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Medicaid and Medicare.

Medicaid and Medicare.

            Medicaid is a program that is jointly funded by the State and Federal government. It provides health care coverage to children, pregnant women, disabled persons, and low-income adults. Primary services that Medicaid funds are hospitals, physicians, and long-term care. Other additional coverages include medical equipment, transportation, family planning, drugs, and laboratory tests. Medicaid is commonly called the Medical Assistance Program in the State of Illinois.

Various specifications must be met before a person is eligible for Illinois Medicaid. A person must be a resident of the State of Illinois. Furthermore, the person must be a United States citizen, permanent resident, or legal alien (Lawndale et al., 2018). The person must need insurance or health care assistance. The person’s income must be characterized as either low or very low income (Candon et al., 2018). Furthermore, the person must be in one of the prescribed populations. The prescribed population: pregnant women, people with a disability or whose family member has a disability, people responsible for a child aged 18 years and below, and persons aged 65 years and above.

All eligible persons must have an annual household income below specific amounts based on the household size. The annual household income is calculated before taxes. For a household of one, the annual income must be less than $ 17,609 (Lawndale et al., 2018). The annual income must be below $23,792 for a household size of 2. The annual income must be below $29,974 for a household size of 3. The income must be below $36,156 for a household size of 4 (Lawndale et al., 2018). It must be less than $42,339 for a household size of 5. The annual income must be below $48,521, $54,704, and $60,886 for a household size of 6, 7, and 8, respectively. For households with more than 8 people, $6,182 is added per person.

The State of Illinois offers long-term Medicaid programs for residents aged 65 years and above. The programs have different eligibility requirements based on the marital status of the person. The three programs are Institutional or Nursing Home Medicaid, Home and Community-Based Services, and Regular Medicaid (Sarah, 2021). For both spouses to be eligible for the three programs, their monthly income limit must be $1,437, and the asset limit must be $3,000. For an unmarried person to be eligible for the three programs, his or her monthly income limit must be $1,063 and asset limit 2,000 (Sarah, 2021). One spouse is eligible for Regular Medicaid if his or her monthly income limit is $1,437 and the asset limit is $3,000. The eligibility criteria of one spouse for the other two programs are a monthly income limit of $1,063, an asset limit of $2,000 for the applicant, and $109,560 for the nonapplicant.

The Children’s Health Insurance Program of Illinois is called Illinois All Kids. Illinois became the first State to offer universal coverage to children when the All-Kids Program was established in 2005 (Castro, 2019). The insurance program pays for premiums of employer and private health insurance plans. It is available free of charge or at low costs. Premium payments are made based on the income and size of the family. It uses the Children’s Health Insurance Program, Medicaid, and State funds to cover all children aged below 18 years.

The Federal and State governments fund all Kids Share and Premium Level 1. The State funds Premium Level 2 and All Kids Rebate. The Medicaid portion of Illinois’ children’s health care program is All Kids Assist (Castro, 2019). Illinois initiated an enrolment effort approximately six months before the implementation of the All Kids Program. Marketing firms, community-based organizations, insurance agents, and medical providers all participated in the enrolment of children for the All Kids Program.

Various specifications must be met for a person to be eligible for Illinois All Kids. The person must be a resident of the State of Illinois. The person must be a United States of America citizen, a national, or a non-citizen who is legally permitted in the United States (Castro, 2019). The person must be aged 18 years and below. A primary caregiver with children aged 18 years and below is also eligible. The person must be uninsured and ineligible for Medicaid.

The annual household income must be below specific amounts for a person to be eligible. The annual household income is calculated before taxes are deducted. The annual income must be below $17,609 for a household size of 1 (Castro, 2019). It must be below $23,792 for a household size of 2. The income must be below $29,974 for a household size of 3. It must be below $36,156, $42,339, and $48,521 for a household size of 4, 5, and 6, respectively. Households sizes of 7 and 8 must have an annual income of less than $54,704 and $60,886, respectively (Castro, 2019). An additional $6,182 is added per person for households with more than eight people.

The Illinois All Kids covers a variety of services. It pays for doctor visits, hospital visits, dental care, and vision care. It also covers prescription drugs, medical equipment such as asthma inhalers and eyeglasses, and mental health services (Castro, 2019). It has two programs that cater to the needs of pregnant women. The programs are Medicaid Presumptive Eligibility and Moms and Babies. The Medicaid Presumptive Eligibility provides immediate, temporary outpatient health care coverage for pregnant women (Degife et al., 2021). It covers all prescription drugs and other prenatal services before formal medical application. Moms and Babies provide health care coverage for pregnant women for 60 days after the baby is born. It covers both Inpatient and Outpatient services, including delivery. It also covers dental, vision, lab tests, immunizations, and newborn checkups.

Medicaid is a program funded by the State and Federal governments. The different States have their specifications of eligible people for their Medicaid Programs. Children’s Health Insurance Programs are unique to specific states. Illinois was the first State to offer universal health coverage for children through the All Kids Program.

References.

Candon, M., Zuckerman, S., Wissoker, D., Saloner, B., Kenney, G. M., Rhodes, K., & Polsky, D. (2018). Declining Medicaid fees and primary care appointment availability for new Medicaid patients. JAMA Internal Medicine, 178(1), 145–146. https://doi.org/10.1001/jamainternmed.2017.6302

Castro, B. R. (2019). It’s Time for All Kids Health Coverage. April.

Degife E, Forman H, Rosenbaum S. (2021). Expanding Presumptive Eligibility as a Key Part of Medicaid Reform. JAMA Health Forum. Published online February 5, 2021. doi:10.1001/jamahealthforum.2021.0017

Lawndale, T., Health, C., Healthcare, A. B., Community, T., Healthcare, B., Idph, B., Icoy, K., Ipha, K., Uic-check, K., Avesis, M., & Gregory, K. K. (2018). Illinois Department of Healthcare and Family Services Medicaid Advisory Committee November 2, 2018, Illinois Department of Healthcare and Family Services Medicaid Advisory Committee November 2, 2018.

Sarah, Thomas. (2021)Assessing the Clinical Accuracy of the Illinois Early Intervention Eligibility Criteria. (2021). May, 1–36.

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Question 


Medicaid and Medicare.

Module 3 – SLP
Use the module required and optional materials and your own research to respond to the following questions:

  1. Locate the Web site for your state’s health department.
  2. Summarize eligibility criteria for the Medicaid program in your state of residence.
  3. Describe your state’s Children’s Health Insurance Program (S-CHIP). What is it called? Who is eligible? What services are covered?

    Medicaid and Medicare.

    Medicaid and Medicare.

Length: Submit a 3-page paper, not including the cover page and the reference list.

Reference:

Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2017). Early impacts of the Affordable Care Act on health insurance coverage in Medicaid expansion and non‐expansion states. Journal of Policy Analysis and Management, 36(1), 178-210. doi:10.1002/pam.21961

Decarolis, F., & Guglielmo, A. (2017). Insurers’ response to selection risk: Evidence from Medicare enrollment reforms. Journal of Health Economics, 56, 383.

Jaffe, S. (2018). Trump administration’s new direction for Medicaid. The Lancet, 391(10126), 1135. doi:10.1016/S0140-6736(18)30681-0

Lee, D., & Jackson, M. (2017). The simultaneous effects of socioeconomic disadvantage and child health on children’s cognitive development. Demography, 54(5), 1845-1871.

Patel, K. K., & Ginsburg, P. B. (2017). Physician payment reform-progress to date. The New England Journal of Medicine, 377(3), 285.

Rollins, J. (2018). Shame on them. Pediatric Nursing, 44(1), 6.

Venkataramani, M., Pollack, C.E., & Roberts, E.T. (2017, November). Spillover effects of adult Medicaid expansions on children’s use of preventive services. Pediatrics, 140(6), 1-8. Retrieved from http://pediatrics.aappublications.org/content/early/2017/11/09/peds.2017-0953

Wang, J., & Trivedi, A. N. (2017). Enrollment in California’s Medicaid program after the Affordable Care Act expansion. American Journal of Public Health, 107(11), 1757-1759. doi:10.2105/AJPH.2017.304031

Ward, L. (2017). Improving outcomes by centralizing data for young patients in Houston. Modern Healthcare, 47(8), 20.

Optional Reading

Centers for Medicare & Medicaid Services (2018). Children’s Health Insurance Program (CHIP). Accessed from https://www.medicaid.gov/chip/index.html

Centers for Medicare & Medicaid Services (2018). Medicaid. Retrieved from https://www.medicaid.gov/medicaid/index.html

Centers for Medicare & Medicaid Services (2018). Medicare program – general information. Retrieved from https://www.cms.gov/Medicare/Medicare-General-Information/MedicareGenInfo/index.html

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