Question

Medicare and Medicaid are two health insurance plans primarily funded by the federal government. Please answer the following questions about them.

a. Who qualifies for Medicaid? Who qualifies for Medicare?

b. How is Medicaid funded? How is Medicare funded?

c.. Have measurable improvements in overall health resulted from enrollment in either program? Explain

Answer 1

a)

Medicare: It is a health insurance program. This plan generally covers people above the age of 65, but it also covers younger people who meet specific eligibility criteria, and individuals with certain diseases.

Medicaid: It is a health insurance program. This plan covers all the people who fall into low income group irrespective of age.

b)

Medicare: This program is partially funded by federal government through tax dollars and remaining is funded by premiums, deductibles and con-insurance payments.

Medicaid: This program is jointly funded by the federal government and the states. In this program, each state administers its own Medicaid program within federal guidelines.

c)

The modern time healthcare system has shifted from volume to value-based care. In this aspect there have been various programs organized to improve the quality of healthcare service to customers.

Medicare:

In 2015, the CMS Innovation Center announced the Medicare Advantage Value-based Insurance Design (VBID) model. The model allowed health plans administering Medicare Advantage plans to offer targeted benefits to enrollees who have certain chronic conditions. The main goals of this model included

· To enhance patients’ overall health

· To prevent the avoidable, costly care processes

· To reduce the costs for the Medicare enrollees

Since 2017, the model started testing the ability of Medicare Advantage plans and was launched in 7 states namely Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee. By, 2019, CMS updated the model to include organizations in 15 additional states including California, Colorado, Florida, Georgia, Hawaii, Maine, Minnesota, Montana, New Jersey, New Mexico, North Carolina, North Dakota, South Dakota, Virginia, and West Virginia . the updated model also includes focusing on chronic conditions other than those previously established by CMS; and revising the existing CMS chronic condition category to focus on a subset of the existing chronic condition.

Medicaid:

The Center for Medicaid and CHIP Services (CMCS) works to propel positive change forward to achieve improved care in maternal and infant health, oral health; and diseases like asthma, obesity, tobacco cessation; and reduced trends in cost through several initiatives.

In 2014, CMCS launched a three-year pilot project to assess the effectiveness of engaging pregnant and postpartum Medicaid enrollees in their health care using mobile technology. This technology includes a free text messaging application, and partnerships to support beneficiary outreach. This program was initially launched in four states—California, Louisiana, Ohio and Oklahoma.