Elimination and Reform

Nikole Chassagne
Professor Carlos Jon

Summary of Article

The article I chose to summarize is on Medicaid, “Rule Would Discourage States’ Cutting Medicaid Payments to Providers.   The reason this article was written is because of the costly entitlement programs for those who can’t afford health insurance and the government is struggling to balance the budget and gain fiscal relief.   Here's how Medicaid currently works, Medicaid is a joint Federal/State program administered by each individual state.   Each State develops its own rules related to eligibility and coverage within broad Federal guidelines. Washington sets minimum requirements for who can enroll and what services must be covered, and pays half of the bill in the richest states and three-quarters of the bill in the poorest state.   If people are poor enough to qualify and a medical service recommended by their doctors is covered, the state and federal governments will pick up the tab, with minimal co-payments by the beneficiaries, but the costs are undeniably high for the government to sustain.   To make up the difference, states would probably have to cut payments to doctors, hospitals or nursing homes, curtail eligibility, reduce benefits or increase their own payments for Medicaid.

How does this relate to the learning for the week in class? What laws and concepts are covered that would help you in the area of benefits?
The Medicaid program is administered by the local county Departments of Social Services and by the Human Resources Administration.   State Medicaid statutes and regulations are subject to and must be consistent with federal law.   Many significant changes in the federal law regarding Medicaid eligibility were promulgated by the Omnibus Budget Reconciliation Act of 1993 (OBRA-93), which was signed into law by President Clinton on August 10, 1993.   As this relates to the weeks discussion of supplemental medical insurance and hospital...