Posted: February 5th, 2023

Policy/Regulation Fact Sheet for Medicaid

Policy/Regulation Fact Sheet

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Policy/Regulation Fact Sheet
• The selected policy is Medicaid. The purpose of the policy is to improve access to healthcare services for people with limited resources. The policy provides benefits that are not covered in Medicare (Cawley et al., 2018). Some of the people who benefit from the policy include low-income families, the elderly, people with disabilities, pregnant women, and children (Cawley et al., 2018). The focus is to enhance the health of millions of Americans previously affected by the high cost of care.
• The policy will affect the system implementation since healthcare workers will need to enhance their programs to cater to the people with limited resources. One of the impacts is to enhance the data storage to easily identify the people with genuine needs (Andrews et al., 2018). Data collection and integration with other healthcare hospitals will be essential to avoid the errors that may occur thus denying people quality health.
• The policy will improve the quality of health among people with low income. It will help them to avoid adverse outcomes of chronic diseases that may shorten their lifespan or undermine their daily activities (Andrews et al., 2018). The policy will improve prevention mechanisms that will improve the quality of health. It will establish fairness and equity in the healthcare sector since everyone, wealthy or poor, will receive quality care (Cawley et al., 2018).
• One of the policies that should be in place is electronic health records. The records are important to identify the medical history of patients and their income (Marino et al., 2018). The data should show that a patient is genuine and requires assistance to access medical care. Security of the data is another issue to avoid hackers which can manipulate the integrity of the data (Marino et al., 2018). Quality data will be effective in effective decision making and allocation of funds by state and federal government.

References
Andrews, C. M., Grogan, C. M., Smith, B. T., Abraham, A. J., Pollack, H. A., Humphreys, K., … & Friedmann, P. D. (2018). Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act. Health Affairs, 37(8), 1216-1222.
Cawley, J., Soni, A., & Simon, K. (2018). Third year of survey data shows continuing benefits of Medicaid expansions for low-income childless adults in the US. Journal of General Internal Medicine, 33(9), 1495-1497.
Marino, M., Angier, H., Valenzuela, S., Hoopes, M., Killerby, M., Blackburn, B., … & DeVoe, J. E. (2018). Medicaid coverage accuracy in electronic health records. Preventive Medicine Reports, 11, 297-304.
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Study Notes
Policy/Regulation Fact Sheet for Medicaid
Medicaid is a joint federal-state health insurance program that provides coverage to low-income individuals, families, and children. It is the largest source of funding for medical and health-related services for people with limited income and resources.
Here are some key points about Medicaid policy and regulations:
Eligibility: To be eligible for Medicaid, an individual must meet certain income, resource, and residency requirements, as determined by the state in which they live. Some states have expanded Medicaid under the Affordable Care Act (ACA), allowing for more individuals to be eligible for coverage.
Benefits: Medicaid provides a wide range of benefits, including doctor visits, hospital care, laboratory and x-ray services, prescription drugs, and more. The specific benefits covered vary by state.
Financing: Medicaid is funded by both the federal government and the states, with the federal government matching a portion of state spending on the program.
Waivers: States can apply for Medicaid waivers, which allow them to make changes to the program to better serve their populations. Some of these changes may include adjusting eligibility criteria, expanding benefits, or implementing innovative delivery systems.
Managed Care: Many states use managed care organizations (MCOs) to provide Medicaid services. MCOs are responsible for coordinating and managing all aspects of an individual’s care.
Quality Control: Medicaid is subject to federal regulations and oversight to ensure that the program is operated in a manner that is consistent with federal law and that provides high-quality care to eligible individuals.
Cost-Sharing: In some cases, Medicaid requires individuals to pay a portion of their medical expenses, known as cost-sharing. The amount of cost-sharing required varies by state and by individual.
Renewal and Re-determination: Medicaid eligibility must be renewed periodically, and individuals must re-determine their eligibility to continue receiving benefits.
Medicaid is a complex program with a wide range of policies and regulations that determine how the program operates, who is eligible, and what benefits are provided. It is important for individuals to understand these policies and regulations to ensure that they are able to take advantage of the benefits available through the program.