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Medicare and Medicaid Research Paper

… Medicare & Medicaid

The two main federal health care programs are Medicare and Medicaid. Both were enacted by Congress in 1965, but they are significantly different. Medicare coverage is granted to all persons over the age of 65 -- younger persons only with specific disabilities or conditions. Medicare eligibility is blanket, and is not income-based. Medicaid, in contrast, is open to Americans of all ages, but is means-tested. Only those whose income falls below the threshold are eligible for Medicaid (Golinker, 2001).

Since being signed into law, Medicare was evolved to meet the needs of a changing society. One of the first changes was the extension of eligibility to people with disabilities and end-stage renal disease (Humana, no date). The program was originally designed only…. [read more]

Medicare and Medicaid These Two Essay

… The certification process involves rigorous writing of examination tests ranging from medical uses of radioactive materials and related physical sciences to demonstrate the required excellence for the practice of nuclear medicine (SNM,2011).

Public health

Public health refers to the science of protecting and improving the health of communities by use preventative medicine, health education, control of communicable diseases, application of sanitary measures, and monitoring of environmental hazards, development of policies and conducting of research by medical practitioners to improve the health of the whole community. (Public health institute, 2011). Public health enlightens the community on how to live healthy lifestyles through personal hygiene and disease control measures.

Ambulatory care

Ambulatory care also known as outpatient care, is kind of medical care which provided to individual…. [read more]

Current Trends in Medicare and Medicaid Research Paper

… Medicare/Medicaid

Current and Future Trends in Medicare and Medicaid

Medicare and Medicaid have been extremely important health and social welfare programs in the United States ever since their inception during Lyndon B. Johnson's presidency. The programs provide access to medical care to many millions of citizens based on issues of age, certain disabilities, and income restrictions, and many parts and entities of the medical industry as well as many individuals depend on the funding provided by these programs either to stay in business or to receive the care they need. For these reasons, understanding the major trends that exist or can be seen coming in terms of individual Medicare and Medicaid beneficiaries and the provision of services to these individuals is vital for reasons of…. [read more]

Medicare and Medicaid Research Paper

… Medicare and Medicaid

Medicare vs. Medicaid

Despite the current resistance to healthcare reform, the United States does possess two public health insurance programs: Medicare and Medicaid. Medicare is the public health insurance program designed to provide the nation's elderly population with health services; Medicaid is designed to provide healthcare services to all Americans living below the poverty line. The primary difference between the two programs is that Medicare is directly financed by the federal government while the federal funds for Medicaid are disbursed to the states, 'matching' the state money used to finance the program.

Medicare is offered to lawful residents of the U.S. age 65 or older who have lived in the U.S. more than five years. Some individuals with certain permanent disabilities and…. [read more]

Medicaid and Medicare Fraud Essay

… The recently passed Affordable Care Act (ACA) attempts to enable a more "rigorous crackdown on illegal activities that plague Medicare, Medicaid, and private insurers" (Iglehart 2010). Some of the most dangerous aspects of fraud are those which involve professional criminals and organized criminal networks according to the FBI (Iglehart 2010). Not all criminals involved in Medicare and Medicaid fraud are criminal 'masterminds,' however. Said one petty criminal, who ran a dummy medical supply company ostensibly providing reimbursable, expensive equipment to Medicare patients: "You're wakin' up every day makin' $20,000, $30,000, $40,000…you're like 'Wow I just won the lottery" (Rosen & Bach 2009:2). His offices served no patients, but merely submitted false claim forms to Medicare.

Greater oversight is clearly needed of these unwieldy government programs.…. [read more]

Medicare and Medicaid Case Study

… With the implementation of the Healthcare Bill, the central changes that are expected to be seen in the Medicare, the Medicaid and the healthcare sector in general at the full implementation will include; prohibiting health insurers from denying coverage or charging based on patients' medical histories or gender, repeal of insurance companies' exemption from anti-trust laws, set minimum standards for qualified health benefit plans, most employers to provide insurance cover for their employees or pay a surtax on the workers' wages up to 8%, an expansion of Medical aid to include more low-income Americans by heightening Medicaid eligibility limits to 150% of the Federal Poverty Level and by covering adults without dependents.

The healthcare also provides for a subsidy to low- and middle-income Americans to…. [read more]

Medicare and Medicaid Term Paper


While many Americans might confuse Medicare and Medicaid for each other, assuming they are just two names for the same program, the differences between the two are clear enough to indicate how distinct and separate these two health programs are. Medicare is a federal insurance program that targets senior citizens of United States and provides them with coverage for many health conditions and treatment. It applies to people over the age of 65 with no regard to their income level. Cost of medical treatment is paid by trust funds that people have invested into. Apart from people over 65, it also serves some exceptions such as younger people with kidney problems or disabilities. It is solely a federal program and is therefore…. [read more]

Centers for Medicare and Medicaid Research Paper

… Centre for Medicare and Medicaid Services (CMS)

The CMS is a federal agency that falls within the United States Department f Health and Human Services (DHHS). It is charged with the administering Medicare and also works with the state governments in providing Medicaid. The Medicare includes involves the federal health insurance for the seniors while the Medicaid basically deals with the needs-based programs. The CMS is also charged with overseeing the Health Insurance Portability and Accountability Act otherwise known as (HIPAA) the Children's Health Insurance Program also known as (CHIP) as well as the Clinical Laboratory Improvement Amendments (CLIA) as the main areas of concentration among several other areas of commitments (Techtarget, 2011).

It is also worth noting that CMS has also been charged with…. [read more]

Medicaid for a Long-Term Care Nursing Home Thesis

… medicaid for Long-Term Care


Long-term care is described as "a variety of services that includes medical and non-medical care to people who have a chronic illness or disability." (, 2009) Medicare is stated to have "contributed substantially to the well-being of the nation's elderly and people with disabilities. Over the past four decades, Medicare has helped to improve the health of its beneficiaries and assure their financial well-being. But Medicare also has significant gaps. Key among them is the fact that Medicare does not pay for long-term care. Medicare pays for nursing home and home care services, but Medicare is designed to pay for the treatment of acute, short-term illness. These services are available only to beneficiaries who need skilled nursing care or…. [read more]

Medicare Reform Term Paper

… Medicare

Combine Parts a and B

One of the ways that experts propose to reform Medicare is through the combination of parts a and b of the Medicare system. According to the National Commission on the reformation of Medicare, parts A and B. have become problematic because of the way that medical care has changed over the years (Building Better Medicare...1999). The commission contends that combining parts A and B. will provide Medicare recipients with several different benefits (Building Better Medicare...1999). The benefits of this reform include improvements in the utilization of medical care and lowered costs for many Medicare recipients (Building Better Medicare...1999).

The commission asserts that the improvements in the utilization of available healthcare services will increase under this reform because it will…. [read more]

Medicare and Medicaid an Important Term Paper

… Income is calculated including wages, interest, social security, dividends, pensions, veterans' benefits, and spousal income (Pennsylvania Department of Public Welfare, 2012). Certain types of income are not included in the determination of eligibility. These include temporary assistance benefits, supplemental security income, foster care payments, and housing and utility subsidies to name a few (Pennsylvania Department of Public Welfare, 2012).

Resource limits are also used in the determination of eligibility for Medicaid (Pennsylvania Department of Public Welfare, 2012). Resources counted include cash, savings and checking accounts, stocks and bonds, as well as life insurance among others (Pennsylvania Department of Public Welfare, 2012). Certain resources such as one's home and one motor vehicle are not included in the determination of eligibility.

CHIP, the Children's Health Insurance Program,…. [read more]

Medicare, SCHIP, and PPACA Essay

… As USDA (2013) further points out, states could elect to either "expand their Medicaid programs, design new child health insurance programs, or a combination of both."

What Government Agency Manages SCHIP? (Local; State; Federal)?

Although the federal government was responsible for the creation of SCHIP, the program is managed and/or operated by individual state governments. Indeed, the workings of each SCHIP is largely dependent on the state. It is however important to note that there are federal laws that each state has to adhere to in the management of the program. For instance, states are required by the law to provide an irreducible minimum set of benefits.

If You Were the HHS Secretary, What Recommendations Would You Make to the PPACA?

Although the relevance of…. [read more]

Medicaid Term Paper

… It seems evident that opponents of the plan are concerned with the type of healthcare that recipients will receive in Medicaid is outsourced to HMO's. Will the problems that have plagued HMO's in the past also be present in the future? How will this affect the working poor who have no other alternatives?

Hall & Sloan 2002 also argue that there is a high turnover rate of HMO members. The authors assert that such a high turnover rate makes it extremely difficult to track the progress of patients and to assess the quality of care that they have received. The authors explain 'the quality of information systems may be adversely affected by member turnover. The data for the information system comes in part from patient…. [read more]

Medicaid Health Care Assistance Essay

… The reason why is because of the problems that federal government is facing with their run away budget deficits.

Does the organization implement financial accountability measures to ensure that funds are being used properly?

No. Since its inception, Medicaid has not been held to various standards that will ensure transparency and accountability. Evidence of this can be seen with study that was conducted by the General Accounting Office. They found that out of every $10 that is spent on providing health care services, $1 is wasted in fraud. This despite the fact, that the program has undergone various reforms to try to improve transparency. However, the overall amounts of abuse continue in spite of various changes to the program and increased amounts of accountability. (Robertson,…. [read more]

Evolution of Medicare and Medicaid Services Term Paper

… Evolution of Medicare and Medicaid


The concept of a national insurance was a preoccupation from 1900 to 1965 (Berkowitz 2005). State management of health care finance programs, consumer choice of health care plan and collaboration between the public and private sectors naturally followed. They also led to the passage of Medicare in 1965. The concept of merging Republican and Democratic concepts of health insurance led to the development of Medicare and Medicaid's 40-year history. U.S. President Lyndon B. Johnson signed the Social Security Amendment of 1965 into law in Missouri. It was an attempt at continuing and realizing the common concept relished by former President Harry S. Truman and previous Presidents. By then, it had undergone major transformations, particularly in the aspects…. [read more]

Health Policies Medicare Research Paper

… In conclusion, the United States is not the only Western nation that is going through this challenge; however we are very probable in the worst location in handling the situation, because of our traditional unusual medical ethos and the high public prospects it has shaped. Somewhat than despair, nevertheless, we need to really start viewing the issues being brought here in medicare as a challenge. It is important that we are using the same inventiveness that has provided us the New Deal and style an essentially more reasonable and maintainable health-care organization-one that talks to the moral needs at all heights. If America fails to accept a widened vision along these positions, the viewpoint for health care in America's long-term upcoming is threatening certainly.

Work…. [read more]

Financing Structuring Health Care Essay

… For the patients this will translate into lower premiums and better coverage. The drawbacks of this kind of plan include: less choices for patients. This is because the health care provider and insurance carriers can have restrictions on certain kinds of doctors and treatments. In the event that someone is very ill, these kind of delays could make their underlying condition worse (leading to a reduction in the quality of care). ("Basic Types of Managed Care," 2009)

A PPO is providing patients with better choices and more services. For health care providers and insurance companies, this is assisting them to be able to streamline costs. As they can use their network of physicians to find someone that can provide the services patients require at an…. [read more]

Senate Government Affairs Subcommittee Fraud and Abuse in Medicare Prescription Drug Program Movie Review

… Medicare Fraud, Abuse and Waste

Senate Government Affairs Committee: Medicare Prescription Drug Program

This memorandum is written with the purpose of exploring the Medicare prescription drug program that was enacted in 2003 under the Medicare Modernization Act. While the program has seen great success, with 85% of its participants believing that it is a good program, its complexity has made it vulnerable to fraud, waste, and abuse. There have been claims that appropriate antifraud safeguards will be implemented to guard against these issues but the critical and basic antifraud safeguards are not yet in place despite the fact that this program has entered into its fifth year of service.

It is imperative that plans to address waste, fraud, and abuse come to fruition and are…. [read more]

Medicare and Medicaid Fraud Term Paper

… Medicaid and Medicare Fraud













In the past few years, an increasing amount of fraudulent claims have been detected in the Medicare and Medicaid programs, raising concerns among taxpayers, the elderly, government agencies and police authorities alike. One of the most significant problems with this activity is that both programs are already facing the depletion of available funds, and in much need of reforms. After working their entire lives, elderly people look forward to many relaxing years…. [read more]

Changes in Medicare and Medicaid Research Paper

… ¶ … Medicare and Medicaid

Recent changes in Medicare and Medicaid: An overview

The most notable effect of the 2010 Healthcare Reform Law may be its expansion of Medicaid coverage to a greater percentage of the working poor. About 45 million people under the age of 65 lack health insurance, 2/3rds of whom have incomes 200% below that of the federal poverty level (FAQ 2010, the New York Times). As well as making it easier to obtain Medicaid coverage, by 2014, the Law would increase the share of federal spending for the states for covering newly eligible people. "The federal government would pay all of the costs until 2016, 95% in 2017, 94% in 2018, 93% in 2019 and 90% thereafter. Some states that already…. [read more]

Medicare Prescription Drug Benefits Term Paper

… Medicare Prescription Drug Benefits

What is the legislation/policy that will be analyzed in this paper?

The principal legislation that is being analyzed is about Medicare and the reach of the service to the intended groups, its pros and cons. The "Medicare Prescription Drug Improvement Act' of 2003 and the consequent Sections 1102, 1106, 1860D -- 1 through 1860D -- 42, and 1871 of the Social Security Act (42 U.S.C. 1302, 1306, 1395w -- 101 through 1395w -- 152, and 1395hh have to be discussed with the issue regarding the use of the act and Medicare allowances for prescription drugs." (ECFR, 2011) The 'Part 423 -- Voluntary Medicare Prescription Drug Benefit of the Federal Regulations' dealing with the 'Prescription Drug Benefits' is also a part of…. [read more]

State Public Health Insurance Programs Research Paper

… Medicaid

State Public Health Insurance Programs

Medicaid is the United States

Millions of people in the United States today are uninsured, despite the fact that the U.S. government officially sponsors a program called Medicaid designed to help the poorest of poor Americans obtain healthcare. Theoretically, everyone whose income falls below a designated limit should be able to rely upon Medicaid for basic care. But given the realities of economic and political life in the U.S., this is not always the case. 16.3% of all individuals (about 44.3 million) had no insurance coverage in 1998 and that number has ballooned since the current recession (Jacobs & Rapoport 2002: 315). Individuals with incomes above the poverty threshold working multiple jobs that do not offer benefits to part-time…. [read more]

Medicare Reform for the Elderly Term Paper

… Medicare Reform for the Elderly

The Medicare reform has been, throughout the last decade, a political and electoral tool used by both the Democrats and the Republicans, as well as a necessity that needs to be implemented in order to assure health security for a large number of the American citizens, including the elderly population.

At this point, the Medicare reform returned for debate in Congress, despite the fact that the approach of the presidential elections would have likely made this as subject to be discussed at a later time rather than now (Medicare reform returns to Congress). However, the problem with Medicare could no longer wait, as budgetary pressures meant that the addition of an extra drug benefit, obviously beneficial for the elderly, was…. [read more]

Medicare Thesis

… Healthcare

Medicare Part D

Medicare began offering outpatient prescription drug benefits under their Medicare part D program in 2006. All Medicare beneficiaries are eligible for this program and as of January 2007 nearly 24 million people had enrolled in some form of the program. Finding ways to control and pay for drug costs is an ever alarming problem for both Medicare and consumers alike. Medicare Part D uses complex and high levels of cost sharing to help defray the high drug costs that face seniors today (Hsu, Fung, Price, Huang, Brand, PharmD, Fireman, and Newhouse, 2008).

Medicare prescription drug coverage was introduced to help people on Medicare with the cost of their prescriptions. Anyone with Medicare is eligible to enroll in a prescription drug plan…. [read more]

Medicare Was Initiated in 1966 Essay

… Government should play an important role in providing healthcare because insurance companies charge a very high premium which not everyone can afford. But healthcare is needed by everyone especially children and the elderly. Government must therefore step in to provide adequate healthcare to those who need it the most.

With government providing healthcare to certain sections, the insurance industry may face some challenges but its survival is definitely not at stake because there is a very large percentage of population that is using the services of the insurance industry by utilizing employer provided plans or buying individual plans. We must understand that not everyone meets the eligibility requirements for government sponsored healthcare insurance and hence those who are ineligible still need insurance and they always…. [read more]

Medicare and Medicaid: Government-Sponsored Programs Term Paper

… However, current discussion surrounds the transformation of Medicaid into a block grant program, which would result in states providing additional funding to Medicaid programs or the elimination of certain services (Ettner 252). In other words, access to Medicaid programs may be threatened by governmental influence in the coming years.

The Importance of Medicare and Medicaid to the Elderly Population

Based upon the previous discussion, it is evident that millions of American elderly and disadvantaged persons depend on government-sponsored Medicare and Medicaid programs in order to obtain necessary health care services. Depending upon age and financial situation, a person may qualify for one or both programs. Both offerings provide patients with a number of quality services and relatively simple access to healthcare providers results in extremely…. [read more]

Medicare: Healthcare to Protect Term Paper

… Kaiser Commission report on the future of Medicaid deals with the problem of Medicaid spending. There was rapid growth in Medicaid, especially between the years of 1988 and 1992. Since 1992, the growth rate for Medicaid has gone down, but there are still a great many individuals needing services. Even though the growth rate has slowed, there are still important lessons to be learned from 1988 to 1992's figures. Because of the growth explosion during those years, Medicaid decided to work with managed care and try a few other avenues that might help them have more money to help more people. Basically, it made them aware that there was a problem with the current system and they could not deal with the number of individuals…. [read more]

Healthcare Finance Term Paper

… Medicare Diabetes Prevention Act of 2013

Healthcare Finance

Senator Franken (D-MN) introduced a bill (S. 452) into the Senate on March 5, 2013 that provides a mechanism through which Medicare and Medicaid recipients, who are at risk for developing diabetes, can receive preventive care services (Medicare Diabetes Prevention Act, 2013; Civic Impulse, 2013). The Senate version of the Medicare Diabetes Prevention Act of 2013 (MDPA) has 14 cosponsors, all Democrats, while the House version has 17 Democrat sponsors. This bill is quite detailed and lengthier than previous bills intended to state a policy position, which suggests there may be considerable interest in moving this bill through the respective committees for a floor vote.

MDPA Details

The main provision in the MDPA gives authority to the…. [read more]

Abuse and Fraud a Joint Venture A-Level Coursework

… ¶ … Abuse and Fraud

A joint venture is proposed between Sundown Community Hospital and Central Park Medical Group, with a large Medicare patient base. This proposed arrangement would involve careful review of the safe harbor provisions of the Medicaid Anti-Kickback Statutes and the exceptions to the Stark Statute. In addition, attention must be paid to carefully and clearly wording the contract to enunciate that the parties are not entering the agreement to induce referrals or solicit remuneration in exchange for Medicare/Medicaid referrals.

The board of directors of Sundown Community Hospital has directed me, as head administrator, to enter into a joint venture with Central Park Medical Group, a physician group practice with patient population (60%) consisting of Medicare patients and the board has authorized…. [read more]

Health Care System Evolution Organizational Analysis and Continuum Essay

… Health Care System Evolution, Organizational Analysis and Continuum of Care

The objective of this work is to examine the evolution of the health care system and how health care delivery systems have influenced the current health care system in regards to Medicare/Medicaid. This work will conduct an organizational analysis for the Centers for Disease Control and Prevention including the stakeholders impacted by this component and how they are affected. Finally, this work will examine the continuum of care for Diabetes care program in the United States including the services provided and how these fit in the continuum of care. This work will examine how the equity contributes or fails to contribute to the overall management of healthcare resources and will examine the future trends of…. [read more]

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