 Medicaid NEWS
Medicaid is
health insurance that helps
many people who can't afford medical care
pay for some or all of their medical bills.
Good health is important
to everyone. If you can't afford to pay for medical care right now,
Medicaid can make it possible for you to get the care that you need so
that you can get healthy and stay healthy.
MEDICAID NEWS FEED |
Are You Poorer Than You Think? If you ask your average middle class senior about applying for Medicaid they would probably say something to the effect that they have “plenty” of resources. Wrong! Maybe they have plenty for having no monthly car note and living in a house bought and paid for 20 years ago. Without a car or mortgage payment, most of us would be doing really well. But, I can assure you, unless you are wealthy, you are not as well off as you think. When I say wealthy, I’m talking multi-hundred thousand dollarnaire at least (in liquid assets). Most retired seniors are a hip fracture, stroke, or heart attack away from the poor house. It’s not the hospital bill that gets you; though, have you seen the cost of a hospital aspirin? It’s not the subsequent rehabilitation stay either. Medicare, which over 42 million people have, will contribute a significant portion to the cost of those services–to a point. The reason you are poorer than you think is because most of you are depending on Medicare and Social Security as your health care and financial lifelines during retirement years. Never mind the fact that both Medicare and Social Security entitlement programs are limping along and without major retooling may not survive the first quarter of the 21st century. Most seniors are depending on Medicare, in particular, to an extent that they fail to see the value of self-funded resource options that provide benefits beyond the point of Medicare exhaustion. Yes, your Medicare benefits for a health care episode of illness can be exhausted. During this time, the depths of your richness will be tested and proven, without a doubt. You see, when your Medicare benefits for a spell of illness are exhausted and you cannot pay out-of-pocket for the care you need, what will you do and how will you get the care you need? The average cost of a nursing home is over $200 per day. The average cost for an assisted living room is roughly $3,000 per month. The average cost of a home health aide is $19 per hour. Can you afford to pay that price? If you do not have a ready answer to that question–and further have a full understanding of the scope of your available and potential financial resources to manage an ongoing health care crisis–you are indeed poorer than you think. What’s in your retirement portfolio? If you are wise, Retirement Life by Design: Living Well is being used (and read) by you. Copyright 2008 Pope Institute for Health and Eduation, LLC. All rights reserved. (Source: CaregivingMinutes™ by Pope Institute)
Author : CaregivingMinutes™ by Pope Institute
Publ.Date : Mon, 05 May 2008 03:39:33 +0100
We are in the midst of a very exciting and important presidential election, so I thought that we could spend some time discussing what we think should be done about healthcare. In particular let’s discuss what we think is wrong with the current healthcare system and what kind of things we think could be done to fix it. Below is a quick summary of the candidate’s healthcare plans (based on a summary from the New York Times). Clinton’s plan - Require everyone to get health insurance, subsidized by employers and the government; pay for it by rolling back tax cuts for households earning over $250,000 and savings in the existing system. • Requires large employers to provide insurance or contribute to the cost. • Provide tax credits to small businesses and subsidies for low-income people. • Create a pool of private plans similar to the program for federal workers and one public plan similar to Medicare. • Make plans portable from job to job. • Expand Medicaid, State Children’s Health Insurance Program. McCain’s plan - For free-market, consumer-based system; has pledged affordable healthcare for every American without a mandate; says universal healthcare is possible without a tax increase. • Sees controlling health costs as a top priority. • Make plans portable from job to job and accessible across state lines. • Provide $2,500 tax credits ($5,000 for families). • Revise tax code to “eliminate the bias toward employer-sponsored health insurance.” • Move to compensate medical providers based on the quality of their work. • Bring greater competition to drug markets by safe reimportation of drugs and streamlining the process for introducing generic drugs. Obama’s plan - Require that all children have health insurance; pay for it by rolling back President Bush’s tax cuts for households earning over $250,000; aims for universal coverage. • Requires employers to provide insurance or contribute to the cost. • Exempt smallest businesses. • Reimburse employers for catastrophic health costs. • Provide subsidies for low-income people. • Create purchasing pool with choice of competing private plans and one public plan like Medicare. • Make plans portable from job to job. • Expand Medicaid, State Children’s Health Insurance Program. When I lived in Europe, I was introduced to the social healthcare system in Holland and in France. It was basically the same as over here, except that the cost to visit a doctor, even a specialist, was very cheap. The most that I ever paid for a doctor visit was 50.00 euros and this was a heart specialist who did an EKG and an ultrasound in the office. I had to pay the cost up front because I was covered under a private insurance and my insurance company would refund the money. But still, I thought that it was cheap enough that I could afford it even if they were not refunding me. If you were covered by the social healthcare system, you had a special card that looked like a credit card and they would use that card as the method of payment. If I recall correctly I don’t think that they had to put money on the card, I think everyone got a certain amount. And, in Holland, they kept track of all your healthcare records electronically. They had a government database that all the doctors and pharmacists were plugged into and everyone knew the same medical information for you. There was no repeating your information to each doctor a thousand times because it was all in the database. I found it very nice and a very high tech system. France was not so sophisticated, they did not have a huge database but each doctor wrote a letter to your general practitioner explaining exactly what he or she did during the visit and what your symptoms were. This allowed my general practitioner to always know what was going on with me because he was in the loop. The big problem with the social system is that the taxes were very high and sometimes there could be a long wait for a procedure. This was obvious to me more in Holland than in France. In Holland, they would often tell me that I could not get the procedure done for six months or so, but they would usually call within a month with a cancellation. For some reason, for me, I didn’t encounter any problems with wait in France. But in France, I went to a private hospital for the fistula complications rather than the main hospital (where I went for my Crohn’s appointments and Humira shots). It was much easier to have a procedure done at a private hospital (clinic) rather than the hospital. I think that the cost of seeing a doctor here in the states is surprisingly high and if you don’t have health insurance, I am not sure how someone with a chronic disease can afford it. I guess you could go to the emergency care or if they have some sort of out patient service. Maybe someone can provide more insight? I think that the cost for a doctor visit is high because all the doctors have to pay such high fees for the malpractice insurance and lawsuit protection. One other problem that is very noticeable is that the insurance companies seem to dictate our medical treatment. The doctor prescribes me a medication and the insurance company says that they will not pay for that medicine that I have to take this other medicine that is not as good. Who are they to decide?! The doctor is the one with the medical degree and is the one who knows my situation and for reasons which the health insurance company may not know, he prescribed me that specific drug – not the one that they want to pay for. It is all about money and it should be about health. I don’t know what the solution is or what it should be, but I think that it would be an interesting topic of discussion. I am interested in hearing your opinions. Take care, Kelly (Source: Life with Crohn's)
Author : Life with Crohn's
Publ.Date : Wed, 07 May 2008 17:35:30 +0100
A series of legal skirmishes by the Centers for Medicare & Medicaid Services and trade groups representing pharmacies - big and small alike - will apparently delay still further a proposed federal rule that would have lowered the reimbursement rates for dispensing generic drugs in Medicaid. You may recall that a federal judge last December granted an injunction that prevented CMS from adopting the formula, which pharmacies have been arguing would have forced untold numbers of drug stores to close their doors if reimbursement rates are slashed below their costs, or drop out of Medicaid. The change would slash pharmacy reimbursements by about $8 billion over five years, according to a CMS estimate. The new formula would use AMP, or average manufacturers price, by the way. Since then, CMS proposed an interim rule that maintained generics are available in every state, a requirement for any reduction in reimbursement to go into effect. But the National Association of Chain Drugs Stores and the National Community Pharmacists Association amended their lawsuit today to object to the interim rule. (Take a look). As a practical matter, this sets up another dogfight and will likely mean a further delay in decided the overarching issue. “The Bush Administration approach was to put in a disincentive for pharmacies to use generics in the medicaid program and they do that by readically reducing payments to pharmacies well below the acquistion costs to the pharmacies,” John Rector, NCPA’s general counsel, tells us. “The bottom line is that, instead of being resolved in, perhaps, November, it may now be January. It pushes everything back by months and keeps the status quo in place.” (Source: Pharmalot)
Author : Pharmalot
Publ.Date : Tue, 22 Apr 2008 20:17:13 +0100
In May 2007, Indiana enacted comprehensive health reform in the form of the Indiana Check-Up Plan and its centerpiece, the Healthy Indiana Plan (HIP). After intense negotiations, the Centers for Medicare and Medicaid Services granted Indiana the 1115b waiver required for the plan to go into effect in December 2007, and within three months over [...] (Source: Health Affairs Blog)
Author : Health Affairs Blog
Publ.Date : Thu, 01 May 2008 14:26:09 +0100
Why do regulators base WC reimbursement on Medicare? It's easy, simple, and already familiar to legislators and regulators alike. It is also a big mistake. Medicare is a program for America's elderly - over-65, mostly sedentary, and mostly not employed.... (Source: Managed Care Matters)
Author : Managed Care Matters
Publ.Date : Wed, 16 Apr 2008 04:00:00 +0100
A study in the March 2008 volume of Pediatrics on psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders noted that there is “ongoing debate” about the uses of psychotropic medications. Only Risperidone, an atypical neuroleptic, has received FDA approval to treat autistic children for aggression and irritability. The AAP study also noted that “medication use is common among children with ASDs and seems to be increasing.” The study sample included 60,641 children under the age of 21 with an autism spectrum disorder diagnosis or an Asperger syndrome diagnosis. Most of the children in the study were 6-11 years old (45%); most were male (78%) and white (50%); and most were eligible for Medicaid because of disability (71%). Of these children, 56% used at least 1 medication during 2001; among those who received any medication, 20% used 3 concurrently. The most commonly used medications were neuroleptic drugs (31%), then antidepressants (25%), stimulants (22%), mood stabilizers (21%), anxiolytic drugs (12%), and sedatives (3%). While older children were more likely to take medications than younger children, it was noted that “use was quite common” in children aged 0 to 2 years (18%) and 3 to 5 years (32%). And, Among 0- to 2-year-olds, sedatives were most common; among 3- to 5- and 6- to 11-year-olds, both neuroleptic drugs and stimulants were most common; and in the oldest 2 age groups, neuroleptic drugs were most common. The researchers acknowledge certain limitations to their finds, due to the children all being enrolled in Medicaid: Use among the Medicaid population may be higher than in the general ASD population because Medicaid typically has less restrictive formulary and copayments than private insurance. Also, Medicaid-eligible children may be more severely affected than the general population of children with ASDs; that 70% of children in this study qualified for Medicaid because of their disability provides some evidence of this. As I have noted before, my son has been taking both Risperdal (Risperidone> and Zoloft (Sertraline) for a few years, to help him with aggressive and self-injurious behavior and anxiety. We tried Ritalin for a very few days; it did increase Charlie’s ability to focus, but it also made him haunted and nervous and completely suppressed his appetite. We have tried very hard to keep the dosages as low as possible and have only used these medications in combination with educational therapies. Prior to Charlie taking Risperdal and Zoloft, we tried giving him various nutritional supplements, whose effects were temporary at best in helping him with his most difficult behaviors. I consider the medications another tool to help Charlie, and one that we have to monitor very carefully, due to Charlie’s limited language and speech. More than a few people have raised questions about the long-term effects of these medications on children and on giving a child more than one medication. I was surprised to see how many young children—-aged 0-2—are given some type of psychotropic medication. The researchers single out the “high levels of use of many different psychotropic agents, often in combination” as a concern, especially in these being given to young children “in whom the effects of these medications on development have not been well studied.” They also note a need for more studies in the use of sedatives for young children, and about the use of psychotropic medications in combination for children with autism. I would also appreciate studies about the long-term use of these medications in children—debate on this issue will indeed be going on for more than a little while. Tags: anxiety, asd, asperger, autism, drugs, medicaid, medication, Medicine, parents, pdd-nos, pediatricsShare This (Source: Autism Vox)
Author : Autism Vox
Publ.Date : Wed, 26 Mar 2008 07:55:09 +0100
The State Children’s Health Insurance Program is a joint federal/state program to insure low income children. The least offensive redistribution of wealth imaginable. Here’s a summary of it. Even I’m a a pom-pom waving supporter of the program. Currently there’s a big fight in Washington over it. In case you somehow missed it, the decade [...] (Source: From Medskool)
Author : From Medskool
Publ.Date : Sat, 29 Sep 2007 04:51:13 +0100
For Some Reason I Don’t Trust You To Make The Smartest Decisions The veto of the S-CHIP expansion came with the biggest cry being that it would drive currently privately insured children onto the federal rolls. The current confrontation stems as much from the White House’s desire to use the bill reauthorizing the State Children’s Health Insurance [...] (Source: From Medskool)
Author : From Medskool
Publ.Date : Fri, 05 Oct 2007 12:16:06 +0100
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