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MEDICAID AND MEDICARE Identify the government agencies involved in administering or oversight of the Medicare and Medicaid programs. The Health Care Financing Administration (HCFA) is the agency that administers Medicare in order to dispense its complex and numerous functions. There are reform proposals that need to restructure the program such as the comprehensive Medicare reforms. (Medicare: 21 st Century Challenges Prompt Fresh Thinking About Programs Administrative Structure). Medicaid is the federal-state health care financing program.
It is a program which covers 54 million low-income people with a cost of $ 276 billion in 2003. This is administered by the Center for Medicare & Medicaid Services (CMS). GAO added Medicaid to its high-risk federal programs (Allen). Compare and contrast the Medicare and Medicaid programs in at least two ways.
Medicare was designed as a supplement to Social Security for elderly recipients, who have more extensive medical needs and expenses than the general population. Medicare is designed to protect this aged population against the risks of medical disaster. It consists of two parts: Hospital Insurance known as Part A and Supplementary Medical Insurance or Part B. The costs of Medicare have far exceeded original estimates and have been prime contributors to health cost inflation.
The reasons for this growth are clear. Because the proportion of the elderly is growing and they are living longer, the increase in beneficiaries and the years they are covered contribute substantially to cost increases. Meanwhile, Medicaid is a public assistance program funded out of general revenues. It is a federal-state program with benefits varying among the states. States must cover SSI and AFDC beneficiaries and certain other poor persons, particularly young children and pregnant women. To receive Medicaid funds, states must offer certain basic medical services without cost to the patient.
Depending on the states per capita income, the federal government reimburses 50 to 80 percent of the costs for these services. They include inpatient and outpatient hospital services; physicians services; prenatal care; laboratory and X-ray services; home health services; skilled nursing; early screening, diagnosis, and treatment of physical and mental defects in those under twenty-one; and family-planning services and supplies. Describe three components that impact your members ability to get reimbursed. In healthcare, there are alternative theoretical models that states that pricing decisions can be influenced by payments from customers with mandated reimbursement levels such as that of Medicaid. But if the providers resources become limited within the production range, the relationship between the retail process and the recognized reimbursement levels would not be the function of the altruism of the provider to the customers who pay in cash. If a profit motive is the dominant factor, then the relationship will be positive.
Some also contend that prescription prices for whose who pay in cash are influenced by the Medicaid pharmacy reimbursement levels (Brooks). High Medicaid reimbursement levels give pharmacies the function to be altruistic and subsidize their cash-paying customers. REFERENCES Medicare: 21 st Century Challenges Prompt Fresh Thinking About Programs Administrative Structure. Retrieved Sept. 29, 2007 at: http: // 209. 85. 165. 104 /search?
q = cache: -LmlTpzU 5 AJ: web Allen, Kathryn. States Efforts to Maximize Federal Reimbursements Highlight Need for Improved Federal Oversight. Retrieved Sept. 29, 2007 at: http: // 209. 85. 165. 104 /search? q = cache: lW 2 mou 9 p 04 IJ: web Brooks JM, Sorofman B, Doucette W.
Book Assoc Health Serv Res Meet. 1998; 15: 17 - 8. Retrieved Sept. 29, 2007 at: web
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Research essay sample on St Century Care Financing
