A Policy Critique on Medicaid Expansion and Dual Eligible Policy in My Home State.
Introduction
Nowadays, the policymakers are getting involved in debates that will lead to economic growth bearing in mind the minimization of the federal budget deficit and debts. Medicare is a United States of America health insurance program that is meant for the adults aged 65 years and above. The health program also includes people with disabilities. Medicare usually is approximated to be about 15% of the United States’ budget, and recently, the program has increased the shared budget in the country’s Gross Domestic Product. The president of the United States, political parties, stakeholders, and the policymakers made a decision to change Medicare, which will be a significant way of minimizing deficit. Previously, there have been differences among various individuals on the best proposals that help in making the program’s savings achievable. This is the reason why, in the future, there is an anticipation that Medicare will increase at a slow rate related to the private health care sector, which his spending on per capita basis. However, the challenges are given as much attention as possible, which is a favorable implication to the federal spending, country’s health care system, stakeholders, healthcare providers who are within the Medicare health system.
Basic Facts
There are many possible paths that are in policy options than can be considered for the purpose of achieving Medicare in the coming generation. For example, a fundamental approach that can be applied would maintain the current structure but ensuring to make some changes to it, such as the adjustment of the current payment guidelines for the people providing healthcare services and other plans which will be very significant in the increment of the beneficiary costs. In addition, another critical approach that can be applied is making attempts to control the Medicare’s essential purpose in the healthcare environment so that they can be able to come up with a stronger encouragement for promoting value over volume. This is possible if the deployment of the delivery system changes was accelerated, ensuring that the models of the healthcare providers are being developed in that it can increase the management of care for the increased cost, introducing new methods that can oblige the excessive payment and operation (Bapat, 2011, p. 56). Nevertheless, the best way can make changes to the essential structure of Medicare, transforming it form a defined program to being a program that will be providing power to a government contribution for the buying of coverage. Each of these ways will put up with some of the significant savings, including the revenue decisions for the Medicare program in the United States of America. The options that be accommodated in the program include costs for the increase of age eligibility, an increase of tax, and covering the yearly program on expenditure.
According to my home location, the institution’s core value community, the Saint Leo University core value community is motivated to the pledge and strong bonds with the country’s armed forces. My community has gone the extra mile to develop a welcoming environment through the spirit of unity and the mutual respect that is established among the community members. The community members also have developed interdependence that is out of respect leading to the creation of a learning environment that is social, enabling all students to learn and serve the community, which is a great challenge to the students. Nevertheless, there are states that don’t have robust misunderstanding mechanisms that can help in achieving the solutions to the problem. The quality assurance requirements and the current oversight techniques for both Medicare and Medicaid can be not enough for the protection of dual-eligible when profit inducements have the capability to overdo the benefits associated with managed care arrangements, there is need for an investment of many resources so that people can adapt the oversight and nursing systems for Medicare and Medicaid managed care can be able to address all the needs pertaining the vulnerable population in the United States.
Identifying many diverse Stakeholders.
When it comes to the stakeholders, they are Medicare and partners, Medicaid and partners, policymakers, politicians, and society overall. This is due to the fact that during the application of HEDIS measures, to Medicaid and Medicare plans and necessities for Medicaid come across information that is considered to be a significant step going forward. This indicates that the stakeholders hardly start addressing the composite issues that are as a result of the measurement of the elderly and the disabled individuals in society (Grabowski, 2012, p. 228). The HEDIS measures do not deal with the population in the nursing home. For example, the health of seniors made use of SF 36 assessments instrument to estimate the changes that are associated with function over time, and this is not applicable to the nursing homes. Thus, the planned method of administration cannot be relied on getting accurate data from the nursing homes.
The Effects on Key Stakeholders
The fact is that even if the states are not given the opportunity to register in dual-eligible in the Medicaid managed care plans, but the registering of dual-eligible is most likely to increase at a high rate in the Medicare managed care plans. Many of the traditional customer advocate groups that include the people working competently in partnership with the residents of the nursing homes are not adequately trained and prepared to handle the matters pertaining to managed care plans. In addition, individuals also lack the resources needed by the people residing in nursing homes.
Therefore, it can be seen that the capacitated payment methods are to be of great significance, like the tools that are used in the management of care services for dual eligible in the imminent as they are intended for other parts of the Medicare people. A lot of people have a belief that it is possible to uphold and improve the quality, including the responsibility of the care and services; policy makers partnered with the state Medicaid should not overlook the problems of fascination. The state-managed care programs for the dual eligible can fail if there is a lack of consumer protection, having poorly knowledgeable consumer advocates and careless oversight. Therefore, enough funding is significant in strengthening the functions which are dynamic so that there can be an assurance of integrity in the system. This will require a joint decision with the involvement of all the stakeholders.
How to find solutions to conflicts between Medicaid and Medicare managed care
In spite of the problems that have been mentioned above, many states have no alternative but to seek advanced better ways of organizing the Medicaid services with Medicare plans because the registration is increasing whereas the problems with managing the reimbursements for the dual eligible are relentless (Wen et al., 2020 p. 169). Besides, the HCFS is available more often so that it can create solutions to the administrative and the registration conflicts for the dual eligible and ready to establish new initiatives around the dual eligible problems.
Supporting the research comments.
The HCFA’s Medicare policies for the administration of Medicare risk plans do not take into consideration of the unique problems affecting dual-eligible. Most of the issues affecting dual eligibles can be solved by an orderly solution that must involve the joining of Medicare and Medicaid policies at the HCFA level. The solutions also can be obtained, establishing some strategies to address the problems for the dual eligibles into Medicare managed care plans. This could be more efficient in creating a practical approach that can be used to obtain better solutions rather than plan by plan.
Conclusion
There are a lot of changes that are needed in the increase of coverage options to be in particular, those that can increase the capability for the integrated acute and long-term care delivery for the dual eligibles more so those that are staying in the rural areas. For example, in my home region, Medicare plans are very unwilling to operate outside of the city because of high cases of low Medicare payments. This is an indication that the state is still not in a position of expanding its program past the metropolitan areas, and the dual eligibles occupying the remote areas will always be denied the opportunity of this program. This is the reason why the AAPAA has applied reforms that will lead to the attraction of a network that is sufficient for the maintenance entry to such locations. However, the Medicare plans give some of the benefits, but the only disadvantage is that the premium remains relatively high; hence many people cannot be able to afford that. For example, the extra benefits that are provided, such as the prescription drugs that are included in the Medicaid benefit package. There are some of the states which are in a position of realizing considerable cost savings for the Medicaid budget though the encouragement of registrations in dual eligibles in their managed plans.
References
Bapat, S. (2011). Details and Devils: Contraceptive Coverage, Health Reform’s Medicaid Expansion, and the Enduring Importance of State Policy. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.1976688
Grabowski, D. C. (2012). Care Coordination for Dually Eligible Medicare-Medicaid Beneficiaries Under the Affordable Care Act. Journal of Aging & Social Policy, 24(2), 221-232. https://doi.org/10.1080/08959420.2012.659113
Wen, H., Johnston, K. J., & Allen, L. (2020). Medicaid Expansion: The Authors Reply. Health Affairs, 39(1), 169-169. https://doi.org/10.1377/hlthaff.2019.01625