The purpose of this paper is to inform the reader about the demand for Medicaid long-term. With the aging population accelerating, the demand for long-term care is needed. “66% of people 65 and older can’t pay for even a year in a nursing home” (Freundlich, 2014). The cost to stay in a nursing home or assisted living is outrageous. As we age this is something we all need to look into. Medicaid is the largest source for funding in nursing homes. “Medicaid is the nation’s primary payer of long-term services and supports (LTSS), including nursing home care and home- and community-based services to allow individuals to age in their homes”(Medicaid, 2015) . Medicaid supports those people with disabilities who live in a nursing home, who need assistance with activities of daily living (ADL); such as bathing, dressing, eating and getting around. Families, individuals, children, pregnant women, people with a mental or physical disability and individuals age 65 and older may qualify for Medicaid services. To be eligible for Medicaid you must meet certain requirements. This paper will lead to a range of key issues Medicaid faces.
In order to qualify for Medicaid there are certain requirements that must be met in order to qualify; such as proof of U.S. citizenship and financial requirements. Medicaid gets funded to every state by the federal government. Medicaid rules vary considerably state-by-state. The Center for Medicare & Medicaid Services (CMS) is responsible for overseeing each state. Each state is responsible for reporting their day-to-day activities, and submitting information to CMS for approval. Rouse states, “The Center for Medicare & Medicaid Services (CMS) is part of the U.S. Department of Health and Human Services. CMS oversees many federal healthcare programs, including those that involve health information technology such as the meaningful use incentive program for electronic health records (EHR)” (Rouse, n.d). It is important to understand how Medicaid services work, and how CMS takes a big role in transpiring data.
Long-term care is changing and it will impact many Americans. As our population ages, the demand for long-term care services is increasing. There is a demand for services and many times people enrolled in Medicaid do not get the services they request. Some of the key issues Medicaid faces are beneficiaries struggling to get services approved; lack of transparency in budget spending; and improving program integrity. Robin Rudowitz and Rachel Garfield (2018) state, “access to certain providers, especially psychiatrists, some specialists, and dentists, are ongoing challenges in Medicaid and often in the health system more broadly due to overall provider shortages, geographic maldistribution of health care providers, and low Medicaid payment rates.” In addition to lack of service access, there are challenges to making price information available to taxpayer.
Taxpayers should have access to detailed information about how Medicaid resources are being distributed. The Centers for Medicare & Medicaid Services (CMS) pays close attention to the information received. CMS works with every state to ensure only eligible individuals receive service. Paying attention to what has been reported is important to ensure that Medicaid is both effective for beneficiaries and taxpayers. It is important to improve and maintain access to quality care. But how can that be done? Each center should have a case manager to ensure and monitor the enrollee has access to care such as transportation to medical appointments, dental visits, ophthalmology, podiatry visits, any specialist visit and so on. Improvement in transparency and oversight is important for many taxpayers. It is important that CMS shows a yearly report of where the funds for Medicaid go. Making these data reports available is an important step towards improving price transparency. Case managers in each center play an important role when they report to CMS. CMS will need to ensure that every state agency reports accurately. CMS is responsible for overseeing every state, to ensure compliance with federal regulations, and that the information gets published for citizens to look at.
On the other hand, it is important to understand how Medicaid services work. Each state establishes and administers their own Medicaid program. Medicaid covers a broad array of services if medically necessary. Things like physical therapy, rehabilitation services, some medical equipment may be covered if medically necessary and needs to be ordered by a medical director. However, these things are only for a limited number of days. Figure below will show the broad range of services offered to a specific population. Bottom line, most of us will be responsible for paying some or all our long-term care cost if there is no secondary insurance. Members who have a secondary insurance have a higher rate of receiving more services. For elderly people over 65 they may be eligible to be on Medicare. Having Medicare and Medical will help pay for premiums and share of cost.
Freundlich, N. (2014, February 01). Long-Term Care: What Are the Issues? Retrieved from. https://www.rwjf.org/en/library/research/2014/02/long-term-care–what-are-the-issues-.html
Medicaid, key issues facing the program: report to congressional addressees. (2015).
Mitts, L. (2014, August). Price Transparency in Health Care: An Introduction.
Rouse, M. (N.D). Centers for Medicare & Medicaid Services (CMS). Retrieved from. https://searchhealthit.techtarget.com/definition/Centers-for-Medicare-Medicaid-Services-CMS
Rudowitz, R. & Garfield, R. 12 March 2018. 10 Things to Know about Medicaid: Setting the Facts Straight. Retrieved from. https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight/