Module 3 – Home

MEDICAID ELIGIBILITY AND FINANCING

Modular Learning Outcomes

Upon successful completion of this module, the student will be able to satisfy the following outcomes:

• Case
  • Examine Medicaid eligibility, operation, and financing, including recent changes to the income determination methodology.
  • Compare and contrast average Medicaid and private insurance reimbursement levels.
• SLP
  • Examine the operations of single-payer systems outside of the United States.
  • Compile both benefits and drawbacks of single-payer systems, examining what works and does not work in other countries compared to the United States.
• Discussion
  • Share and discuss examples of how single-payer systems are successful and unsuccessful outside of the United States.

Module Overview

Medicaid is a joint federal-state program that provides health insurance coverage to low-income individuals in particular eligibility categories, persons with certain diagnosed disabilities, pregnant women, parents and/or caretakers of dependent children in their homes, and also children to age eighteen (under the State Children’s Health Insurance/SCHIP programs). The economics behind the Medicaid program have been extensively studied, especially the potential poverty-reducing effects in the context of other public health insurance programs. As the largest single-payer for long-term care in the United States, Medicaid deserves study of its economics, utilizations, out-of-pocket costs, and health outcomes.

The Module 3 Case and SLP challenge you to learn about the financing and relevant statistical data of this single-payer system, and its attempts to increase access to care for the populations it serves. Would a single-payer health insurance system ever work in the United States? Why or why not? Let’s take a look at the various economic and service-related factors involved.

Module 3 – Background

MEDICAID ELIGIBILITY AND FINANCING

Required Reading/Viewing

Dillender, M. (2017). Medicaid, family spending, and the financial implications of crowd-out. Journal of Health Economics. Vol. 53, 1-16. Available in the Trident Online Library.

Kaiser Family Foundation. (2019). Ten things to know about Medicaid: Setting the facts straight. Available at  https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight/

Perez, K. (2017). The fiscal realities of a single-payer healthcare system. Healthcare Financial Management, 71(11), 108-109. Available in the Trident Online Library.

Petrou, P., Samoutis, G., & Lionis, C. (2018). Single-payer or a multipayer system: A systematic literature review. Public Health, Vol. 163, 141-152. Available in the Trident Online Library.

Robert Wood Johnson Foundation. (2019). Medicaid: The basics. Available at https://www.rwjf.org/en/library/research/2019/02/medicaid-the-basics.html.

Yu, J., & Zhang, Y. (2017). Comparison of single-payer and non single-payer health care systems: A study of health administration efficiency. Modern Economy, 8(6), 816-833. Available in the Trident Online Library.

Module 3 – Case

MEDICAID ELIGIBILITY AND FINANCING

Assignment Overview

Over 72 million Americans are currently covered by Medicaid (along with coverage by the SCHIP programs), which makes Medicaid the single-largest source of health insurance coverage in the United States. Depending on income, children, pregnant women, parents, senior citizens, and individuals with certain disabilities are able to access the health care system for needed services. In this Case Assignment, benefits, eligibility, financing, and reimbursement levels will be examined – including how the Patient Protection and Affordable Care Act impacted the program. How do the economics of Medicare reimbursement levels vs. private insurance reimbursement levels affect health care systems and providers?

Case Assignment

Using the information in the required readings, as well as some additional research in peer-reviewed sources, complete your Case assignment by answering the following:

1. Examine the benefits and eligibility of the Medicaid program. Who can be covered, and what are the specific income restrictions when qualifying via financial status? How did the Patient Protection and Affordable Care Act change the income determination methodology?
2. Describe how the Medicaid program is financed. How much do the individual states (including your home state) contribute?
3. Determine how the average Medicaid reimbursement level specifically compares to the average reimbursement for private insurance. How can these reimbursement levels affect the bottom line at your facility?

Assignment Expectations

1. Conduct additional research to gather sufficient information to support your analysis.
2. Provide a response of 3-5 pages, not including title page and references
3. There are multiple required items to be addressed herein; please use subheadings to show where you are responding to each required item and to ensure that none are omitted.
4. Support your paper with peer-reviewed articles, with at least 3 references. Use the following link for additional information on how to recognize peer-reviewed journals:
   Angelo State University Library. (n.d.). Library Guides: How to recognize peer-reviewed (refereed) journals. Retrieved from https://www.angelo.edu/services/library/handouts/peerrev.php
5. You may use the following source to assist in formatting your assignment:
   Purdue Online Writing Lab. (n.d.). General APA guidelines. Retrieved from https://owl.english.purdue.edu/owl/resource/560/01/.
6. For additional information on reliability of sources, review the following source:
   Georgetown University Library. (n.d.). Evaluating internet resources. Retrieved from https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content

Module 3 – SLP

MEDICAID ELIGIBILITY AND FINANCING

The United States is one of the remaining countries in the developed world that does not have a single-payer health care insurance system in place. With the future of the Patient Protection and Affordable Care Act being uncertain, we hear continuing discussion as to whether the United States could (and/or should) adopt a single-payer system. Could a single-payer system be possible, even though it is forecast to cost trillions of dollars? How would it affect health care costs, coverage networks, types of covered vs. noncovered services, patient waiting times (for appointments, testing, procedures, and surgeries), coinsurances, and (finally) our taxes? Would currently working employees be required to give up their existing coverage for what will be provided under the single-payer system?

Once you have read the assigned background readings, as well as completed some peer-reviewed research of your own, address the following:

1. Describe an example of how a single-payer system (such as ‘Medicare For All’, as just one example) works in the United States.
2. Looking at examples of other countries with a single-payer system, what are the specific benefits of having such a single-payer system? Include at least three specific benefits, citing credible sources for your facts.
3. Looking at examples of other countries with a single-payer system, what are the specific drawbacks of having such a single-payer system? Include at least three specific drawbacks, citing credible sources for your facts.
4. Are you in favor of a single-payer system in the United States? Justify your position for or against this with credible sources.

SLP Assignment Expectations

1. Conduct additional research to gather sufficient information to support your analysis.
2. Provide a response of 3-5 pages, not including title page and references.
3. There are multiple required items to be addressed herein; please use subheadings to show where you are responding to each required item and to ensure that none are omitted.
4. Support your paper with peer-reviewed articles, with at least 3 references. Use the following link for additional information on how to recognize peer-reviewed journals:
   Angelo State University Library. (n.d.). Library Guides: How to recognize peer-reviewed (refereed) journals. Retrieved from https://www.angelo.edu/services/library/handouts/peerrev.php
5. You may use the following source to assist in formatting your assignment:
   Purdue Online Writing Lab. (n.d.). General APA guidelines. Retrieved from https://owl.english.purdue.edu/owl/resource/560/01/.
6. For additional information on reliability of sources, review the following source:
   Georgetown University Library. (n.d.). Evaluating internet resources. Retrieved from https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content

Module 3 – Outcomes

MEDICAID ELIGIBILITY AND FINANCING

• Module
  • Examine Medicaid eligibility and financing, including recent changes to the income determination methodology.
  • Compare and contrast average Medicaid and private insurance reimbursement levels.
  • Examine the operations of single-payer systems outside of the United States.
  • Compile both benefits and drawbacks of single-payer systems, examining what works and does not work in other countries compared to the United States.
  • Share and discuss examples of how single-payer systems are successful and unsuccessful outside of the United States.
• Case
  • Examine Medicaid eligibility and financing, including recent changes to the income determination methodology.
  • Compare and contrast average Medicaid and private insurance reimbursement levels.
• SLP
  • Examine the operations of single-payer systems outside of the United States.
  • Compile both benefits and drawbacks of single-payer systems, examining what works and does not work in other countries compared to the United States.
• Discussion
  • Share and discuss examples of how single-payer systems are successful and unsuccessful outside of the United States.

Module 3 Discussion: Single-payer Systems – What Works (and What Doesn’t Work) Outside of the United States

 

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After researching a country (outside of the United States) with a single-payer health care system, share a summary of information regarding how the single-payer system works in that country of your choice. Include both the specific benefits and specific drawbacks of the system. Look at the discussion board to see what countries’ information has already been posted, and choose a country that is not posted yet to ensure a wide variety of examples for us to review. Your summary should be a concise 200-word response, using peer-reviewed sources to find facts to support your points.

Your posts will be graded on how well they meet the Discussion Requirements posted in the “Before You Begin” section”. Please review this section, as well as the discussion scoring rubric.