovations the state has implemented with the aim of “increas[ing] health care quality and reducing the costs of care.” The AHCPII’s intent is to shift Arkansas’s payment system from “one that primarily rewards service volume to one that rewards desired outcomes, particularly with respect to quality and affordability.” Applying to Medicaid, Medicare, and private payers, payment innovation will move away from fee-for-service health care (where quantity all too often trumps quality) to pay for quality. In doing so, the hope is that Arkansas will gain a “new, sustainable model of financing” with the help of a multi-payer leadership and support.

The Medicaid expansion is clearly a great need that the state of Texas should take advantage of as it has numerous positive impacts that could result in even greater successes for the state. Although the decision will have profound implications, the state is given the option to develop alternative approaches to meet state needs and desires that would improve overall health status and increase revenue to advance a larger mission for its

Missouri is one of a twenty-four states that has failed to expand Medicaid. Missouri’s failure to expand medicaid to working Missourians is based on political party rhetoric, misinformation and health care provider resistance. The Missouri Legislature has failed to expand access of quality healthcare to working Missourians because politician follow party line banter. This is evident in the Missouri House and Senate.

Leading up to the twentieth-century, Kentucky had to deal with pressing issues that arose through lack of proper health regulations and proper prison regulations. The lack of change within each of these issues created major problems for Kentuckians. Two governors of Kentucky, seen these issues as pressing problems. Political leaders such as, Gov. James McCreary and Gov. Luke Blackburn, made efforts to remedy these two problems that they recognized as major issues for Kentucky.

Medicare enrollees in Utah have saved about $78 million on prescription drugs due to the ACA. Coverage for both brand name and generic drugs will continue to increase until the coverage gap is closed. The ACA also allows Medicare beneficiaries to seek preventive services without worrying about cost, due to the lack of deductibles and copays. This aids in detecting and treating health problems early on. In Utah in 2014, 220,972 individuals with Medicare used free preventive services. In addition to that, fraud is at a minimum due to tougher screening procedures, penalties, and technology developments.

In the state of Texas Medicaid is funded by state and federal programs. Those eligible to receive Medicare benefit is the low income individuals, families, children, pregnant women, elderly and individuals who suffer with disabilities (Hegar). The Texas Health and Human Service commission (HHSC) distributes the Medicaid (Hegar). Those receiving Medicaid benefits in the fiscal year of 2010 were found to be 55 percent female and 77 percent under the age of 21 (Hegar). Children accounted for 66 percent of all Texas Medicaid recipients in that year; however, 32 percent of those children actually received health care (Hegar).

The Affordable Care Act (ACA) highlighted the importance Medicaid played in insuring every American receive healthcare coverage. (42 U.S.C., 2010) Medicaid provides health benefits to over 71 million across the country. While involvement is optional, all 50 states participate in the program and requirements differ across the nation. The flexibility given to each state has allowed them to make their own decisions to work towards improvements that they believe would best benefit their region (Feldstein, 2015, p. 125-126).

In the article, This Is What Happens When Your State Blocks The Medicaid Expansion Jonathan Cohn discusses the impact that the Affordable Care Act has had on the percentage of people that have health insurance in the United States. Cohn goes in depth about what the Affordable Care Act is and why it has been so beneficial to the states that have adopted it, most specifically the expansion of Medicaid. Cohn also addresses the loophole that allows states to opt out of the federal program due to a Supreme Court ruling in 2012 that allows states to block the Medicaid expansion. The new Medicaid expansion has helped lots of Americans get access to health insurance that they would not have had access to otherwise, but some states are not taking

Medicaid provides medical assistance to citizens in the United States who fall within the eligibility requirements. Medicaid has been enacted since 1965 and has faced many changes. One change most recently was the Patient Protection and Affordable Care Act, and the attempt to require states to expand Medicaid coverage to include more citizens. However, Medicaid is a states’ right and therefore Congress decided to leave expansion up to each individual state. As some states decide to move forward with expansion and some do not, this paper will discuss the pros and cons to each option and the financial impact that Medicaid expansion has on healthcare entities.

Any Texas resident at the age of 65 years and above is eligible for the Medicare insurance plan, which covers a percentage of the total medical treatment. However, the original Medicare leaves a certain percentage, which the policyholder has to pay. For example, Medicare pays 80% of the total medical costs leaving the policyholder with 20% to cover. A Medigap insurance policy covers gaps that the Medicare Part A and Part B does not cover. The out of pocket expenses include deductibles, medical care provided while traveling out of the country, any treatment fee, coinsurance, and copayments.

The Kentucky Cabinet for Health and Human Services is entrusted with the oversight of the mental and physical health of the citizens of Kentucky. This agency is responsible for the oversight of senior, children, adult, and family health. It also coordinates activities with the federal government, in the form of the state Medicaid program, the health insurance program for the poor which is state-run but dependent upon funding from the federal Department of Health and Human Services and tracks patterns of disease determined significant by the Centers for Disease Control (CDC). "The Cabinet for Health and Family Services (CHFS) is home to most of the state's human services and health care programs, including Medicaid, the Department for Community Based Services and the Department for Public Health. CHFS is one of the largest agencies in state government, with nearly 8,000 full and part-time employees" (About CHFS, 2013, CHFS). Some of its programs are specific to the state of Kentucky, such as KinCare which assists grandparents who are caring for their children as primary caregivers and Presumptive Eligibility "a program that enables eligible pregnant women to receive prenatal care through Medicaid for up to 90 days while their eligibility for full Medicaid benefits is determined" (Adults CHFS, 2013, CHFS).

Bill Haslam, the Tennessee state governor, announced that the state of Tennessee would accept the Medicaid expansion offer. The Medicaid expansion expands Medicaid eligibility to the region’s underserved populations living near or below the poverty line. The Medicaid expansion offer looked to be a major win for the state; however, others disagreed with this idea. Some of Tennessee’s lawmakers decided to deny the federal government’s Medicaid offer, even though many others wanted the offer to be accepted. The deal’s breakdown might be the result of “squabbling along party lines” which is a common theme at all levels of government. Although the deal was denied, it is still possible that the bill could still be passed with the help of the governor. The likelihood of Tennessee reviving its Medicaid expansion is a difficult one considering the state would have to fight. The Medicaid expansion could offer the state low-income citizens medical insurance, the state would come out of the deal with a net financial gain, and the state hospitals would come out on top.

Medicaid expansion is seen as a huge problem in this case it takes place among the 50 states. The environment includes the 50 states such as California, Texas, New York and New Jersey. Medicaid expansion offers financial protection. It also addresses the uncompensated care problem which involves paying and reimbursement for service rendered. Medicaid expansion also provides customers access to affordable coverage, as well as customers taking up that cover, which is a moral duty of the government. Medicaid also supports politically powerful interest groups who support expansion. The expansion of Medicaid helps rural hospitals stay afloat in states like Colorado, which added 400,000 people to the health insurance program under

Maine Department of Human Services (DHS) believed that they needed a new Medicaid system so that information could be safer, accurate, and provided more functions. This new system needed to be updated with the new HIPAA requirements. DHS managers reasoned that building a new system would be easier and less expensive to maintain than upgrading and maintaining the old system (Oz, 2009). In 2001 DHS put together a proposal. They received two offers. DHS chose the lowest bid from a company called CNSI. CNSI had no experience with a Medicaid system. When trying to build this new system there was very little

As a society we can change it first by not being judgemental against medicaid. When i say judmental i mean for an example, low income families and individuals will be turned down by healthcare providers just because they have medicaid. It seems like the people with private insurance wont be turned down because providers will get paid the full amount of service that was provided to the patient. What about the people with Medicaid? Or the people who has public insurance that is funded by the government? They dont deserve treatment because they cant afford private insurance? Thats not fair. I do understand the health care workers who dont get paid the full amount they deserve but to deny someone to get medical treatment