Currently, the responsibilities as the CEO of the healthcare facility to provide essential information on the critical importance of Medicaid and Medicare for our healthcare facility. In providing this information to the new board members, they will be able to fully access the significance that these programs provides for the patients, the public, and more importantly to the organization. In absorbing this information, the board members will be more effective in handling the roles and responsibilities of their duties to the organization and to the patients.
Medicare and Medicaid
Healthcare in the United States has gone through dramatic changes that have left millions without proper healthcare, and organizations without the proper technology, tools, and funding to care for these patients. Only in the last 60 years has there been readily available healthcare insurance for a majority of Americans that were for non-profit. However, once private insurers saw the tax incentives that were available from the government, many private insurance flooded the market, only insuring young, employed, and health individuals, which cause premiums to rise and millions were excluded. Although a national healthcare system has always been a favorable option it has not yet come into fruition. Up until President Kennedy’s presidency was congress mobilizing in that direction, after Lyndon B. Johnson step into the presidency, millions were without healthcare coverage include the poor, the old, and more importantly the children. The best way to go about the process to national healthcare was to step the first steps in insuring the old, low income, and children.
President Lyndon B. Johnson signed the Social Security Act on July 30, 1965 that created the Medicaid and Medicare federal enacted programs. (Medical News Today, n.d) Medicare is an entitlement program that was created in order to provide insurance for citizens that are over the age of 65 or who are disabled in any capacity regardless of their level of income. Medicare is a social insurance program that serves more than 48 million enrollees (as of 2011). The program costs over $549 billion. (Gov, n.d) The services they provide include, Part A, hospital insurance, Part B, supplementary insurance that covers home health and outpatient services, Part C that gives seniors the option to enroll in private plans like, Medicare Advantage, and Part D, that covers prescription costs. Medicare is essential in providing insurance for the growing number of seniors who are left without insurance, healthcare bills, and no money to pay for prescriptions or services. The current issues are however that the price of healthcare is increasing, and it is estimated the number of people enrolled will continue to increase. Fraud, waste, and mismanagement are rampant issues with this program. According to Forbes fraud in both programs cost taxpayers billions of dollars. (Matthews, 2012) “Original Medicare isn’t designed to achieve outcomes beyond paying beneficiaries’ claims and guarding against fraud and abuse in the program. Lawmakers built the Medicare program on this limited model in 1965 – and little has changed.” (Humana, 2013)
Medicaid is another entitlement program that is generally referred as a social welfare program that provides healthcare insurance services for low income individuals, children and families, elderly, and people with disabilities. “This entitlement program is means-tested which means that eligibility for benefits requires the beneficiary to be at or near the Federal poverty level.” (Concord Coalition, 2013) This program covers over 55 million citizens and costs over $350 billion. (Gov, n.d) There services include providing insurance for children to cover all healthcare expenses, pre-natal care, physician services, family planning services, ambulance services, lab and x-rays, clinic services, and other healthcare services. These services provide a great strength in ensuring that children and their families, along with other groups have access to premium healthcare services for their medical needs. Issues with Medicaid are similar to Medicare, fraud and the increase in costs are essential in deciding the longevity of the program. “Medicaid is a particular burden on states, consuming on average 22 percent of state budgets… states will be forced to spend another $60 billion on Medicaid through 2021, while another tally estimates the costs to state could reach at least $118 billion through 2023.” (Senate, 2012)
Both government programs are managed by the Centers for Medicare and Medicaid Services, which is a division held by the U.S Department of Health and Human Services. Medicare is funded by Federal payroll taxes paid by most employees and employers, beneficiary premiums, and general tax revenues paid on Social Security benefits. The funds are authorized by Congress which are set aside in trust funds to be used as reimbursements for hospitals, private clinics and insurance companies, and doctors. Medicaid is a joint initiative of the State and Federal governments that are delegated at the state-level. Medicaid is funded by both levels of governments from general tax revenues, where the Federal government matches Medicaid spending dollar for dollar of State spending. Medicaid operates by sending direct payments to the healthcare providers, based on state fee-for-service agreement and pre-arrange payments through HMO’s. States are able to be reimburse from the Federal government of their share of the expenditures, which are dependent on the FMAP or Federal Medical Assistance Percentage and average per capita income level. (Gov, n.d)
Healthcare costs are continuing to rise, and millions are still without healthcare coverage due to lack of affordability and access. Quality care is essential in healthcare organizations, providing the same care to all patients is a significant duty that healthcare officials must make. Quality care is dependent on the share practices and mission of the organization. The way that patients are treated, and the recommend care is a testament of quality care. It is measured in the feedback from patients, the outcome of patients, and the way the staff is treated and treat others. In providing quality care, the organization must remember to put the patients’ needs first in getting to them quickly, accessing the problem, recommending the correct procedures, and ensuring they get the best outcome. Within healthcare organizations quality care needs to consistently monitored, accessed, reevaluated, and drilled into staff on a continual basis in order to ensure that patients receive the best quality care from the organization.
How is Medicare Funded? (2013). Medicare.Gov. Retrieved from http://www.medicare.gov/about-us/how-medicare-is-funded/medicare-funding.html
Matthews, Merril. (2012). “Medicare and Medicaid Fraud Is Costing Taxpayers Billions.” Forbes. Retrieved from http://www.forbes.com/sites/merrillmatthews/2012/05/31/medicare-and-medicaid-fraud-is-costing-taxpayers-billions/
Medicare – Humana Government Relations. (2013). Humana. Retrieved from https://www.humana.com/about/public-policy/humana-on-the-issues/medicare
Medicaid and Medicare – Tom Coburn. (N.d.). Senate. Gov. Retrieved from http://www.coburn.senate.gov/public/index.cfm?a=Files.Serve&File_id=4d81849a-33f
Medicare and Medicaid Funding Challenges | The Concord Coalition. (N.d.). Concord Coalition. Retrieved from http://www.concordcoalition.org/medicare/medicare-and-medicaid-funding-challenge
What is Medicaid/Medicare? (2013). MNT. Retrieved from http://www.medicalnewstoday.com/info/medicare-medicaid/
Understanding Health Care Quality. (2013). AHRQ. Retrieved from http://www.ahrq.gov/legacy/consumer/guidetoq/guidetoq4.htm