***IT DOESNT MATTER WHAT STATE YOU PICK. Third party payers It is important to b
ID: 414967 • Letter: #
Question
***IT DOESNT MATTER WHAT STATE YOU PICK.
Third party payers
It is important to become familiar with your state’s health and human services programs in order to provide helpful information to your patients. In this discussion, you will gather information about your state’s Medicaid program.
Research and summarize your state’s Medicaid program. You are to select two Medicaid programs that are offered.
Identify:
1) Who is qualified for coverage
2) Financial requirements for coverage,
3) What services are covered and
4) Your opinion about how your Medicaid program is doing.
If it is not meeting the needs of the community, what suggestions would you give your state in order to enhance the program or if it meeting the needs, what can should be done to ensure they continue to do so.
Please include the website address of the Medicaid program you discussed.
Also, please discuss how the "PRICE of Success" can be used when it comes to third party payers to help patients receive resources to meet their needs.
Explanation / Answer
What is Medicaid?
Medicaid is a program initiated by American government for its citizen with low income base; it includes low income adults, children, pregnant women, elder people and people with disabilities. Such program is an initiation of the government to help and support its people. Under this program there are two types of benefits, mandatory and optional, mandatory benefits are mandate for the government to include according to the federal guidelines, like hospital services, physician services, laboratory services, X-ray and others, whereas in optional benefits are not necessary be there in all policies, it includes drugs services, therapy, etc.
There are two main program that are working in the state of Jersey city, they are Medicaid and CHIP
According to this programs the low income peoples are eligible for the program, CHIP is mainly designed for the children’s welfare and is directed to children. The eligibility for both the plans are based on modified adjusted gross income
State Medicaid & CHIP Eligibility1 as of June 1, 2016
State
Children
Pregnant Women
Adults (Medicaid)
Medicaid Ages 0-12
Medicaid Ages 1-52
Medicaid Ages 6-182
Separate CHIP3
Medicaid
CHIP4
Parent/CareTaker5
Expansion to Adults
New Jersey
194%
142%
142%
350%
194%
200%
32%($)
133%
Cost of the plans (Source – Mediciad, as this is a factual point)
States can charge limited premiums and enrollment fees on the following groups of Medicaid enrollees:
States have the option to impose higher, alternative premiums on other groups of enrollees, if their family incomes exceed 150% of the federal poverty level. Certain groups, such as institutionalized individuals and most children, are excluded from higher cost sharing.
Things covered under the plan:
Hospital charges
Nursing facilities
Physician services
Home health services
Laboratory and X-ray
Family planning services
All of the above are mandatory services, the below mentioned list is for optional services
Prescription drugs
Physical therapy
Occupational therapy
Dental services
Eyeglasses
Personal care.
In my opinion medical program is growing its route in the state, as per the recent analysis the program has shown remarkable increase among the citizens and its growing since its launch.
To maintain its pace in the market the program should include more benefits and can make flexible policy program as well.
State Medicaid & CHIP Eligibility1 as of June 1, 2016
State
Children
Pregnant Women
Adults (Medicaid)
Medicaid Ages 0-12
Medicaid Ages 1-52
Medicaid Ages 6-182
Separate CHIP3
Medicaid
CHIP4
Parent/CareTaker5
Expansion to Adults
New Jersey
194%
142%
142%
350%
194%
200%
32%($)
133%
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