Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.
A component of the Department of Health and Human Services to oversee and direct the Medicare and Medicaid programs and related Federal medical care quality control staffs. Name was changed effective June 14, 2001.
State plans prepared by the State Health Planning and Development Agencies which are made up from plans submitted by the Health Systems Agencies and subject to review and revision by the Statewide Health Coordinating Council.
The term "United States" in a medical context often refers to the country where a patient or study participant resides, and is not a medical term per se, but relevant for epidemiological studies, healthcare policies, and understanding differences in disease prevalence, treatment patterns, and health outcomes across various geographic locations.
Criteria to determine eligibility of patients for medical care programs and services.
Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.
Payment by a third-party payer in a sum equal to the amount expended by a health care provider or facility for health services rendered to an insured or program beneficiary. (From Facts on File Dictionary of Health Care Management, 1988)
The level of governmental organization and function below that of the national or country-wide government.
Individuals or groups with no or inadequate health insurance coverage. Those falling into this category usually comprise three primary groups: the medically indigent (MEDICAL INDIGENCY); those whose clinical condition makes them medically uninsurable; and the working uninsured.
Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)
Generally refers to the amount of protection available and the kind of loss which would be paid for under an insurance contract with an insurer. (Slee & Slee, Health Care Terms, 2d ed)
Processes or methods of reimbursement for services rendered or equipment.
The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others.
A method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount without regard to the actual number or nature of services provided to each patient.
Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.
Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.
The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (HEALTH CARE COSTS) and may or may not be shared among the patient, insurers, and/or employers.
The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed)
A method of examining and setting levels of payments.
Organized services to provide health care for children.
Amounts charged to the patient as payer for medical services.
Payments that include adjustments to reflect the costs of uncompensated care and higher costs for inpatient care for certain populations receiving mandated services. MEDICARE and MEDICAID include provisions for this type of reimbursement.
The design, completion, and filing of forms with the insurer.
Health care provided to individuals.
An Act prohibiting a health plan from establishing lifetime limits or annual limits on the dollar value of benefits for any participant or beneficiary after January 1, 2014. It permits a restricted annual limit for plan years beginning prior to January 1, 2014. It provides that a health plan shall not be prevented from placing annual or lifetime per-beneficiary limits on covered benefits. The Act sets up a competitive health insurance market.
The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)
Medical services for which no payment is received. Uncompensated care includes charity care and bad debts.
Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer.
A situation in which the level of living of an individual, family, or group is below the standard of the community. It is often related to a specific income level.
Works about lists of drugs or collections of recipes, formulas, and prescriptions for the compounding of medicinal preparations. Formularies differ from PHARMACOPOEIAS in that they are less complete, lacking full descriptions of the drugs, their formulations, analytic composition, chemical properties, etc. In hospitals, formularies list all drugs commonly stocked in the hospital pharmacy.
Organized systems for providing comprehensive prepaid health care that have five basic attributes: (1) provide care in a defined geographic area; (2) provide or ensure delivery of an agreed-upon set of basic and supplemental health maintenance and treatment services; (3) provide care to a voluntarily enrolled group of persons; (4) require their enrollees to use the services of designated providers; and (5) receive reimbursement through a predetermined, fixed, periodic prepayment made by the enrollee without regard to the degree of services provided. (From Facts on File Dictionary of Health Care Management, 1988)
The level of governmental organization and function at the national or country-wide level.
Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.
I'm sorry for any confusion, but the term "Oregon" is a geographical location and not a medical concept or condition. It is a state in the Pacific Northwest region of the United States. If you have any questions related to medical topics, I would be happy to help answer those!
I'm sorry for any confusion, but the term "Tennessee" is not a medical concept or condition that has a defined meaning within the medical field. It is a geographical location, referring to a state in the United States. If you have any questions related to healthcare, medicine, or health conditions, I would be happy to help answer those!
I'm sorry for any confusion, but "Florida" is a geographical location and not a medical term or condition with a specific definition. It is the 27th largest state by area in the United States, located in the southeastern region of the country and known for its diverse wildlife, beautiful beaches, and theme parks. If you have any medical questions or terms that need clarification, please feel free to ask!
I'm sorry for any confusion, but the term "Maryland" is not a recognized medical term with a specific definition in the medical field. It refers to a state in the United States. If you have any questions about a medical condition or treatment, I would be happy to try and help answer those!
Facilities which provide nursing supervision and limited medical care to persons who do not require hospitalization.
Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.
Detailed financial plans for carrying out specific activities for a certain period of time. They include proposed income and expenditures.
Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.
I'm sorry for any confusion, but the term "Arkansas" is a place name and does not have a medical definition. It is a state located in the southern region of the United States.
The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from HEALTH EXPENDITURES, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost.
Insurance providing for payment of services rendered by the pharmacist. Services include the preparation and distribution of medical products.
Economic aspects related to the management and operation of a hospital.
(I'm assuming you are asking for a play on words related to the state of New Jersey, as "New Jersey" is not a medical term.)
The amount that a health care institution or organization pays for its drugs. It is one component of the final price that is charged to the consumer (FEES, PHARMACEUTICAL or PRESCRIPTION FEES).
(Note: 'North Carolina' is a place, not a medical term. However, I can provide a fun fact related to health and North Carolina.)
**I'm really sorry, but I can't fulfill your request.**
The giving of attention to the special dental needs of children, including the prevention of tooth diseases and instruction in dental hygiene and dental health. The dental care may include the services provided by dental specialists.
Payments or services provided under stated circumstances under the terms of an insurance policy. In prepayment programs, benefits are the services the programs will provide at defined locations and to the extent needed.
I'm sorry for any confusion, but the term "Michigan" is not a medical concept or condition that has a defined meaning within the medical field. It refers to a state in the United States, and does not have a direct medical connotation.
I'm sorry for any confusion, but "California" is a place, specifically a state on the western coast of the United States, and not a medical term or concept. Therefore, it doesn't have a medical definition.
An increase in the volume of money and credit relative to available goods resulting in a substantial and continuing rise in the general price level.
Concept referring to the standardized fees for services rendered by health care providers, e.g., laboratories and physicians, and reimbursement for those services under Medicare Part B. It includes acceptance by the physician.
A scheme which provides reimbursement for the health services rendered, generally by an institution, and which provides added financial rewards if certain conditions are met. Such a scheme is intended to promote and reward increased efficiency and cost containment, with better care, or at least without adverse effect on the quality of the care rendered.
##### Not a valid request: I'm sorry for any confusion, but "Maine" is a state in the northeastern United States and not a medical term or condition with a specific definition in the healthcare context.
Any system which allows payors to share some of the financial risk associated with a particular patient population with providers. Providers agree to adhere to fixed fee schedules in exchange for an increase in their payor base and a chance to benefit from cost containment measures. Common risk-sharing methods are prospective payment schedules (PROSPECTIVE PAYMENT SYSTEM), capitation (CAPITATION FEES), diagnosis-related fees (DIAGNOSIS-RELATED GROUPS), and pre-negotiated fees.
Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter.
Organized institutions which provide services to ameliorate conditions of need or social pathology in the community.
Financing of medical care provided to public assistance recipients.
Formal programs for assessing drug prescription against some standard. Drug utilization review may consider clinical appropriateness, cost effectiveness, and, in some cases, outcomes. Review is usually retrospective, but some analysis may be done before drugs are dispensed (as in computer systems which advise physicians when prescriptions are entered). Drug utilization review is mandated for Medicaid programs beginning in 1993.
Outside services provided to an institution under a formal financial agreement.
A listing of established professional service charges, for specified dental and medical procedures.
Provisions of an insurance policy that require the insured to pay some portion of covered expenses. Several forms of sharing are in use, e.g., deductibles, coinsurance, and copayments. Cost sharing does not refer to or include amounts paid in premiums for the coverage. (From Dictionary of Health Services Management, 2d ed)
Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care.
## I'm sorry for any confusion, but "Ohio" is a U.S. state and not a term used in medical definitions.
Insurance providing benefits for the costs of care by a physician which can be comprehensive or limited to surgical expenses or for care provided only in the hospital. It is frequently called "regular medical expense" or "surgical expense".
Laws and regulations concerning hospitals, which are proposed for enactment or enacted by a legislative body.
Financial assistance to impoverished persons for the essentials of living through federal, state or local government programs.
The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.
Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.
I'm sorry for any confusion, but "Kentucky" is a proper noun and not a term that has a medical definition. It is a state located in the eastern region of the United States. If you have any questions related to medical conditions or terminology, I would be happy to help answer those!
Federal, state, or local government organized methods of financial assistance.
An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.
The assignment, to each of several particular cost-centers, of an equitable proportion of the costs of activities that serve all of them. Cost-center usually refers to institutional departments or services.
The utilization of drugs as reported in individual hospital studies, FDA studies, marketing, or consumption, etc. This includes drug stockpiling, and patient drug profiles.
Health services required by a population or community as well as the health services that the population or community is able and willing to pay for.
I'm sorry for any confusion, but "South Carolina" is a geographical location and not a medical term or concept, so it doesn't have a medical definition. It is a state located in the Southeastern region of the United States.
A system for classifying patient care by relating common characteristics such as diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay. Its purpose is to provide a framework for specifying case mix and to reduce hospital costs and reimbursements and it forms the cornerstone of the prospective payment system.
A traditional term for all the activities which a physician or other health care professional normally performs to insure the coordination of the medical services required by a patient. It also, when used in connection with managed care, covers all the activities of evaluating the patient, planning treatment, referral, and follow-up so that care is continuous and comprehensive and payment for the care is obtained. (From Slee & Slee, Health Care Terms, 2nd ed)
Care provided the pregnant woman in order to prevent complications, and decrease the incidence of maternal and prenatal mortality.
Persons with physical or mental disabilities that affect or limit their activities of daily living and that may require special accommodations.
Absolute, comparative, or differential costs pertaining to services, institutions, resources, etc., or the analysis and study of these costs.
Directions written for the obtaining and use of DRUGS.
Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.
Economic sector concerned with the provision, distribution, and consumption of health care services and related products.
The legal relation between an entity (individual, group, corporation, or-profit, secular, government) and an object. The object may be corporeal, such as equipment, or completely a creature of law, such as a patent; it may be movable, such as an animal, or immovable, such as a building.
The application of mathematical formulas and statistical techniques to the testing and quantifying of economic theories and the solution of economic problems.
I'm sorry for any confusion, but "Massachusetts" is a geographical location and not a medical term or concept. It is a state located in the northeastern region of the United States. If you have any medical questions or terms you would like me to define, please let me know!
Differences in access to or availability of medical facilities and services.
Laws and regulations, pertaining to the field of medicine, proposed for enactment or enacted by a legislative body.
whoa, I'm just an AI and I don't have the ability to provide on-the-fly medical definitions. However, I can tell you that "Missouri" is not a term commonly used in medicine. It's a state in the United States, and I assume you might be looking for a medical term that is associated with it. If you could provide more context or clarify what you're looking for, I'd be happy to help further!
A cabinet department in the Executive Branch of the United States Government concerned with administering those agencies and offices having programs pertaining to health and human services.
Extended care facilities which provide skilled nursing care or rehabilitation services for inpatients on a daily basis.
Community health and NURSING SERVICES providing coordinated multiple services to the patient at the patient's homes. These home-care services are provided by a visiting nurse, home health agencies, HOSPITALS, or organized community groups using professional staff for care delivery. It differs from HOME NURSING which is provided by non-professionals.
Amounts charged to the patient or third-party payer for medication. It includes the pharmacist's professional fee and cost of ingredients, containers, etc.

Can restrictions on reimbursement for anti-ulcer drugs decrease Medicaid pharmacy costs without increasing hospitalizations? (1/1973)

OBJECTIVE: To examine the impact of a policy restricting reimbursement for Medicaid anti-ulcer drugs on anti-ulcer drug use and peptic-related hospitalizations. DATA SOURCES/STUDY SETTING: In addition to U.S. Census Bureau data, all of the following from Florida: Medicaid anti-ulcer drug claims data, 1989-1993; Medicaid eligibility data, 1989-1993; and acute care nonfederal hospital discharge abstract data (Medicaid and non-Medicaid), 1989-1993. STUDY DESIGN: In this observational study, a Poisson multiple regression model was used to compare changes, after policy implementation, in Medicaid reimbursement for prescription anti-ulcer drugs as well as hospitalization rates between pre- and post-implementation periods in Medicaid versus non-Medicaid patients hospitalized with peptic ulcer disease. PRINCIPAL FINDINGS: Following policy implementation, the rate of Medicaid reimbursement for anti-ulcer drugs decreased 33 percent (p < .001). No associated increase occurred in the rate of Medicaid peptic-related hospitalizations. CONCLUSIONS: Florida's policy restricting Medicaid reimbursement for anti-ulcer drugs was associated with a substantial reduction in outpatient anti-ulcer drug utilization without any significant increase in the rate of hospitalization for peptic-related conditions.  (+info)

Incidence and duration of hospitalizations among persons with AIDS: an event history approach. (2/1973)

OBJECTIVE: To analyze hospitalization patterns of persons with AIDS (PWAs) in a multi-state/multi-episode continuous time duration framework. DATA SOURCES: PWAs on Medicaid identified through a match between the state's AIDS Registry and Medicaid eligibility files; hospital admission and discharge dates identified through Medicaid claims. STUDY DESIGN: Using a Weibull event history framework, we model the hazard of transition between hospitalized and community spells, incorporating the competing risk of death in each of these states. Simulations are used to translate these parameters into readily interpretable estimates of length of stay, the probability that a hospitalization will end in death, and the probability that a nonhospitalized person will be hospitalized within 90 days. PRINCIPAL FINDINGS: In multivariate analyses, participation in a Medicaid waiver program offering case management and home care was associated with hospital stays 1.3 days shorter than for nonparticipants. African American race and Hispanic ethnicity were associated with hospital stays 1.2 days and 1.0 day longer than for non-Hispanic whites; African Americans also experienced more frequent hospital admissions. Residents of the high-HIV-prevalence area of the state had more frequent admissions and stays two days longer than those residing elsewhere in the state. Older PWAs experienced less frequent hospital admissions but longer stays, with hospitalizations of 55-year-olds lasting 8.25 days longer than those of 25-year-olds. CONCLUSIONS: Much socioeconomic and geographic variability exists both in the incidence and in the duration of hospitalization among persons with AIDS in New Jersey. Event history analysis provides a useful statistical framework for analysis of these variations, deals appropriately with data in which duration of observation varies from individual to individual, and permits the competing risk of death to be incorporated into the model. Transition models of this type have broad applicability in modeling the risk and duration of hospitalization in chronic illnesses.  (+info)

Making Medicaid managed care research relevant. (3/1973)

OBJECTIVE: To help researchers better understand Medicaid managed care and the kinds of research studies that will be both feasible and of value to policymakers and program staff. The article builds on our experience researching Medicaid managed care to provide insight for researchers who want to be policy relevant. PRINCIPAL FINDINGS: We draw four lessons from our work on Medicaid managed care in seven states. First, these are complex programs that differ substantially across states. Second, each program faces common challenges and issues. The need to address common design elements involving program eligibility, managed care and provider contracting, beneficiary enrollment, education, marketing, and administration and oversight provides a vehicle that researchers can use to help understand states and to provide them with relevant insight. Third, well-designed case studies can provide invaluable descriptive insights. Such case studies suggest that providing effective descriptions of state programs and experience, monitoring information on program performance and tradeoffs, and insight on implementation and design are all valuable products of such studies that have considerable potential to be converted into policy-actionable advice. And fourth, some questions demand impact studies but the structure of Medicaid managed care poses major barriers to such studies. CONCLUSIONS: Many challenges confront researchers seeking to develop policy-relevant research on managed care. Researchers need to confront these challenges in turn by developing second-best approaches that will provide timely insight into important questions in a relatively defensible and rigorous way in the face of many constraints. If researchers do not, others will, and researchers may find their contributions limited in important areas for policy debate.  (+info)

The changing elderly population and future health care needs. (4/1973)

The impending growth of the elderly population requires both fiscal and substantive changes in Medicare and Medicaid that are responsive to cost issues and to changing patterns of need. More emphasis is required on chronic disease management, on meaningful integration between acute and long-term care services, and on improved coordination between Medicare and Medicaid initiatives. This paper reviews various trends, including the growth in managed-care approaches, experience with social health maintenance organizations and Program of All-Inclusive Care for the Elderly demonstrations, and the need for a coherent long-term care policy. Such policies, however, transcend health care and require a broad range of community initiatives.  (+info)

Who bears the burden of Medicaid drug copayment policies? (5/1973)

This DataWatch examines the impact of Medicaid prescription drug copayment policies in thirty-eight states using survey data from the 1992 Medicare Current Beneficiary Survey. Findings indicate that elderly and disabled Medicaid recipients who reside in states with copay provisions have significantly lower rates of drug use than their counterparts in states without copayments. After controlling for other factors, we find that the primary effect of copayments is to reduce the likelihood that Medicaid recipients fill any prescription during the year. This burden falls disproportionately on recipients in poor health.  (+info)

What quality measurements miss. (6/1973)

Measurable indices of health care quality are all the rage these days. But physicians know that not everything in health care can be quantified. If reportable numbers become our principal focus, what is in danger of falling through the cracks?  (+info)

Prepaid capitation versus fee-for-service reimbursement in a Medicaid population. (7/1973)

Utilization of health resources by 37,444 Medicaid recipients enrolled in a capitated health maintenance organization was compared with that of 227,242 Medicaid recipients enrolled in a traditional fee-for-service system over a 1-year period (1983-1984) in the state of Kentucky. Primary care providers in the capitated program had financial incentives to reduce downstream costs like specialist referral, emergency room use, and hospitalizations. The average number of physician visits was similar for both groups (4.47/year in the capitated program; 5.09/year in the fee-for-service system). However, the average number of prescriptions (1.9 versus 4.9 per year), average number of hospital admissions per recipient (0.11 versus 0.22 per year), and average number of hospital days per 1,000 recipients (461 versus 909 per year) were 5% to 60% lower in the capitated group than in the fee-for-service group. The Citicare capitated program resulted in a dramatic reduction in healthcare resource utilization compared with the concurrent fee-for-service system for statewide Medicaid recipients.  (+info)

Hospitals and managed care: catching up with the networks. (8/1973)

Although the growth of managed care is having a significant impact on hospitals, organizational response to managed care remains fragmented. We conducted a survey of 83 hospitals nationwide that indicated that most hospitals now have at least one person devoted to managed care initiatives. These individuals, however, often spend most of their time on current issues, such as contracting with managed care organizations and physician relations. Concerns for the future, such as network development and marketing, although important, receive less immediate attention form these individuals. Hospital managed care executives must take a more proactive role in long range managed care planning by collaborating with managed care organizations and pharmaceutical companies.  (+info)

Medicaid is a joint federal-state program that provides health coverage for low-income individuals, including children, pregnant women, elderly adults, and people with disabilities. Eligibility, benefits, and administration vary by state, but the program is designed to ensure that low-income individuals have access to necessary medical services. Medicaid is funded jointly by the federal government and the states, and is administered by the states under broad federal guidelines.

Medicaid programs must cover certain mandatory benefits, such as inpatient and outpatient hospital services, laboratory and X-ray services, and physician services. States also have the option to provide additional benefits, such as dental care, vision services, and prescription drugs. In addition, many states have expanded their Medicaid programs to cover more low-income adults under the Affordable Care Act (ACA).

Medicaid is an important source of health coverage for millions of Americans, providing access to necessary medical care and helping to reduce financial burden for low-income individuals.

"State Health Plans" is a general term that refers to the healthcare coverage programs offered or managed by individual states in the United States. These plans can be divided into two main categories: Medicaid and state-based marketplaces.

1. **Medicaid**: This is a joint federal-state program that provides healthcare coverage to low-income individuals, families, and qualifying groups, such as pregnant women, children, elderly people, and people with disabilities. Each state administers its own Medicaid program within broad federal guidelines, and therefore, the benefits, eligibility criteria, and enrollment processes can vary from state to state.

2. **State-based Marketplaces (SBMs)**: These are online platforms where individuals and small businesses can compare and purchase health insurance plans that meet the standards set by the Affordable Care Act (ACA). SBMs operate in accordance with federal regulations, but individual states have the flexibility to design their own marketplace structure, manage their own enrollment process, and determine which insurers can participate.

It is important to note that state health plans are subject to change based on federal and state laws, regulations, and funding allocations. Therefore, it is always recommended to check the most recent and specific information from the relevant state agency or department.

I'm sorry for any confusion, but "United States" is a geopolitical entity, specifically the name of the country consisting of 50 states, and it is not a medical term or concept. Therefore, I can't provide a medical definition for it. If you have any questions related to health, medicine, or biology, I would be happy to try to help answer those!

Eligibility determination is the process of evaluating whether an individual meets the required criteria or conditions to be qualified for a particular program, benefit, service, or position. This process typically involves assessing various factors such as medical condition, functional abilities, financial status, age, and other relevant aspects based on the specific eligibility requirements.

In the context of healthcare and medical services, eligibility determination is often used to establish whether a patient qualifies for certain treatments, insurance coverage, government assistance programs (like Medicaid or Medicare), or disability benefits. This process may include reviewing medical records, conducting assessments, and comparing the individual's situation with established guidelines or criteria.

The primary goal of eligibility determination is to ensure that resources are allocated fairly and appropriately to those who genuinely need them and meet the necessary requirements.

Managed care programs are a type of health insurance plan that aims to control healthcare costs and improve the quality of care by managing the utilization of healthcare services. They do this by using a network of healthcare providers who have agreed to provide services at reduced rates, and by implementing various strategies such as utilization review, case management, and preventive care.

In managed care programs, there is usually a primary care physician (PCP) who acts as the patient's main doctor and coordinates their care within the network of providers. Patients may need a referral from their PCP to see specialists or access certain services. Managed care programs can take various forms, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Point-of-Service (POS) plans, and Exclusive Provider Organizations (EPOs).

The goal of managed care programs is to provide cost-effective healthcare services while maintaining or improving the quality of care. They can help patients save money on healthcare costs by providing coverage for a range of services at lower rates than traditional fee-for-service plans, but they may also limit patient choice and require prior authorization for certain procedures or treatments.

Health Insurance Reimbursement refers to the process of receiving payment from a health insurance company for medical expenses that you have already paid out of pocket. Here is a brief medical definition of each term:

1. Insurance: A contract, represented by a policy, in which an individual or entity receives financial protection or reimbursement against losses from an insurance company. The company pools clients' risks to make payments more affordable for the insured.
2. Health: Refers to the state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.
3. Reimbursement: The act of refunding or compensating a person for expenses incurred, especially those that have been previously paid by the individual and are now being paid back by an insurance company.

In the context of health insurance, reimbursement typically occurs when you receive medical care, pay the provider, and then submit a claim to your insurance company for reimbursement. The insurance company will review the claim, determine whether the services are covered under your policy, and calculate the amount they will reimburse you based on your plan's benefits and any applicable co-pays, deductibles, or coinsurance amounts. Once this process is complete, the insurance company will issue a payment to you to cover a portion or all of the costs you incurred for the medical services.

I'm sorry for any confusion, but "State Government" is not a medical term. It refers to the level of government in the United States that is responsible for governing each of the individual states. This includes executives (such as governors), legislative bodies (like state senates and houses of representatives), and courts.

If you have any questions related to medicine or healthcare, I'd be happy to try and help answer those for you!

"Medically uninsured" is not a term that has an official medical definition. However, it generally refers to individuals who do not have health insurance coverage. This can include those who cannot afford it, those who are not offered coverage through their employer, and those who are ineligible for government-sponsored programs like Medicaid or Medicare. Being medically uninsured can lead to financial strain if an individual experiences a medical emergency or needs ongoing care, as they will be responsible for paying for these services out of pocket.

Medicare is a social insurance program in the United States, administered by the Centers for Medicare & Medicaid Services (CMS), that provides health insurance coverage to people who are aged 65 and over; or who have certain disabilities; or who have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

The program consists of four parts:

1. Hospital Insurance (Part A), which helps pay for inpatient care in hospitals, skilled nursing facilities, hospices, and home health care.
2. Medical Insurance (Part B), which helps pay for doctors' services, outpatient care, medical supplies, and preventive services.
3. Medicare Advantage Plans (Part C), which are private insurance plans that provide all of your Part A and Part B benefits, and may include additional benefits like dental, vision, and hearing coverage.
4. Prescription Drug Coverage (Part D), which helps pay for medications doctors prescribe for treatment.

Medicare is funded by payroll taxes, premiums paid by beneficiaries, and general revenue. Beneficiaries typically pay a monthly premium for Part B and Part D coverage, while Part A is generally free for those who have worked and paid Medicare taxes for at least 40 quarters.

Insurance coverage, in the context of healthcare and medicine, refers to the financial protection provided by an insurance policy that covers all or a portion of the cost of medical services, treatments, and prescription drugs. The coverage is typically offered by health insurance companies, employers, or government programs such as Medicare and Medicaid.

The specific services and treatments covered by insurance, as well as the out-of-pocket costs borne by the insured individual, are determined by the terms of the insurance policy. These terms may include deductibles, copayments, coinsurance, and coverage limits or exclusions. The goal of insurance coverage is to help individuals manage the financial risks associated with healthcare expenses and ensure access to necessary medical services.

Reimbursement mechanisms in a medical context refer to the various systems and methods used by health insurance companies, government agencies, or other payers to refund or recompense healthcare providers, institutions, or patients for the costs associated with medical services, treatments, or products. These mechanisms ensure that covered individuals receive necessary medical care while protecting payers from unnecessary expenses.

There are several types of reimbursement mechanisms, including:

1. Fee-for-service (FFS): In this model, healthcare providers are paid for each service or procedure they perform, with the payment typically based on a predetermined fee schedule. This can lead to overutilization and increased costs if providers perform unnecessary services to increase their reimbursement.
2. Capitation: Under capitation, healthcare providers receive a set amount of money per patient enrolled in their care for a specified period, regardless of the number or type of services provided. This encourages providers to manage resources efficiently and focus on preventive care to maintain patients' health and reduce overall costs.
3. Bundled payments: Also known as episode-based payment, this model involves paying a single price for all the services related to a specific medical event, treatment, or condition over a defined period. This encourages coordination among healthcare providers and can help eliminate unnecessary procedures and costs.
4. Resource-Based Relative Value Scale (RBRVS): RBRVS is a payment system that assigns relative value units (RVUs) to various medical services based on factors such as time, skill, and intensity required for the procedure. The RVUs are then converted into a monetary amount using a conversion factor. This system aims to create more equitable and consistent payments across different medical specialties and procedures.
5. Prospective payment systems (PPS): In PPS, healthcare providers receive predetermined fixed payments for specific services or conditions based on established diagnosis-related groups (DRGs) or other criteria. This system encourages efficiency in care delivery and can help control costs by setting limits on reimbursement amounts.
6. Pay-for-performance (P4P): P4P models tie a portion of healthcare providers' reimbursements to their performance on specific quality measures, such as patient satisfaction scores or adherence to evidence-based guidelines. This system aims to incentivize high-quality care and improve overall healthcare outcomes.
7. Shared savings/risk arrangements: In these models, healthcare providers form accountable care organizations (ACOs) or other collaborative entities that assume responsibility for managing the total cost of care for a defined population. If they can deliver care at lower costs while maintaining quality standards, they share in the savings with payers. However, if costs exceed targets, they may be required to absorb some of the financial risk.

These various reimbursement models aim to balance the need for high-quality care with cost control and efficiency in healthcare delivery. By aligning incentives and promoting coordination among providers, these systems can help improve patient outcomes while reducing unnecessary costs and waste in the healthcare system.

Health services accessibility refers to the degree to which individuals and populations are able to obtain needed health services in a timely manner. It includes factors such as physical access (e.g., distance, transportation), affordability (e.g., cost of services, insurance coverage), availability (e.g., supply of providers, hours of operation), and acceptability (e.g., cultural competence, language concordance).

According to the World Health Organization (WHO), accessibility is one of the key components of health system performance, along with responsiveness and fair financing. Improving accessibility to health services is essential for achieving universal health coverage and ensuring that everyone has access to quality healthcare without facing financial hardship. Factors that affect health services accessibility can vary widely between and within countries, and addressing these disparities requires a multifaceted approach that includes policy interventions, infrastructure development, and community engagement.

A capitation fee is a payment model in healthcare systems where physicians or other healthcare providers receive a set amount of money per patient assigned to their care, per period of time, whether or not that patient seeks care. This fee is intended to cover all the necessary medical services for that patient during that time frame. It is a type of risk-based payment model that encourages providers to manage resources efficiently and provide appropriate care to keep patients healthy and avoid unnecessary procedures or hospitalizations. The amount of the capitation fee can vary based on factors such as the patient's age, health status, and any specific healthcare needs they may have.

Health Insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over a large number of persons. By purchasing health insurance, insured individuals pay a premium to an insurance company, which then pools those funds with other policyholders' premiums to pay for the medical care costs of individuals who become ill or injured. The coverage can include hospitalization, medical procedures, prescription drugs, and preventive care, among other services. The goal of health insurance is to provide financial protection against unexpected medical expenses and to make healthcare services more affordable.

An insurance claim review is the process conducted by an insurance company to evaluate a claim made by a policyholder for coverage of a loss or expense. This evaluation typically involves examining the details of the claim, assessing the damages or injuries incurred, verifying the coverage provided by the policy, and determining the appropriate amount of benefits to be paid. The insurance claim review may also include investigating the circumstances surrounding the claim to ensure its validity and confirming that it complies with the terms and conditions of the insurance policy.

Health expenditures refer to the total amount of money spent on health services, goods, and resources in a given period. This can include expenses for preventive care, medical treatments, medications, long-term care, and administrative costs. Health expenditures can be made by individuals, corporations, insurance companies, or governments, and they can be measured at the national, regional, or household level.

Health expenditures are often used as an indicator of a country's investment in its healthcare system and can reflect the overall health status of a population. High levels of health expenditures may indicate a strong commitment to healthcare, but they can also place a significant burden on individuals, businesses, and governments. Understanding patterns and trends in health expenditures is important for policymakers, healthcare providers, and researchers who are working to improve the efficiency, effectiveness, and accessibility of healthcare services.

Cost control in a medical context refers to the strategies and practices employed by healthcare organizations to manage and reduce the costs associated with providing patient care while maintaining quality and safety. The goal is to optimize resource allocation, increase efficiency, and contain expenses without compromising the standard of care. This may involve measures such as:

1. Utilization management: Reviewing and monitoring the use of medical services, tests, and treatments to ensure they are necessary, appropriate, and evidence-based.
2. Case management: Coordinating patient care across various healthcare providers and settings to improve outcomes, reduce unnecessary duplication of services, and control costs.
3. Negotiating contracts with suppliers and vendors to secure favorable pricing for medical equipment, supplies, and pharmaceuticals.
4. Implementing evidence-based clinical guidelines and pathways to standardize care processes and reduce unwarranted variations in practice that can drive up costs.
5. Using technology such as electronic health records (EHRs) and telemedicine to streamline operations, improve communication, and reduce errors.
6. Investing in preventive care and wellness programs to keep patients healthy and reduce the need for costly interventions and hospitalizations.
7. Continuously monitoring and analyzing cost data to identify trends, opportunities for improvement, and areas of potential waste or inefficiency.

"Rate setting and review" is not a commonly used medical term with a specific definition in the field. However, I can provide you with information about what these terms might refer to in a broader healthcare context:

Rate setting generally refers to the process of determining the payment rates for healthcare services, programs, or products. This could involve setting reimbursement rates for medical procedures, medications, or durable medical equipment under government-funded health insurance programs like Medicare and Medicaid, or in the private insurance sector. Rate setting can be influenced by various factors, including the cost of providing care, resource utilization, quality metrics, and market competition.

Review, in this context, typically refers to the process of evaluating and assessing healthcare services, programs, or products to ensure their quality, effectiveness, and efficiency. This could involve reviewing medical records, clinical outcomes, and financial data to determine if the care provided is consistent with evidence-based guidelines, industry best practices, and regulatory requirements. Regular reviews are essential for maintaining high standards of care, identifying areas for improvement, and ensuring that resources are allocated efficiently.

Together, "rate setting and review" may refer to a comprehensive approach to managing healthcare costs and quality by establishing appropriate payment rates while continuously monitoring and improving the effectiveness and efficiency of healthcare services.

Child health services refer to a range of medical and supportive services designed to promote the physical, mental, and social well-being of children from birth up to adolescence. These services aim to prevent or identify health problems early, provide treatment and management for existing conditions, and support healthy growth and development.

Examples of child health services include:

1. Well-child visits: Regular checkups with a pediatrician or other healthcare provider to monitor growth, development, and overall health.
2. Immunizations: Vaccinations to protect against infectious diseases such as measles, mumps, rubella, polio, and hepatitis B.
3. Screening tests: Blood tests, hearing and vision screenings, and other diagnostic tests to identify potential health issues early.
4. Developmental assessments: Evaluations of a child's cognitive, emotional, social, and physical development to ensure they are meeting age-appropriate milestones.
5. Dental care: Preventive dental services such as cleanings, fluoride treatments, and sealants, as well as restorative care for cavities or other dental problems.
6. Mental health services: Counseling, therapy, and medication management for children experiencing emotional or behavioral challenges.
7. Nutrition counseling: Education and support to help families make healthy food choices and promote good nutrition.
8. Chronic disease management: Coordinated care for children with ongoing medical conditions such as asthma, diabetes, or cerebral palsy.
9. Injury prevention: Programs that teach parents and children about safety measures to reduce the risk of accidents and injuries.
10. Public health initiatives: Community-based programs that promote healthy lifestyles, provide access to healthcare services, and address social determinants of health such as poverty, housing, and education.

Medical fees are the charges for services provided by medical professionals and healthcare facilities. These fees can vary widely depending on the type of service, the provider, and the geographic location. They may include charges for office visits, procedures, surgeries, hospital stays, diagnostic tests, and prescribed medications. In some cases, medical fees may be covered in part or in full by health insurance, but in other cases patients may be responsible for paying these fees out of pocket. It is important for patients to understand the fees associated with their medical care and to ask questions about any charges that they do not understand.

Disproportionate Share Hospital (DSH) payments are a type of reimbursement made to hospitals by Medicare and Medicaid programs in the United States. These payments are intended to compensate hospitals for providing care to a large number of low-income and uninsured patients, who are more likely to be unable to pay for their medical expenses.

The term "disproportionate share" refers to the fact that these hospitals bear a disproportionate share of the financial burden associated with providing care to this population. DSH payments are calculated based on the hospital's proportion of low-income patients to its total patient population, and are intended to help offset the losses that hospitals incur when treating these patients.

It is important to note that while DSH payments can provide important financial support to hospitals that serve large numbers of low-income patients, they have also been subject to controversy and debate. Some critics argue that DSH payments may create incentives for hospitals to treat more low-income patients in order to receive higher payments, while others argue that the payment formula is overly complex and difficult to administer. Nonetheless, DSH payments remain an important component of the Medicare and Medicaid programs, and are critical to ensuring that hospitals can continue to provide care to all patients, regardless of their ability to pay.

Insurance claim reporting is the process of informing an insurance company about a potential claim that an insured individual or business intends to make under their insurance policy. This report typically includes details about the incident or loss, such as the date, time, location, and type of damage or injury, as well as any relevant documentation, such as police reports or medical records.

The purpose of insurance claim reporting is to initiate the claims process and provide the insurance company with the necessary information to evaluate the claim and determine coverage. The insured individual or business may be required to submit additional information or evidence to support their claim, and the insurance company will conduct an investigation to assess the validity and value of the claim.

Prompt and accurate reporting of insurance claims is important to ensure that the claim is processed in a timely manner and to avoid any potential delays or denials of coverage based on late reporting. It is also important to provide complete and truthful information during the claims process, as misrepresentations or false statements can lead to claim denials or even fraud investigations.

Personal health services refer to healthcare services that are tailored to an individual's specific needs, preferences, and goals. These services can include preventive care, such as vaccinations and screenings, as well as medical treatments for acute and chronic conditions. Personal health services may be provided by a variety of healthcare professionals, including doctors, nurses, physician assistants, and allied health professionals.

The goal of personal health services is to promote the overall health and well-being of the individual, taking into account their physical, mental, emotional, and social needs. This approach recognizes that each person is unique and requires a customized plan of care to achieve their optimal health outcomes. Personal health services may be delivered in a variety of settings, including hospitals, clinics, private practices, and long-term care facilities.

The Patient Protection and Affordable Care Act (ACA) is a comprehensive healthcare reform law passed in 2010 in the United States. Its primary goal is to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of healthcare for individuals, businesses, and government.

The ACA achieves these goals through several key provisions:

1. Individual mandate: Requires most individuals to have health insurance or pay a penalty, with some exceptions.
2. Employer mandate: Requires certain employers to offer health insurance to their employees or face penalties.
3. Insurance market reforms: Prohibits insurers from denying coverage based on pre-existing conditions, limits out-of-pocket costs, and requires coverage of essential health benefits.
4. Medicaid expansion: Expands Medicaid eligibility to cover more low-income individuals and families.
5. Health insurance exchanges: Establishes state-based marketplaces where individuals and small businesses can purchase qualified health plans.
6. Subsidies: Provides premium tax credits and cost-sharing reductions to help eligible individuals and families afford health insurance.
7. Prevention and public health fund: Invests in prevention, wellness, and public health programs.
8. Medicare reforms: Improves benefits for Medicare beneficiaries, reduces costs for some beneficiaries, and extends the solvency of the Medicare Trust Fund.

The ACA has been subject to numerous legal challenges and political debates since its passage. Despite these controversies, the law has significantly reduced the number of uninsured Americans and reshaped the U.S. healthcare system.

Health services research (HSR) is a multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to healthcare, the quality and cost of care, and ultimately, our health and well-being. The goal of HSR is to inform policy and practice, improve system performance, and enhance the health and well-being of individuals and communities. It involves the use of various research methods, including epidemiology, biostatistics, economics, sociology, management science, political science, and psychology, to answer questions about the healthcare system and how it can be improved.

Examples of HSR topics include:

* Evaluating the effectiveness and cost-effectiveness of different healthcare interventions and technologies
* Studying patient-centered care and patient experiences with the healthcare system
* Examining healthcare workforce issues, such as shortages of primary care providers or the impact of nurse-to-patient ratios on patient outcomes
* Investigating the impact of health insurance design and financing systems on access to care and health disparities
* Analyzing the organization and delivery of healthcare services in different settings, such as hospitals, clinics, and long-term care facilities
* Identifying best practices for improving healthcare quality and safety, reducing medical errors, and eliminating wasteful or unnecessary care.

Uncompensated care refers to healthcare services provided by hospitals or other healthcare providers that are not paid for by the patient or by third-party payers such as insurance companies. This can include both charity care, where services are provided for free or at reduced costs to patients who cannot afford to pay, and bad debt, where services are provided but remain unpaid because the patient is unable or unwilling to pay their bills. Uncompensated care is a significant issue for many hospitals, particularly those that serve large numbers of low-income or uninsured patients, as it can result in significant financial losses for the institution.

Cost savings in a medical context generally refers to the reduction in expenses or resources expended in the delivery of healthcare services, treatments, or procedures. This can be achieved through various means such as implementing more efficient processes, utilizing less expensive treatment options when appropriate, preventing complications or readmissions, and negotiating better prices for drugs or supplies.

Cost savings can also result from comparative effectiveness research, which compares the relative benefits and harms of different medical interventions to help doctors and patients make informed decisions about which treatment is most appropriate and cost-effective for a given condition.

Ultimately, cost savings in healthcare aim to improve the overall value of care delivered by reducing unnecessary expenses while maintaining or improving quality outcomes for patients.

I'm sorry for any confusion, but "poverty" is not a medical condition or term. It is a social condition defined by the World Bank as "pronounced deprivation in well-being," and measured through indicators such as income, consumption, and access to basic services. Poverty can have significant impacts on health outcomes and healthcare access, but it is not considered a medical diagnosis. If you have any questions related to health or medicine, I'd be happy to try my best to help answer them!

A formulary is a list of prescription drugs, both generic and brand-name, that are approved for use in a specific health plan or healthcare system. The formulary includes information on the preferred drugs within each therapeutic class, along with any restrictions or limitations on their use. Formularies are developed and maintained by a committee of healthcare professionals, including pharmacists and physicians, who evaluate the safety, efficacy, and cost-effectiveness of different medications.

The purpose of a formulary is to promote the appropriate use of medications, improve patient outcomes, and manage healthcare costs. By establishing a preferred list of drugs, health plans and healthcare systems can negotiate better prices with pharmaceutical manufacturers and ensure that patients receive high-quality, evidence-based care.

Formularies may include various types of medications, such as oral solid dosage forms, injectables, inhalants, topicals, and others. They are typically organized by therapeutic class, and each drug is assigned a tier based on its cost and clinical value. Tier 1 drugs are usually preferred generics or lower-cost brand-name medications, while Tier 2 drugs may be higher-cost brand-name medications that have no generic equivalent. Tier 3 drugs are typically specialty medications that are used to treat complex or rare conditions and are often associated with high costs.

Healthcare providers are encouraged to prescribe drugs that are listed on the formulary, as these medications have been thoroughly reviewed and deemed safe and effective for use in their patient population. However, there may be situations where a non-formulary medication is necessary to treat a particular patient's condition. In such cases, healthcare providers can request an exception or prior authorization to prescribe the non-formulary drug.

Formularies are regularly updated to reflect new drugs that come on the market, changes in clinical guidelines, and shifts in the therapeutic landscape. Health plans and healthcare systems may also modify their formularies in response to feedback from patients and providers or to address concerns about safety, efficacy, or cost.

In summary, a formulary is a comprehensive list of prescription drugs that are approved for use in a specific health plan or healthcare system. Formularies promote the appropriate use of medications, improve patient outcomes, and manage costs by encouraging the prescribing of safe and effective drugs that have been thoroughly reviewed and deemed appropriate for their patient population.

A Health Maintenance Organization (HMO) is a type of managed care organization (MCO) that provides comprehensive health care services to its members, typically for a fixed monthly premium. HMOs are characterized by a prepaid payment model and a focus on preventive care and early intervention to manage the health of their enrolled population.

In an HMO, members must choose a primary care physician (PCP) who acts as their first point of contact for medical care and coordinates all aspects of their healthcare needs within the HMO network. Specialist care is generally only covered if it is referred by the PCP, and members are typically required to obtain medical services from providers that are part of the HMO's network. This helps to keep costs down and ensures that care is coordinated and managed effectively.

HMOs may also offer additional benefits such as dental, vision, and mental health services, depending on the specific plan. However, members may face higher out-of-pocket costs if they choose to receive care outside of the HMO network. Overall, HMOs are designed to provide comprehensive healthcare coverage at a more affordable cost than traditional fee-for-service insurance plans.

The Federal Government, in the context of medical definitions, typically refers to the national government of a country that has a federal system of government. In such a system, power is divided between the national government and regional or state governments. The Federal Government is responsible for matters that affect the entire nation, such as foreign policy, national defense, and regulating interstate commerce, including certain aspects of healthcare policy and regulation.

In the United States, for example, the Federal Government plays a significant role in healthcare through programs like Medicare, Medicaid, and the Affordable Care Act (ACA), which are designed to ensure access to affordable healthcare services for specific populations or address broader health reform initiatives. The Federal Government also regulates food and drugs through agencies such as the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). These federal entities work to ensure the safety, efficacy, and security of medical products, foods, and public health.

Health care reform refers to the legislative efforts, initiatives, and debates aimed at improving the quality, affordability, and accessibility of health care services. These reforms may include changes to health insurance coverage, delivery systems, payment methods, and healthcare regulations. The goals of health care reform are often to increase the number of people with health insurance, reduce healthcare costs, and improve the overall health outcomes of a population. Examples of notable health care reform measures in the United States include the Affordable Care Act (ACA) and Medicare for All proposals.

I'm sorry for any confusion, but "Oregon" is not a medical term or concept. It is a geographical location, being the name of a state in the United States, located in the Pacific Northwest region. If you have any questions related to medical topics, I would be happy to try and help answer those for you!

I'm sorry for any confusion, but "Tennessee" is a proper noun and not a medical term or condition. It is the name of a state located in the southeastern United States. If you have any questions about medical conditions or terminology, I would be happy to help clarify those for you.

I'm not aware of any medical definition for the term "Florida." It is primarily used to refer to a state in the United States located in the southeastern region. If you have any specific medical context in which this term was used, please let me know and I will do my best to provide a relevant answer.

I'm sorry for any confusion, but "Maryland" is a proper noun and does not have a medical definition. It is a state located in the Mid-Atlantic region of the United States. However, if you are referring to a specific medical term or concept that includes "Maryland," could you please provide more context? I'll do my best to help with accurate information based on the provided context.

A nursing home, also known as a skilled nursing facility, is a type of residential healthcare facility that provides round-the-clock care and assistance to individuals who require a high level of medical care and support with activities of daily living. Nursing homes are designed for people who cannot be cared for at home or in an assisted living facility due to their complex medical needs, mobility limitations, or cognitive impairments.

Nursing homes provide a range of services, including:

1. Skilled nursing care: Registered nurses and licensed practical nurses provide 24-hour medical care and monitoring for residents with chronic illnesses, disabilities, or those recovering from surgery or illness.
2. Rehabilitation services: Physical, occupational, and speech therapists help residents regain strength, mobility, and communication skills after an injury, illness, or surgery.
3. Personal care: Certified nursing assistants (CNAs) help residents with activities of daily living, such as bathing, dressing, grooming, and using the bathroom.
4. Meals and nutrition: Nursing homes provide three meals a day, plus snacks, and accommodate special dietary needs.
5. Social activities: Recreational programs and social events are organized to help residents stay active and engaged with their peers.
6. Hospice care: Some nursing homes offer end-of-life care for residents who require palliative or comfort measures.
7. Secure environments: For residents with memory impairments, specialized units called memory care or Alzheimer's units provide a secure and structured environment to help maintain their safety and well-being.

When selecting a nursing home, it is essential to consider factors such as the quality of care, staff-to-resident ratio, cleanliness, and overall atmosphere to ensure the best possible experience for the resident.

Health care surveys are research tools used to systematically collect information from a population or sample regarding their experiences, perceptions, and knowledge of health services, health outcomes, and various other health-related topics. These surveys typically consist of standardized questionnaires that cover specific aspects of healthcare, such as access to care, quality of care, patient satisfaction, health disparities, and healthcare costs. The data gathered from health care surveys are used to inform policy decisions, improve healthcare delivery, identify best practices, allocate resources, and monitor the health status of populations. Health care surveys can be conducted through various modes, including in-person interviews, telephone interviews, mail-in questionnaires, or online platforms.

In medical terminology, a budget is not explicitly defined. However, in a general sense, it refers to a financial plan that outlines the anticipated costs and expenses for a specific period. In healthcare, budgets can be used by hospitals, clinics, or other medical facilities to plan for and manage their finances.

A healthcare organization's budget may include expenses related to:

* Salaries and benefits for staff
* Equipment and supply costs
* Facility maintenance and improvements
* Research and development expenses
* Insurance and liability coverage
* Marketing and advertising costs

Budgets can help healthcare organizations manage their finances effectively, allocate resources efficiently, and make informed decisions about spending. They may also be used to plan for future growth and expansion.

Health policy refers to a set of decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a population. It is formulated by governmental and non-governmental organizations with the objective of providing guidance and direction for the management and delivery of healthcare services. Health policies address various aspects of healthcare, including access, financing, quality, and equity. They can be designed to promote health, prevent disease, and provide treatment and rehabilitation services to individuals who are sick or injured. Effective health policies require careful consideration of scientific evidence, ethical principles, and societal values to ensure that they meet the needs of the population while being fiscally responsible.

I apologize for any confusion, but "Arkansas" is a proper noun and refers to a state in the United States. It does not have a medical definition. Arkansas is located in the southern region of the U.S. and is known for its diverse geography, which includes mountains, forests, and lowlands. The capital and largest city of Arkansas is Little Rock.

If you have any questions related to health or medicine, I would be happy to try to help answer them.

Health care costs refer to the expenses incurred for medical services, treatments, procedures, and products that are used to maintain or restore an individual's health. These costs can be categorized into several types:

1. Direct costs: These include payments made for doctor visits, hospital stays, medications, diagnostic tests, surgeries, and other medical treatments and services. Direct costs can be further divided into two subcategories:
* Out-of-pocket costs: Expenses paid directly by patients, such as co-payments, deductibles, coinsurance, and any uncovered medical services or products.
* Third-party payer costs: Expenses covered by insurance companies, government programs (like Medicare, Medicaid), or other entities that pay for health care services on behalf of patients.
2. Indirect costs: These are the expenses incurred as a result of illness or injury that indirectly impact an individual's ability to work and earn a living. Examples include lost productivity, absenteeism, reduced earning capacity, and disability benefits.
3. Non-medical costs: These are expenses related to caregiving, transportation, home modifications, assistive devices, and other non-medical services required for managing health conditions or disabilities.

Health care costs can vary significantly depending on factors such as the type of medical service, geographic location, insurance coverage, and individual health status. Understanding these costs is essential for patients, healthcare providers, policymakers, and researchers to make informed decisions about treatment options, resource allocation, and health system design.

Pharmaceutical services insurance refers to a type of coverage that helps individuals and families pay for their prescription medications. This type of insurance is often offered as part of a larger health insurance plan, but can also be purchased as a standalone policy.

The specifics of pharmaceutical services insurance coverage can vary widely depending on the policy. Some plans may cover only generic medications, while others may cover both brand-name and generic drugs. Additionally, some policies may require individuals to pay a portion of the cost of their prescriptions in the form of copays or coinsurance, while others may cover the full cost of medications.

Pharmaceutical services insurance can be especially important for individuals who have chronic medical conditions that require ongoing treatment with expensive prescription medications. By helping to offset the cost of these medications, pharmaceutical services insurance can make it easier for people to afford the care they need to manage their health and improve their quality of life.

Hospital economics refers to the study and application of economic principles and concepts in the management and operation of hospitals and healthcare organizations. This field examines issues such as cost containment, resource allocation, financial management, reimbursement systems, and strategic planning. The goal of hospital economics is to improve the efficiency and effectiveness of hospital operations while maintaining high-quality patient care. It involves understanding and analyzing various economic factors that affect hospitals, including government regulations, market forces, technological advancements, and societal values. Hospital economists may work in a variety of settings, including hospitals, consulting firms, academic institutions, and government agencies.

I'm sorry for any confusion, but "New Jersey" is not a medical term or concept. It is a state located in the Mid-Atlantic region of the United States. If you have any questions about medical terminology or concepts, I would be happy to help!

"Drug costs" refer to the amount of money that must be paid to acquire and use a particular medication. These costs can include the following:

1. The actual purchase price of the drug, which may vary depending on factors such as the dosage form, strength, and quantity of the medication, as well as whether it is obtained through a retail pharmacy, mail-order service, or other distribution channel.
2. Any additional fees or charges associated with obtaining the drug, such as shipping and handling costs, insurance copayments or coinsurance amounts, and deductibles.
3. The cost of any necessary medical services or supplies that are required to administer the drug, such as syringes, needles, or alcohol swabs for injectable medications, or nebulizers for inhaled drugs.
4. The cost of monitoring and managing any potential side effects or complications associated with the use of the drug, which may include additional medical appointments, laboratory tests, or other diagnostic procedures.

It is important to note that drug costs can vary widely depending on a variety of factors, including the patient's insurance coverage, the pharmacy where the drug is obtained, and any discounts or rebates that may be available. Patients are encouraged to shop around for the best prices and to explore all available options for reducing their out-of-pocket costs, such as using generic medications or participating in manufacturer savings programs.

I'm sorry for any confusion, but "North Carolina" is a geographical location and not a medical term or condition. It is a state located in the southeastern region of the United States. If you have any questions about medical terms or conditions, I'd be happy to help with those!

I'm sorry for any confusion, but "New York" is not a medical term or concept. New York refers to a state in the United States, as well as its largest city. If you have any questions about medical terminology or concepts, I would be happy to help with those!

Dental care for children, also known as pediatric dentistry, is a branch of dentistry that focuses on the oral health of children from infancy through adolescence. The medical definition of dental care for children includes:

1. Preventive Dentistry: This involves regular dental check-ups, professional cleaning, fluoride treatments, and sealants to prevent tooth decay and other dental diseases. Parents are also educated on proper oral hygiene practices for their children, including brushing, flossing, and dietary habits.
2. Restorative Dentistry: If a child develops cavities or other dental problems, restorative treatments such as fillings, crowns, or pulpotomies (baby root canals) may be necessary to restore the health and function of their teeth.
3. Orthodontic Treatment: Many children require orthodontic treatment to correct misaligned teeth or jaws. Early intervention can help guide proper jaw development and prevent more severe issues from developing later on.
4. Habit Counseling: Dental care for children may also involve habit counseling, such as helping a child stop thumb sucking or pacifier use, which can negatively impact their oral health.
5. Sedation and Anesthesia: For children who are anxious about dental procedures or have special needs, sedation or anesthesia may be used to ensure their comfort and safety during treatment.
6. Emergency Care: Dental care for children also includes emergency care for injuries such as knocked-out teeth, broken teeth, or severe toothaches. Prompt attention is necessary to prevent further damage and alleviate pain.
7. Education and Prevention: Finally, dental care for children involves educating parents and children about the importance of good oral hygiene practices and regular dental check-ups to maintain optimal oral health throughout their lives.

Insurance benefits refer to the coverage, payments or services that a health insurance company provides to its policyholders based on the terms of their insurance plan. These benefits can include things like:

* Payment for all or a portion of medical services, such as doctor visits, hospital stays, and prescription medications
* Coverage for specific treatments or procedures, such as cancer treatment or surgery
* Reimbursement for out-of-pocket expenses, such as deductibles, coinsurance, and copayments
* Case management and care coordination services to help policyholders navigate the healthcare system and receive appropriate care.

The specific benefits provided will vary depending on the type of insurance plan and the level of coverage purchased by the policyholder. It is important for individuals to understand their insurance benefits and how they can access them in order to make informed decisions about their healthcare.

I'm sorry for any confusion, but "Michigan" is not a medical term or concept. It is a geographical location, referring to the state of Michigan in the United States. If you have any questions related to medical topics, I would be happy to try and help answer those for you!

"California" is a geographical location and does not have a medical definition. It is a state located on the west coast of the United States, known for its diverse landscape including mountains, beaches, and forests. However, in some contexts, "California" may refer to certain medical conditions or situations that are associated with the state, such as:

* California encephalitis: a viral infection transmitted by mosquitoes that is common in California and other western states.
* California king snake: a non-venomous snake species found in California and other parts of the southwestern United States, which can bite and cause allergic reactions in some people.
* California roll: a type of sushi roll that originated in California and is made with avocado, cucumber, and crab meat, which may pose an allergy risk for some individuals.

It's important to note that these uses of "California" are not medical definitions per se, but rather descriptive terms that refer to specific conditions or situations associated with the state.

I apologize for the confusion, but "inflation" is an economic term and not a medical one. Here's a simple explanation of what it means:

Economic inflation is a rise in the general price level of goods and services in an economy over a period of time. When the overall prices of these items increase, each unit of currency buys fewer goods and services; consequently, inflation reflects a reduction in the purchasing power of money – a loss of real value in the medium of exchange and unit of account within an economic system. This is typically measured by the Consumer Price Index (CPI) or the Producer Price Index (PPI), and central banks attempt to limit inflation, and avoid deflation, in order to keep the economy running smoothly.

Medicare Assignment is a term used in the United States healthcare system that refers to an agreement between healthcare providers (such as doctors, clinics, or hospitals) and the Medicare program. When a provider accepts assignment, they agree to accept the Medicare-approved amount as payment in full for covered services provided to Medicare beneficiaries. This means that the provider cannot charge patients more than the Medicare deductible and coinsurance amounts for those services.

For beneficiaries, accepting Medicare Assignment offers several advantages:

1. Predictable costs: Beneficiaries only need to pay their designated share (deductibles and coinsurances) of the Medicare-approved amount for covered services. Providers cannot bill them for any additional amounts beyond this.
2. No surprise bills: With providers accepting assignment, beneficiaries are protected from receiving unexpected or balance bills for more than the Medicare-approved amount.
3. Easier claims processing: When using an assigned provider, Medicare directly pays the provider, and the patient only needs to pay their share of the costs. This simplifies the claims process and reduces administrative burdens for beneficiaries.

Providers also benefit from accepting Medicare Assignment as they receive timely payments from Medicare without having to chase down payments or deal with complex billing issues. However, providers may choose not to accept assignment in certain situations, which could potentially result in higher out-of-pocket costs for beneficiaries.

"Reimbursement, Incentive" is not a standard medical term, but I can provide an explanation based on the individual terms:

1. Reimbursement: This refers to the act of paying back or giving compensation for expenses that have already been incurred. In a medical context, this often relates to insurance companies reimbursing patients or healthcare providers for the costs of medical services or supplies after they have been paid.
2. Incentive: An incentive is a motivating factor that encourages someone to do something. In healthcare, incentives can be used to encourage patients to make healthier choices or to participate in certain programs. They can also be used to motivate healthcare providers to follow best practices or to improve the quality of care they provide.

Therefore, "Reimbursement, Incentive" could refer to a payment made after the fact to compensate for expenses incurred, with the added intention of encouraging certain behaviors or actions. For example, an insurance company might offer to reimburse patients for the cost of gym memberships as an incentive to encourage them to exercise regularly.

I'm sorry for any confusion, but "Maine" is not a medical term or concept. It is actually the name of a state, the 23rd state to join the United States of America. Maine is located in the northeastern part of the country and is known for its rocky coastline, maritime history, and natural beauty. If you have any questions about medical terms or concepts, I'd be happy to help answer those!

"Financial Risk Sharing" in a medical context generally refers to the allocation of financial risk between parties involved in the provision, financing, or coverage of healthcare services. This can include arrangements such as capitation payments, where healthcare providers receive a set amount of money per patient enrolled in their care, regardless of the number of services provided; or reinsurance, where insurance companies share the risk of large claims with other insurers. The goal of financial risk sharing is to create incentives for efficient and cost-effective care while also protecting against unexpectedly high costs.

In the context of medical law and ethics, fraud refers to a deliberate and intentional deception or misrepresentation of facts, motivated by personal gain, which is made by a person or entity in a position of trust, such as a healthcare professional or organization. This deception can occur through various means, including the provision of false information, the concealment of important facts, or the manipulation of data.

Medical fraud can take many forms, including:

1. Billing fraud: This occurs when healthcare providers submit false claims to insurance companies or government programs like Medicare and Medicaid for services that were not provided, were unnecessary, or were more expensive than the services actually rendered.
2. Prescription fraud: Healthcare professionals may engage in prescription fraud by writing unnecessary prescriptions for controlled substances, such as opioids, for their own use or to sell on the black market. They may also alter prescriptions or use stolen identities to obtain these drugs.
3. Research fraud: Scientists and researchers can commit fraud by manipulating or falsifying data in clinical trials, experiments, or studies to support predetermined outcomes or to secure funding and recognition.
4. Credentialing fraud: Healthcare professionals may misrepresent their qualifications, licenses, or certifications to gain employment or admitting privileges at healthcare facilities.
5. Identity theft: Stealing someone's personal information to obtain medical services, prescription medications, or insurance benefits is another form of medical fraud.

Medical fraud not only has severe legal consequences for those found guilty but also undermines the trust between patients and healthcare providers, jeopardizes patient safety, and contributes to rising healthcare costs.

"Social welfare" is a broad concept and not a medical term per se, but it is often discussed in the context of public health and medical social work. Here's a definition related to those fields:

Social welfare refers to the programs, services, and benefits provided by governmental and non-governmental organizations to promote the well-being of individuals, families, and communities, with a particular focus on meeting basic needs, protecting vulnerable populations, and enhancing social and economic opportunities. These efforts aim to improve overall quality of life, reduce health disparities, and strengthen the social determinants of health.

Examples of social welfare programs include Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), Medicaid, Section 8 housing assistance, and various community-based services such as mental health counseling, substance abuse treatment, and home healthcare.

In the medical field, social workers often play a crucial role in connecting patients to available social welfare resources to address various psychosocial needs that can impact their health outcomes.

"Medical Assistance" is a term used in the United States that primarily refers to government-funded health care programs for individuals who are unable to afford medical care on their own. The most well-known program is Medicaid, which is a joint federal-state program that provides health coverage for low-income individuals, including children, pregnant women, elderly adults, and people with disabilities.

Medical Assistance can also refer to other government-funded programs that provide financial assistance for medical care, such as the Children's Health Insurance Program (CHIP), which provides low-cost health insurance for children in families who earn too much to qualify for Medicaid but still cannot afford private insurance.

In general, Medical Assistance programs are designed to help ensure that all individuals have access to necessary medical care, regardless of their ability to pay. These programs are funded through a combination of federal and state funds, and eligibility criteria and benefits may vary from state to state.

A Drug Utilization Review (DUR) is a systematic retrospective examination of a patient's current and past use of medications to identify medication-related problems, such as adverse drug reactions, interactions, inappropriate dosages, duplicate therapy, and noncompliance with the treatment plan. The goal of DUR is to optimize medication therapy, improve patient outcomes, reduce healthcare costs, and promote safe and effective use of medications.

DUR is typically conducted by pharmacists, physicians, or other healthcare professionals who review medication records, laboratory results, and clinical data to identify potential issues and make recommendations for changes in medication therapy. DUR may be performed manually or using automated software tools that can analyze large datasets of medication claims and electronic health records.

DUR is an important component of medication management programs in various settings, including hospitals, long-term care facilities, managed care organizations, and ambulatory care clinics. It helps ensure that patients receive the right medications at the right doses for the right indications, and reduces the risk of medication errors and adverse drug events.

I am not a medical professional, but I can tell you that the term "contract services" is more commonly used in business and healthcare administration than in clinical medicine. It generally refers to an agreement between a healthcare provider or organization and another entity for the delivery of specific medical services over a defined period of time. The contract outlines the scope, expectations, and compensation for these services.

For example, a hospital may have a contract with a staffing agency to provide nursing personnel on a temporary basis. Or, an insurance company might have a contract with a network of healthcare providers to deliver medical care to their policyholders at agreed-upon rates. These arrangements can help ensure consistent quality and cost control in the delivery of healthcare services.

A fee schedule in a medical context refers to a list of fees that healthcare providers charge for various procedures, services, or treatments. It is essentially a price list that outlines the cost of each service offered by the healthcare provider. Fee schedules can be established by individual practitioners, hospitals, clinics, or insurance networks and may vary based on factors such as location, specialty, and complexity of the procedure.

In some cases, fee schedules are negotiated between healthcare providers and insurance companies to determine the allowed amount for reimbursement. This helps ensure that patients receive consistent and predictable pricing for medical services while also allowing healthcare providers to maintain a sustainable practice. Additionally, fee schedules can help patients understand their financial responsibilities before undergoing medical procedures or treatments.

Cost sharing in a medical or healthcare context refers to the portion of health care costs that are paid by the patient or health plan member, rather than by their insurance company. Cost sharing can take various forms, including deductibles, coinsurance, and copayments.

A deductible is the amount that a patient must pay out of pocket for medical services before their insurance coverage kicks in. For example, if a health plan has a $1,000 deductible, the patient must pay the first $1,000 of their medical expenses before their insurance starts covering costs.

Coinsurance is the percentage of medical costs that a patient is responsible for paying after they have met their deductible. For example, if a health plan has 20% coinsurance, the patient would pay 20% of the cost of medical services, and their insurance would cover the remaining 80%.

Copayments are fixed amounts that patients must pay for specific medical services, such as doctor visits or prescription medications. Copayments are typically paid at the time of service and do not count towards a patient's deductible.

Cost sharing is intended to encourage patients to be more cost-conscious in their use of healthcare services, as they have a financial incentive to seek out lower-cost options. However, high levels of cost sharing can also create barriers to accessing necessary medical care, particularly for low-income individuals and families.

Long-term care (LTC) is a term used to describe various medical and support services that are required by individuals who need assistance with activities of daily living (such as bathing, dressing, using the toilet) or who have chronic health conditions that require ongoing supervision and care. LTC can be provided in a variety of settings, including nursing homes, assisted living facilities, adult day care centers, and private homes.

The goal of LTC is to help individuals maintain their independence and quality of life for as long as possible, while also ensuring that they receive the necessary medical and support services to meet their needs. LTC can be provided on a short-term or long-term basis, depending on the individual's needs and circumstances.

LTC is often required by older adults who have physical or cognitive limitations, but it can also be needed by people of any age who have disabilities or chronic illnesses that require ongoing care. LTC services may include nursing care, therapy (such as occupational, physical, or speech therapy), personal care (such as help with bathing and dressing), and social activities.

LTC is typically not covered by traditional health insurance plans, but it may be covered by long-term care insurance policies, Medicaid, or other government programs. It's important to plan for LTC needs well in advance, as the cost of care can be significant and can have a major impact on an individual's financial resources.

I'm sorry for any confusion, but "Ohio" is not a medical term or condition. It is the name of a state located in the Midwestern region of the United States. If you have any questions about medical conditions or terms, I would be happy to help answer those!

Physician services insurance refers to a type of health insurance coverage that helps pay for medically necessary services provided by licensed physicians. This can include office visits, hospital care, diagnostic tests, and treatments for injuries and illnesses. The specific services covered and the amount reimbursed will depend on the terms of the individual's insurance policy. Some policies may also have restrictions on which providers are considered in-network and covered under the plan. It is important to understand the details of one's coverage to know what is included and what out-of-pocket costs may be required.

I'm not aware of a specific medical definition for "Legislation, Hospital." However, I can provide some information related to legislation that affects hospitals and the healthcare industry.

Healthcare legislation refers to laws, regulations, and policies that govern the delivery, financing, and regulation of healthcare services. These laws have a significant impact on hospitals, as they set standards for patient care, establish guidelines for reimbursement, and shape the overall healthcare system. Some examples of major federal healthcare legislation in the United States include:

1. The Social Security Act (1935): Established the framework for federal involvement in healthcare, including funding for public health programs and income support for vulnerable populations.
2. The Hill-Burton Act (1946): Provided federal funding to construct and modernize hospitals, with a requirement that they provide a certain amount of free or reduced-cost care to uninsured patients.
3. The Medicare Act (1965): Created the federal health insurance program for people aged 65 and older, as well as some younger individuals with disabilities. This legislation significantly expanded access to healthcare services for millions of Americans.
4. The Medicaid Act (1965): Established a joint federal-state program that provides health insurance coverage for low-income individuals and families.
5. The Patient Protection and Affordable Care Act (ACA, 2010): Expanded healthcare coverage to millions of uninsured Americans through the creation of state-based health insurance marketplaces, Medicaid expansion, and various insurance reforms.

Hospitals must comply with these laws and regulations, which can impact their operations, finances, and patient care delivery. Additionally, hospitals may also be subject to state and local healthcare legislation that further shapes the regulatory environment in which they operate.

"Public assistance" is a term used in the field of social welfare and public health to refer to government programs that provide financial aid, food, housing, or other necessary resources to individuals and families who are experiencing economic hardship or have limited means to meet their basic needs. These programs are funded by taxpayers' dollars and are administered at the federal, state, or local level. Examples of public assistance programs include Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), Medicaid, and Section 8 housing vouchers. The goal of public assistance is to help individuals and families achieve self-sufficiency and improve their overall well-being.

Quality of health care is a term that refers to the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. It encompasses various aspects such as:

1. Clinical effectiveness: The use of best available evidence to make decisions about prevention, diagnosis, treatment, and care. This includes considering the benefits and harms of different options and making sure that the most effective interventions are used.
2. Safety: Preventing harm to patients and minimizing risks associated with healthcare. This involves identifying potential hazards, implementing measures to reduce errors, and learning from adverse events to improve systems and processes.
3. Patient-centeredness: Providing care that is respectful of and responsive to individual patient preferences, needs, and values. This includes ensuring that patients are fully informed about their condition and treatment options, involving them in decision-making, and providing emotional support throughout the care process.
4. Timeliness: Ensuring that healthcare services are delivered promptly and efficiently, without unnecessary delays. This includes coordinating care across different providers and settings to ensure continuity and avoid gaps in service.
5. Efficiency: Using resources wisely and avoiding waste, while still providing high-quality care. This involves considering the costs and benefits of different interventions, as well as ensuring that healthcare services are equitably distributed.
6. Equitability: Ensuring that all individuals have access to quality healthcare services, regardless of their socioeconomic status, race, ethnicity, gender, age, or other factors. This includes addressing disparities in health outcomes and promoting fairness and justice in healthcare.

Overall, the quality of health care is a multidimensional concept that requires ongoing evaluation and improvement to ensure that patients receive the best possible care.

Data collection in the medical context refers to the systematic gathering of information relevant to a specific research question or clinical situation. This process involves identifying and recording data elements, such as demographic characteristics, medical history, physical examination findings, laboratory results, and imaging studies, from various sources including patient interviews, medical records, and diagnostic tests. The data collected is used to support clinical decision-making, inform research hypotheses, and evaluate the effectiveness of treatments or interventions. It is essential that data collection is performed in a standardized and unbiased manner to ensure the validity and reliability of the results.

I'm sorry for any confusion, but "Kentucky" is not a medical term or condition. It is a geographical location, being the name of a state in the United States. If you have any questions related to medical conditions or terminology, I would be happy to try and help answer those for you!

'Government Financing' in the context of healthcare refers to the role of government in funding healthcare services, programs, and infrastructure. This can be achieved through various mechanisms such as:

1. Direct provision of healthcare services: The government operates and funds its own hospitals, clinics, and other healthcare facilities, where it employs healthcare professionals to deliver care.
2. Public insurance programs: The government establishes and manages health insurance programs, like Medicare and Medicaid in the United States, which provide coverage for specific populations and reimburse healthcare providers for services delivered to enrollees.
3. Tax subsidies and incentives: Governments may offer tax breaks or other financial incentives to encourage private investments in healthcare infrastructure, research, and development.
4. Grants and loans: Government agencies can provide funding to healthcare organizations, researchers, and educational institutions in the form of grants and loans for specific projects, programs, or initiatives.
5. Public-private partnerships (PPPs): Governments collaborate with private entities to jointly fund and manage healthcare services, facilities, or infrastructure projects.

Government financing plays a significant role in shaping healthcare systems and ensuring access to care for vulnerable populations. The extent of government involvement in financing varies across countries, depending on their political, economic, and social contexts.

Utilization review (UR) is a comprehensive process used by healthcare insurance companies to evaluate the medical necessity, appropriateness, and efficiency of the healthcare services and treatments that have been rendered, are currently being provided, or are being recommended for members. The primary goal of utilization review is to ensure that patients receive clinically necessary and cost-effective care while avoiding unnecessary or excessive treatments.

The utilization review process may involve various steps, including:

1. Preauthorization (also known as precertification): A prospective review to approve or deny coverage for specific services, procedures, or treatments before they are provided. This step helps ensure that the planned care aligns with evidence-based guidelines and medical necessity criteria.
2. Concurrent review: An ongoing evaluation of a patient's treatment during their hospital stay or course of therapy to determine if the services remain medically necessary and consistent with established clinical pathways.
3. Retrospective review: A retrospective analysis of healthcare services already provided to assess their medical necessity, appropriateness, and quality. This step may lead to adjustments in reimbursement or require the provider to justify the rendered services.

Utilization review is typically conducted by a team of healthcare professionals, including physicians, nurses, and case managers, who apply their clinical expertise and adhere to established criteria and guidelines. The process aims to promote high-quality care, reduce wasteful spending, and safeguard patients from potential harm caused by inappropriate or unnecessary treatments.

Cost allocation is the process of distributing or assigning costs to different departments, projects, products, or services within an organization. The goal of cost allocation is to more accurately determine the true cost of producing a product or providing a service, taking into account all related expenses. This can help organizations make better decisions about pricing, resource allocation, and profitability analysis.

There are various methods for allocating costs, including activity-based costing (ABC), which assigns costs based on the activities required to produce a product or provide a service; traditional costing, which uses broad categories such as direct labor, direct materials, and overhead; and causal allocation, which assigns costs based on a specific cause-and-effect relationship.

In healthcare, cost allocation is particularly important for determining the true cost of patient care, including both direct and indirect costs. This can help hospitals and other healthcare organizations make informed decisions about resource allocation, pricing, and reimbursement strategies.

Drug utilization refers to the use of medications by patients or healthcare professionals in a real-world setting. It involves analyzing and evaluating patterns of medication use, including prescribing practices, adherence to treatment guidelines, potential duplications or interactions, and outcomes associated with drug therapy. The goal of drug utilization is to optimize medication use, improve patient safety, and minimize costs while achieving the best possible health outcomes. It can be studied through various methods such as prescription claims data analysis, surveys, and clinical audits.

Health services needs refer to the population's requirement for healthcare services based on their health status, disease prevalence, and clinical guidelines. These needs can be categorized into normative needs (based on expert opinions or clinical guidelines) and expressed needs (based on individuals' perceptions of their own healthcare needs).

On the other hand, health services demand refers to the quantity of healthcare services that consumers are willing and able to pay for, given their preferences, values, and financial resources. Demand is influenced by various factors such as price, income, education level, and cultural beliefs.

It's important to note that while needs represent a population's requirement for healthcare services, demand reflects the actual utilization of these services. Understanding both health services needs and demand is crucial in planning and delivering effective healthcare services that meet the population's requirements while ensuring efficient resource allocation.

I'm sorry for any confusion, but "South Carolina" is a geographical location and not a medical term or condition. It is a state located in the southeastern region of the United States. If you have any questions about medical conditions or terminology, I would be happy to help clarify those for you.

Diagnosis-Related Groups (DRGs) are a system of classifying hospital patients based on their severity of illness, resource utilization, and other factors. DRGs were developed by the US federal government to determine the relative cost of providing inpatient care for various types of diagnoses and procedures.

The DRG system categorizes patients into one of several hundred groups based on their diagnosis, treatment, and other clinical characteristics. Each DRG has a corresponding payment weight that reflects the average resource utilization and costs associated with caring for patients in that group. Hospitals are then reimbursed for inpatient services based on the DRG payment weights, providing an incentive to provide more efficient and cost-effective care.

DRGs have been widely adopted as a tool for managing healthcare costs and improving quality of care. They are used by Medicare, Medicaid, and many private insurers to determine payments for inpatient hospital services. DRGs can also be used to compare the performance of hospitals and healthcare providers, identify best practices, and support quality improvement initiatives.

Case management is a collaborative process that involves the assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's health needs through communication and available resources to promote patient safety, quality of care, and cost-effective outcomes. It is commonly used in healthcare settings such as hospitals, clinics, and long-term care facilities to ensure that patients receive appropriate and timely care while avoiding unnecessary duplication of services and managing costs.

The goal of case management is to help patients navigate the complex healthcare system, improve their health outcomes, and enhance their quality of life by coordinating all aspects of their care, including medical treatment, rehabilitation, social support, and community resources. Effective case management requires a team-based approach that involves the active participation of the patient, family members, healthcare providers, and other stakeholders in the decision-making process.

The specific duties and responsibilities of a case manager may vary depending on the setting and population served, but typically include:

1. Assessment: Conducting comprehensive assessments to identify the patient's medical, psychosocial, functional, and environmental needs.
2. Planning: Developing an individualized care plan that outlines the goals, interventions, and expected outcomes of the patient's care.
3. Facilitation: Coordinating and facilitating the delivery of services and resources to meet the patient's needs, including arranging for appointments, tests, procedures, and referrals to specialists or community agencies.
4. Care coordination: Ensuring that all members of the healthcare team are aware of the patient's care plan and providing ongoing communication and support to ensure continuity of care.
5. Evaluation: Monitoring the patient's progress towards their goals, adjusting the care plan as needed, and evaluating the effectiveness of interventions.
6. Advocacy: Advocating for the patient's rights and needs, including access to healthcare services, insurance coverage, and community resources.

Overall, case management is a critical component of high-quality healthcare that helps patients achieve their health goals while managing costs and improving their overall well-being.

Prenatal care is a type of preventive healthcare that focuses on providing regular check-ups and medical care to pregnant women, with the aim of ensuring the best possible health outcomes for both the mother and the developing fetus. It involves routine prenatal screenings and tests, such as blood pressure monitoring, urine analysis, weight checks, and ultrasounds, to assess the progress of the pregnancy and identify any potential health issues or complications early on.

Prenatal care also includes education and counseling on topics such as nutrition, exercise, and lifestyle choices that can affect pregnancy outcomes. It may involve referrals to specialists, such as obstetricians, perinatologists, or maternal-fetal medicine specialists, for high-risk pregnancies.

Overall, prenatal care is an essential component of ensuring a healthy pregnancy and reducing the risk of complications during childbirth and beyond.

According to the World Health Organization (WHO), "disabled persons" are those who have long-term physical, mental, intellectual or sensory impairments which may hinder their participation in society on an equal basis with others. The term "disability" is not meant to be understood as a 'personal tragedy' but rather as a complex interaction between the features of a person's body and mind, the activities they wish to perform and the physical and social barriers they encounter in their environment.

It's important to note that the term 'disabled persons' has been largely replaced by 'people with disabilities' or 'persons with disabilities' in many contexts, as it is considered more respectful and empowering to put the person first, rather than focusing on their disability. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) uses the term "persons with disabilities" throughout its text.

Costs refer to the total amount of resources, such as money, time, and labor, that are expended in the provision of a medical service or treatment. Costs can be categorized into direct costs, which include expenses directly related to patient care, such as medication, supplies, and personnel; and indirect costs, which include overhead expenses, such as rent, utilities, and administrative salaries.

Cost analysis is the process of estimating and evaluating the total cost of a medical service or treatment. This involves identifying and quantifying all direct and indirect costs associated with the provision of care, and analyzing how these costs may vary based on factors such as patient volume, resource utilization, and reimbursement rates.

Cost analysis is an important tool for healthcare organizations to understand the financial implications of their operations and make informed decisions about resource allocation, pricing strategies, and quality improvement initiatives. It can also help policymakers and payers evaluate the cost-effectiveness of different treatment options and develop evidence-based guidelines for clinical practice.

A drug prescription is a written or electronic order provided by a licensed healthcare professional, such as a physician, dentist, or advanced practice nurse, to a pharmacist that authorizes the preparation and dispensing of a specific medication for a patient. The prescription typically includes important information such as the patient's name and date of birth, the name and strength of the medication, the dosage regimen, the duration of treatment, and any special instructions or precautions.

Prescriptions serve several purposes, including ensuring that patients receive the appropriate medication for their medical condition, preventing medication errors, and promoting safe and effective use of medications. They also provide a legal record of the medical provider's authorization for the pharmacist to dispense the medication to the patient.

There are two main types of prescriptions: written prescriptions and electronic prescriptions. Written prescriptions are handwritten or printed on paper, while electronic prescriptions are transmitted electronically from the medical provider to the pharmacy. Electronic prescriptions are becoming increasingly common due to their convenience, accuracy, and security.

It is important for patients to follow the instructions provided on their prescription carefully and to ask their healthcare provider or pharmacist any questions they may have about their medication. Failure to follow a drug prescription can result in improper use of the medication, which can lead to adverse effects, treatment failure, or even life-threatening situations.

Retrospective studies, also known as retrospective research or looking back studies, are a type of observational study that examines data from the past to draw conclusions about possible causal relationships between risk factors and outcomes. In these studies, researchers analyze existing records, medical charts, or previously collected data to test a hypothesis or answer a specific research question.

Retrospective studies can be useful for generating hypotheses and identifying trends, but they have limitations compared to prospective studies, which follow participants forward in time from exposure to outcome. Retrospective studies are subject to biases such as recall bias, selection bias, and information bias, which can affect the validity of the results. Therefore, retrospective studies should be interpreted with caution and used primarily to generate hypotheses for further testing in prospective studies.

The Health Care Sector is a segment of the economy that includes companies and organizations that provide goods and services to treat patients with medical conditions, as well as those that work to maintain people's health through preventative care and health education. This sector includes hospitals, clinics, physician practices, dental practices, pharmacies, home health care agencies, nursing homes, laboratories, and medical device manufacturers, among others.

The Health Care Sector is often broken down into several subsectors, including:

1. Providers of healthcare services, such as hospitals, clinics, and physician practices.
2. Payers of healthcare costs, such as insurance companies and government agencies like Medicare and Medicaid.
3. Manufacturers of healthcare products, such as medical devices, pharmaceuticals, and biotechnology products.
4. Distributors of healthcare products, such as wholesalers and pharmacy benefit managers.
5. Providers of healthcare information technology, such as electronic health record systems and telemedicine platforms.

The Health Care Sector is a significant contributor to the economy in many countries, providing employment opportunities and contributing to economic growth. However, it also faces significant challenges, including rising costs, an aging population, and increasing demands for access to high-quality care.

In the context of medicine, the term "ownership" is not typically used as a formal medical definition. However, it may be used informally to refer to the responsibility and authority that a healthcare provider has in managing a patient's care. For example, a physician may say that they "take ownership" of a patient's care, meaning that they will oversee and coordinate all aspects of the patient's medical treatment. Additionally, in medical research or clinical trials, "data ownership" refers to who has the rights to access, use, and share the data collected during the study.

I'm sorry for any confusion, but "Models, Econometric" is not a medical term. Econometric models are statistical tools used in the field of economics to estimate economic relationships and forecast future outcomes. They are based on economic theory and use historical data to estimate the parameters of mathematical equations that describe these relationships.

If you have any questions about medical terms or concepts, I'd be happy to try to help! Just let me know what you're looking for.

I'm sorry for any confusion, but "Massachusetts" is not a medical term. It is the name of a state located in the northeastern region of the United States. If you have any questions about medical terms or concepts, I would be happy to help clarify those for you.

Healthcare disparities refer to differences in the quality, accessibility, and outcomes of healthcare that are systematically related to social or economic disadvantage. These disparities may exist between different racial, ethnic, socioeconomic, gender, sexual orientation, geographic, or disability status groups. They can result from a complex interplay of factors including provider bias, patient-provider communication, health system policies, and structural racism, among others. Healthcare disparities often lead to worse health outcomes and reduced quality of life for disadvantaged populations.

Medical legislation refers to laws and regulations that govern the practice of medicine and related healthcare fields. These laws are established by federal, state, or local governments to ensure that medical professionals provide safe, ethical, and effective care to their patients. They cover a wide range of issues including:

1. Licensing and certification of healthcare providers
2. Standards of care and professional conduct
3. Patient rights and privacy (e.g., HIPAA)
4. Prescription medication use and abuse
5. Medical malpractice and liability
6. Healthcare facility accreditation and safety
7. Public health and prevention measures
8. Research involving human subjects
9. Reimbursement for medical services (e.g., Medicare, Medicaid)
10. Telemedicine and telehealth practices

Medical legislation aims to protect both patients and healthcare providers while maintaining a high standard of care and promoting the overall health of the population.

I'm sorry for any confusion, but "Missouri" is not a medical term or concept. It is a geographical location, being the name of a state located in the central United States. If you have any questions related to medical terminology or concepts, I would be happy to help with those!

The United States Department of Health and Human Services (HHS) is not a medical term per se, but it is a government organization that oversees and provides funding for many public health initiatives, services, and institutions in the United States. Here's a brief definition:

The HHS is a cabinet-level department in the US federal government responsible for protecting the health of all Americans and providing essential human services. It achieves this by promoting effective and efficient delivery of high-quality healthcare, conducting critical medical research through its agencies, such as the National Institutes of Health (NIH), and enforcing public health laws and regulations, including those related to food safety, through its agencies, such as the Food and Drug Administration (FDA). Additionally, HHS oversees the Medicare and Medicaid programs, which provide healthcare coverage for millions of elderly, disabled, and low-income Americans.

Skilled Nursing Facilities (SNFs) are healthcare facilities that provide round-the-clock skilled nursing care and medical supervision to individuals who require rehabilitation or long-term care. These facilities are designed for patients who need more medical attention and assistance with activities of daily living than can be provided at home or in an assisted living facility.

SNFs offer a wide range of services, including:

1. Skilled nursing care: Registered nurses (RNs) and licensed practical nurses (LPNs) provide 24-hour medical care and monitoring for patients with complex medical needs.
2. Rehabilitation services: Physical, occupational, and speech therapists work with patients to help them regain strength, mobility, and communication skills after an illness, injury, or surgery.
3. Medical management: SNFs have a team of healthcare professionals, such as physicians, nurse practitioners, and pharmacists, who collaborate to manage each patient's medical needs and develop individualized care plans.
4. Nutritional support: Registered dietitians assess patients' nutritional needs and provide specialized diets and feeding assistance when necessary.
5. Social services: Case managers and social workers help patients and their families navigate the healthcare system, coordinate discharge planning, and connect them with community resources.
6. Personal care: Certified nursing assistants (CNAs) provide assistance with activities of daily living, such as bathing, dressing, grooming, and using the bathroom.
7. Therapeutic recreation: Recreational therapists offer activities designed to improve patients' physical, cognitive, and emotional well-being.

SNFs may be standalone facilities or part of a larger healthcare system, such as a hospital or continuing care retirement community (CCRC). To qualify for Medicare coverage in an SNF, individuals must have a qualifying hospital stay of at least three days and need skilled nursing or rehabilitation services. Medicaid and private insurance may also cover the cost of care in Skilled Nursing Facilities.

Home care services, also known as home health care, refer to a wide range of health and social services delivered at an individual's residence. These services are designed to help people who have special needs or disabilities, those recovering from illness or surgery, and the elderly or frail who require assistance with activities of daily living (ADLs) or skilled nursing care.

Home care services can include:

1. Skilled Nursing Care: Provided by registered nurses (RNs), licensed practical nurses (LPNs), or licensed vocational nurses (LVNs) to administer medications, wound care, injections, and other medical treatments. They also monitor the patient's health status, provide education on disease management, and coordinate with other healthcare professionals.
2. Therapy Services: Occupational therapists, physical therapists, and speech-language pathologists help patients regain strength, mobility, coordination, balance, and communication skills after an illness or injury. They develop personalized treatment plans to improve the patient's ability to perform daily activities independently.
3. Personal Care/Assistance with Activities of Daily Living (ADLs): Home health aides and personal care assistants provide assistance with bathing, dressing, grooming, toileting, and other personal care tasks. They may also help with light housekeeping, meal preparation, and shopping.
4. Social Work Services: Provided by licensed social workers who assess the patient's psychosocial needs, connect them to community resources, and provide counseling and support for patients and their families.
5. Nutritional Support: Registered dietitians evaluate the patient's nutritional status, develop meal plans, and provide education on special diets or feeding techniques as needed.
6. Telehealth Monitoring: Remote monitoring of a patient's health status using technology such as video conferencing, wearable devices, or mobile apps to track vital signs, medication adherence, and symptoms. This allows healthcare providers to monitor patients closely and adjust treatment plans as necessary without requiring in-person visits.
7. Hospice Care: End-of-life care provided in the patient's home to manage pain, provide emotional support, and address spiritual needs. The goal is to help the patient maintain dignity and quality of life during their final days.
8. Respite Care: Temporary relief for family caregivers who need a break from caring for their loved ones. This can include short-term stays in assisted living facilities or hiring professional caregivers to provide in-home support.

Pharmaceutical fees are charges that healthcare professionals or institutions may impose on patients for various services related to the prescribing and dispensing of medications. These fees can include costs associated with medication therapy management, drug monitoring, medication reconciliation, and other clinical services provided by pharmacists or other healthcare providers.

It's important to note that these fees are separate from the cost of the medication itself and may not be covered by insurance. Patients should always ask about any potential fees before receiving pharmaceutical services and clarify whether they will be responsible for paying them out-of-pocket.

As of 2019, Medicaid paid for half of all births in the United States. Medicaid super utilizers (defined as Medicaid patients ... "Medicaid". www.medicaid.gov. U.S. Centers for Medicare & Medicaid Services in Baltimore. Retrieved February 24, 2023. Gottlieb ... Reports regarding Medicaid "Medicaid Research" and "Medicaid Primer" from Georgetown University Center for Children and ... Medicaid. Retrieved February 14, 2021. "Eligibility". Medicaid. Retrieved April 12, 2018. "December 2022 Medicaid & CHIP ...
"Waivers". Medicaid.gov. Centers for Medicare & Medicaid Services. Retrieved January 10, 2014. "MedicaidWaiver.org". ... Medicaid Waiver programs help provide services to people who would otherwise be in an institution, nursing home, or hospital to ... Prior to 1991, the Federal Medicaid program paid for services only if a person lived in an institution. The approval of Federal ... Use mdy dates from January 2014, Federal assistance in the United States, Medicare and Medicaid (United States)). ...
Medicaid expansion). However, the court also ruled 5-4 that Medicaid expansion without the federal threat of defunding Medicaid ... While Medicaid expansion was to come into force in 2014, the ACA also provided states the option to expand Medicaid early and ... Most states implemented Medicaid expansion via expansion of their Medicaid programs while some states did so by other means ... States choosing to participate in Medicaid expansion would also have additional Medicaid costs fully covered by the federal ...
... Medicaid and additional services in the United States through an arrangement between a state Medicaid ... "Medicaid Managed Care Enrollment Report" (PDF). Centers for Medicare & Medicaid Services. 2011-07-01. "Medicaid Managed Care ... Currently, managed care is the most common health care delivery system in Medicaid. In 2007, nearly two-thirds of all Medicaid ... Of those, 147 were Medicaid-focused health plans that specialize in serving the unique needs of Medicaid and other public ...
The 2010 Medicaid fraud was a case of Medicaid fraud carried out by an Armenian-American organized crime group called the ... According to officials, about $35 million of the bills claimed by the network was paid out by Medicaid already. A total of 118 ... A scandal surfaced involving a case to defraud the Medicaid and other healthcare programs such as Medicare. With an estimated ... operating and filing false claims to defraud Medicaid from five fake clinics in Brunswick, Savannah and Macon such as " ...
The HCBS/DD medicaid waiver program helps cover the cost for things that regular medicaid does not pay for. The HCBS Waiver ... Florida has several Medicaid Waiver Programs. Medicaid Waiver Programs allow recipients to 'waive' institutionalization and ... "Florida Medicaid Income Limits and Eligibility". coveringcfl.net. Retrieved 2022-12-19. "elder law attorney". "Medicaid ... Florida Medicaid is "The Payer of Last Resort". The rate for support coordination was reduced in 2011. The highest rate paid ...
... is the tenth and final studio album by American band Parliament, led by George Clinton. It was released on ... Medicaid Fraud Dogg was released in Japan by P-Vine records on September 12, 2018. The album followed a 38-year dry spell since ... Gotrich, Lars (May 22, 2018). "George Clinton, Doctor of the Mothership, Prescribes Funk in 'Medicaid Fraud Dogg'". All Songs ... Schatz, Lake (May 22, 2018). "George Clinton's Parliament return with new album, Medicaid Fraud Dogg". Consequence of Sound. v ...
But it didn't show that Medicaid harms people, or that the ACA is a failure, or that anything supporters of Medicaid have said ... "What Oregon Really Told Us About Medicaid". The New Republic. Retrieved May 14, 2013. "Oregon Medicaid report raises more ... Having Medicaid reduces your likelihood of facing medical expenses that exceed 30 percent of your income by 80 percent. This ... Medicaid coverage was associated with a 2.1 percentage point (30%) increase in the likelihood of having a hospital admission, ...
... for Medicaid eligibility refers to roughly those people added to Medicaid in expanded Medicaid. Medicaid estate recovery ... "NY State Medicaid and other application (see p. 23)" (PDF). 2019-08-08. "CT scales back Medicaid repayment rules for some ... "PA Medicaid Estate Recovery Document" (PDF). 2019-08-16. "The Idaho Medicaid Estate Recovery Program". Idaho Care Line (2-1-1 ... "Medicaid Estate Recovery: Medicaid: Medical Services: Services: Department of Human Services: State of North Dakota". nd.gov. ...
Least restrictive environment Medicaid waiver Medicaid Home and Home and Community-Based Services Waivers Olmstead v. L.C. ... A Katie Beckett waiver or TEFRA waiver is a Medicaid waiver concerning the income eligibility for home-based Medicaid services ... Katie Beckett waivers allow Medicaid to cover medical services for children in the home, regardless of the parents' income, in ... Disabled people can transition to Medicaid Home and Home and Community-Based Services Waivers after age nineteen. Mary ...
"Medicaid Drug Rebate Program". Medicaid.gov. Centers for Medicare & Medicaid Services. Archived from the original on 11 ... sought to equalize the treatment of prescription drug discounts between Medicaid managed care and Medicaid fee-for-service. In ... The Medicaid Drug Rebate Program is a program in the United States that was created by the Omnibus Budget Reconciliation Act of ... The Medicaid Drug Rebate Program has undergone a number of changes since its inception. For example, Section 606 of the ...
Medicaid Services reports and recommendations from the Government Accountability Office Grants to States for Medicaid account ... HCFA was renamed the Centers for Medicare and Medicaid Services on July 1, 2001. In 2013, a report by the inspector general ... The head of CMS is the Administrator of the Centers for Medicare & Medicaid Services. The position is appointed by the ... The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human ...
"Home , Center for Medicare & Medicaid Innovation". innovation.cms.gov. Retrieved 2017-12-19. "Centers for Medicare and Medicaid ... The Center for Medicare and Medicaid Innovation (CMMI; also known as the CMS Innovation Center) is an organization of the ... Meredith B. Rosenthal (May 2011). "Hard choices - Alternatives for reining in Medicare and Medicaid spending". The New England ... Official website (Healthcare reform in the United States, Medicare and Medicaid (United States), United States Department of ...
Medicaid waiver Olmstead v. L.C. Least restrictive environment Florida Medicaid waiver North Carolina's 1915(b)(c) Waiver ... "Home & Community Based Services Final Regulation , Medicaid". www.medicaid.gov. Retrieved 2023-02-10. Smith, David G.; Moore, ... Under an HCBS waiver, states can use Medicaid funds to provide a broad array of non-medical services (excluding room and board ... 7, § 1396n §§ 1915(c), are a type of Medicaid waiver. HCBS waivers expand the types of settings in which people can receive ...
The Medicare and Medicaid Extenders Act of 2010 is a federal law of the United States, enacted in 2010. The law was first ... H.R. 4994, Legislative History v t e (Medicare and Medicaid (United States), United States federal health legislation, Acts of ...
The Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (also called the Balanced Budget Refinement Act or ... Medicare and Medicaid (United States), United States federal health legislation, Acts of the 106th United States Congress). ...
"Medicaid.gov: Self Directed Services". Medicaid. Archived from the original on 19 June 2017. Retrieved 19 June 2017. "NIRAMAYA ... In the United States, many states allow Medicaid beneficiaries to use their Medicaid funds to hire their own PCAs, instead of ... one of the film's protagonists and publicly stated that her top priority was deinstitutionalization through medicaid expansion ...
Medicaid , Medicare (United States)". The Roosevelt Institute Campus Network. Retrieved 2 November 2020. "Conversations with ...
Medicaid; hurricanes; and the Iraq War. Next, Desjardins moved to CNN, where she worked for nine years from 2005 to 2014. She ...
Medicaid; and Public Health and Welfare. She voted for changing the Mississippi state flag in 2020. She is a member of the ...
"Nursing Facilities , Medicaid". www.medicaid.gov. Retrieved 20 September 2021. "A Guide to Nursing Homes - HelpGuide.org". www. ... Each state defines poverty and therefore Medicaid eligibility. Those eligible for Medicaid may be low-income parents, children ... that oversees Medicare and Medicaid. A large portion of Medicare and Medicaid dollars is used each year to cover nursing home ... Medicaid is the federal program implemented with each state to provide health care and related services to those who are below ...
Hughes again served on Judiciary A; Judiciary En Banc; Medicaid; Accountability, Efficiency & Transparency; and Constitution ... Hughes served on Judiciary A; Judiciary En Banc; Medicaid; Accountability, Efficiency & Transparency; and Constitution ...
"Mandatory & Optional Medicaid Benefits , Medicaid". www.medicaid.gov. Retrieved 15 November 2021. Goldberg E (13 January 2021 ... Medicaid, or health insurance. Menstruating is an expensive process, and thus difficulty in accessing period products ...
"Unemployment Benefit; Government Foreclosure; Medicaid". Theofficialchart.com. Retrieved 22 November 2011. "2005 The Number One ...
Those who are "medically indigent earn too much to qualify for Medicaid but too little to purchase either health insurance or ... Many states do not allow people access to Medicaid,[clarification needed] even in cases of extreme poverty, if no minor ... "Eligibility". Medicaid.gov. Retrieved 2018-08-13. "MEDICALLY INDIGENT ASSISTANCE PROGRAM (MIAP) MANUAL" (PDF). South Carolina ... the United States are persons who do not have health insurance and who are not eligible for other health care such as Medicaid ...
Ohio Department of Medicaid. "2019 MANAGED CARE PLANS REPORT CARD" (PDF). Ohio Medicaid. Retrieved 2020-02-05. Economic Impact ... It is the largest Medicaid plan in Ohio and is second largest in the United States. CareSource was founded by Pamela Morris in ... CareSource is a nonprofit that began as a managed health care plan serving Medicaid members in Ohio. Today, it provides public ... The DAHP would become the first mandatory Medicaid managed care program in 1989 In 1993 the federal waiver would expire and in ...
"Medicaid Expansion". American Public Health Association (APHA). Is Medicaid eligibility expanding to 133 or 138 percent FPL, ... As of August 2016, 31 states and the District of Columbia have expanded Medicaid. (See: State rejections of Medicaid expansion ... Medicare and Medicaid drug reimbursement rates are decreased, and other Medicare and Medicaid spending is cut. Members of ... and the rebate is extended to Medicaid managed care plans; the Medicaid rebate for non-innovator, multiple source drugs is ...
Additionally, an analysis of changes in mortality post Medicaid expansion suggests that Medicaid saves lives at a relatively ... Medicaid). In 2013, 64% of health spending was paid for by the government, and funded via programs such as Medicare, Medicaid, ... Those insured by Medicaid tend to report fair or poor health, as opposed to excellent or very good health. On December 22, 2017 ... "Status of State Medicaid Expansion Decisions: Interactive Map". KFF. Map is updated as changes occur. Click on states for ...
"Medicaid legislation". Office of the Governor of Alabama. "Governor Bentley Signs Medicaid Reform Bill & New Executive Order ... The legislation allows ICNs to contract with Medicaid to provide long-term care under a capitated system. Alabama Medicaid ... "Alabama Senate passes Medicaid reforms that could save $1.5 Billion over 10 Years". Yellowhammer News. May 20, 2015. Retrieved ... During his tenure, he sponsored and passed Medicaid reform legislation that created Regional Care Organizations (RCOs). RCOs ...
"Official , Medicaid at". Theofficialchart.com. Retrieved 22 November 2011. "2005 The Number One Albums". Official Charts. ...
Q: How does a VFC program registered provider, who is not already a Medicaid provider, file for Medicaid reimbursement for the ... A: If the State has chosen the option of expanding its Medicaid program under SCHIP, the children are Medicaid-enrolled and ... Q: Can a State require Medicaid providers to become VFC program registered providers, in order to ensure that Medicaid eligible ... How does a VFC program registered provider, who is not already a Medicaid provider, file for Medicaid reimbursement for the ...
New nationwide data show that Medicaid expansion is associated with more treatment and a reduction in the death rate from ... In Medicaid expansion states, there was a greater absolute reduction in 2-year mortality among Black patients with pancreatic ... Cite this: Medicaid Expansion Closing Racial Gap in GI Cancer Deaths - Medscape - May 25, 2023. ... "The findings of this study provide a solid step for closing the gap, showing that the Medicaid expansion opportunity offered by ...
... medicaid - Featured Topics from the National Center for Health Statistics ... Tags medicaid, medicare, public-use data, rdc, research data center, social security ... in part because they are less likely to have Medicaid coverage. See more at http://www.cdc.gov/nchs/data/databriefs/db11.htm. ...
Centers for Medicare and Medicaid Services. In April 2020, CMS recommended that all nonessential planned surgeries and ... Guideline] Centers for Medicare & Medicaid Services (CMS) recommendations: re-opening facilities to provide non-emergent non- ... a recent history and physical examination within 30 days per Centers for Medicare and Medicaid Services (CMS) requirement is ... Centers for Medicare and Medicaid Services. Available at https://www.cms.gov/files/document/covid-elective-surgery- ...
As of 2019, Medicaid paid for half of all births in the United States. Medicaid super utilizers (defined as Medicaid patients ... "Medicaid". www.medicaid.gov. U.S. Centers for Medicare & Medicaid Services in Baltimore. Retrieved February 24, 2023. Gottlieb ... Reports regarding Medicaid "Medicaid Research" and "Medicaid Primer" from Georgetown University Center for Children and ... Medicaid. Retrieved February 14, 2021. "Eligibility". Medicaid. Retrieved April 12, 2018. "December 2022 Medicaid & CHIP ...
New research predicts that ObamaCare will swell the Medicaid pop ulation by nearly 16 million individuals. This proposed ... Americans on Medicaid would jump 15.9 million - from 43.5 million to 59.4 million. The 14.5 percent of the nation on Medicaid ... Gillibrand: Would boost NYs Medicaid cohort by 20 percent. New research predicts that ObamaCare will swell the Medicaid pop ... ObamaCares Medicaid explosion By Deroy Murdock Social Links for Deroy Murdock * View Author Archive ...
An official website of the Indiana State Government ...
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 , Phone 202-347-5270 www.kff.org , Email Alerts: kff.org/email , facebook.com/KFF , twitter.com/kff. The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California. ...
As for Medicaid, the plan aims to cut as much a $1 trillion from the low-income program by routing federal money to large block ...
In compliance with House Enrolled Act 1194, the Office of Medicaid Policy and Planning has developed and will maintain an ... Indiana Code 12-16 Payment for Health Services Other than Medicaid. *IC 12-16-2.5 Hospital Care for the Indigent; ... Indiana Code 12-15 Medicaid. *IC 12-15-15 Payments to Hospitals; General (includes UPL) ...
Medicaid Expansion Spurs States to Fight Fraud, Overpayments. BY: Susan Milligan - March 5, 2014 U.S. Attorney Preet Bharara ... Half a million people in 11 states have lost Medicaid coverage since April. BY: Casey Quinlan - June 1, 2023 More than 500,000 ... States Enroll Former Foster Youth in Medicaid. BY: Christine Vestal - April 30, 2014 Jose Antonio Machado, 18, cooks pasta at ... Beyond the Private Option for Medicaid Expansion. BY: Christine Vestal - October 24, 2014 AP Chad Latch with his daughter ...
Medicaid could look radically different by 2040, driven by five major changes. ... what does this change mean for Medicaid beneficiaries and Medicaid agencies? Medicaids mission may still be to improve the ... How might Medicaid beneficiaries use smart medical devices in the future?. Racquel is a 32-year-old Medicaid beneficiary who is ... How might Medicaid beneficiaries use interoperable data in the future?. Eric is a six-year-old Medicaid beneficiary who lives ...
Medicare and Medicaid Infographic (PDF) (1 page). *Non-Emergency Medical Transportation Booklet for Providers (PDF) (17 pages) ... Best Practices for Medicaid Program Integrity Units Collection of Disclosures in Provider Enrollment (PDF) (10 pages) ... The resources on these pages cover important topics in Medicaid program integrity. We have organized the resources by audience ... A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. ...
Medicaid Pharmacy Benefits State Fact Sheets * Medicaid Coverage of Family Planning Benefits: Findings from a 2021 State Survey ...
Medicaid Spending Per Full-Benefit Enrollee. Medicaid Spending Per Full-Benefit Enrollee. Facebook Twitter LinkedIn Email Print ... Medicaid Spending and Enrollment by Enrollment Group. * ...
Knowledge of Medicaid - Salary - Get a free salary comparison based on job title, skills, experience and education. Accurate, ... Skills in the same category as Knowledge of Medicaid, ranked by salary ...
Medicaid Waivers CLASP monitors requests from states to modify their Medicaid program through waivers. Here you will find ... "All of these policies that we are seeing are inconsistent with the objectives of Medicaid. They dont seem to seem to have a ... After approving Medicaid work requirements, Trumps HHS aims for lifetime coverage limits. ... If approved by CMS, they would have a profound negative impact on Medicaid recipients and their families. ...
Centers for Medicare & Medicaid Services. A federal government managed website by the. Centers for Medicare & Medicaid Services ... State Budget & Expenditure Reporting for Medicaid and CHIP * Expenditure Reports MBES/CBES * CMS-64 FFCRA Increased FMAP ... Actuarial Report on the Financial Outlook for Medicaid * Section 223 Demonstration Program to Improve Community Mental Health ... Improving Care for Medicaid Beneficiaries with Complex Care Needs and High Costs ...
School-Based Medicaid Program (SBMP) Trainings Need Help with the School-Based Medicaid Program (SBMP)? School-Based Medicaid ... Whats New with the School-Based Medicaid Program (SBMP)? What is the School-Based Medicaid Program (SBMP)? School-Based ... School-Based Medicaid Program (SBMP). * …. This page is located more than 3 levels deep within a topic. Some page levels are ... School-Based Medicaid Program (SBMP) A reimbursement mechanism to offset local education agency costs for providing certain ...
Medicaid.gov. Information about the program and policy details of Medicaid and the Childrens Health Insurance Program. ... Medicaid renewals. As states resume normal operations, were working to make sure people stay covered. ... Information for people who need health insurance and want to apply or enroll in the Marketplace or Medicaid. ... A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. ...
Three of the states with the highest prevalence of multiple chronic conditions havent accepted the Medicaid expansion, and one ... Governor Bevins proposed Medicaid waiver puts Kentuckys successful Medicaid expansion and the coverage of nearly HALF A ... What happens to the poorest residents in states declining the Medicaid expansion? (April 2013). Medicaid opt-out resulting in ... havent accepted the ACAs Medicaid expansion. (If you want to know more about the Medicaid expansion, check out the posts ...
Medicaid enrollment is surging, but states shunning Obamacares huge Medicaid expansion are getting left behind, according to ... Medicaid enrollment related to the health care law has been difficult to pinpoint, in part because states report their ... Medicaid enrollment has increasingly become a political weapon for Democrats, who argue that governors turning down the ... Those states saw a 15 percent surge in sign-ups - led by Oregon, West Virginia and Nevada, where Medicaid rolls climbed more ...
The Trump administration has taken a major step in allowing states to impose work requirements on Medicaid recipients for the ... able-bodied citizens on Medicaid," Verma told a conference of state Medicaid directors in November. "They want to develop ... Medicaid Services released a guidance Thursday outlining what states need to do to mandate that certain Medicaid enrollees work ... "Medicaid needs to be more flexible so that states can best address the needs of this population. Our fundamental goal is to ...
He intends to cover the states share of Medicaid expansion costs using revenue from an existing cigarette tax and an ... Chris Christie before him, announced a major push Thursday to expand Medicaid under the health care law and follow 26 states ... In fact, a summary of the proposal describes it as a move to "eliminate traditional Medicaid" for non-disabled Hoosiers. ... Yet the Obama administration labeled his move a "Medicaid coverage expansion." It praised Pence, a vocal critic of Obamacare, ...
"The vast majority of people on Medicaid are families with children, but Medicaid spending is driven by seniors and people with ... "Medicaid is now the primary funder of long-term care.". Giving the states block grants is like tossing them a deflated football ... Coverage gap leaves up to 7 million ineligible for Medicaid 02:37 In a 2016 bill that President Barrack Obama vetoed, the ... "There are 18 states that wont extend Medicaid, and if you give them a block grant, they will take that money and run," he ...
Republican Medicaid Cruelty. "The essential American soul," claimed D.H. Lawrence, "is hard, isolate, stoic, and a killer." ... While the rejection by five state governments of the Affordable Care Acts Medicaid expansion may not precisely illustrate ...
... you are jeopardizing benefits for seniors and people with disabilities who get long-term care through Medicaid. ... But Medicaid, Social Security and Medicare often are targeted for cost cutting in times of rising deficits. Medicaid is ... For 53 years, Medicaid has served as a safety net for millions of people who needed assistance as their ability to care for ... If Medicaid enrollees needed more care than the block grant paid for, states would have to make up the difference - or cut ...
Sean Parnell announced Friday that Alaska will not participate in Medicaid expansion under the Affordable Care Act, describing ... Medicaid is already one of the states most costly programs, the governor said. About 140,000 Alaskans currently are covered ... Parnell said he was creating a Medicaid reform group to study the system and report back in a year. He also directed Streur to ... The Lewin study estimated it would cost the state just over $200 million over a seven-year period to expand Medicaid, while the ...
Medicaid [r]: Title 19 of the U.S. Social Security Act, adopted in 1965. Provides means-tested medical care for the poor. [e] ... Retrieved from "https://citizendium.org/wiki/index.php?title=Medicaid&oldid=669140" ...
  • 65years of age adult Medicaid enrollees. (cdc.gov)
  • Today, all but a few states use managed care to provide coverage to a significant proportion of Medicaid enrollees. (wikipedia.org)
  • Nationwide, roughly 80% of Medicaid enrollees are enrolled in managed care plans. (wikipedia.org)
  • A 2014 Kaiser Family Foundation report estimates the national average per capita annual cost of Medicaid services for children to be $2,577, adults to be $3,278, persons with disabilities to be $16,859, aged persons (65+) to be $13,063, and all Medicaid enrollees to be $5,736. (wikipedia.org)
  • At least 11,762,000 Medicaid enrollees have been disenrolled as of December 1, 2023, based on the most current data from all 50 states and the District of Columbia. (kff.org)
  • The Centers for Medicare & Medicaid Services released a guidance Thursday outlining what states need to do to mandate that certain Medicaid enrollees work to qualify for benefits. (abcactionnews.com)
  • Among them: placing enrollees in private insurance instead of traditional Medicaid, requiring some enrollees to pay modest premiums, conditioning enrollment for some on paying into a health savings account, encouraging unemployed or underemployed beneficiaries to pursue work opportunities and attempting to limit overuse of the emergency room. (politico.com)
  • That's despite the requirement - written into the fabric of Michigan's Medicaid expansion - that all enrollees get a primary care appointment within 90 days of getting coverage. (eurekalert.org)
  • The federal government is requiring Minnesota and 28 other states to restart coverage for a large subset of Medicaid enrollees who may have mistakenly lost benefits this summer through a procedural glitch. (startribune.com)
  • 5. Please note: If there has been a change of address since March, 2020, families of Medicaid enrollees with IDD should be certain that NJ Medicaid has the up-to-date address on file. (constantcontact.com)
  • They'll be facing an uptick in Medicaid enrollees among the newly unemployed, just as their tax revenues collapse thanks to the recession. (wnd.com)
  • Medicaid is a money pit that fails in its most basic mission of improving the health of its enrollees. (wnd.com)
  • A bombshell 2013 study published in the New England Journal of Medicine compared Medicaid enrollees to uninsured patients in Oregon and found that "Medicaid coverage generated no significant improvement in measured physical health outcomes. (wnd.com)
  • Part of what motivated this study is that there is a lot of rhetoric and what we would call misinformation around 'What does Medicaid do, how effective is it, and how satisfied are enrollees with their coverage? (npr.org)
  • The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding. (wikipedia.org)
  • Core eligibility groups of low-income families are most likely to be enrolled in managed care, while the "aged" and "disabled" eligibility groups more often remain in traditional "fee for service" Medicaid. (wikipedia.org)
  • That could be wiped out, though, if the 80 percent increase in Medicaid eligibility identified by Heritage's study resulted in a proportionate, or $372 million, increase in state-funded Medicaid expenditures. (nypost.com)
  • As Haislmaier told the Senate Small Business and Entrepreneurship Committee, "The effects of any new federal requirement to expand Medicaid eligibility up the income scale will be not only to impose new costs on state taxpayers, but also to draw more, younger, healthier individuals out of the private insurance pool in which small employers participate. (nypost.com)
  • HHS emphasized that actual Medicaid enrollment may be substantially higher because some people who signed up are still being processed for eligibility and a handful of states didn't report complete numbers. (politico.com)
  • He said states could react by narrowing eligibility for Medicaid, which would in turn divert more patients to self-pay. (cbsnews.com)
  • However, eligibility differs significantly between workers in states that have and have not expanded Medicaid. (rwjf.org)
  • Authors find that whether unemployment compensation is included in determining eligibility for Medicaid and Affordable Care Act (ACA) marketplace subsidies affects workers living in states that expanded Medicaid differently than those living in states that do not. (rwjf.org)
  • Having an ABLE account does not jeopardize one's eligibility for Supplemental Security Income (SSI) or NJ Medicaid. (constantcontact.com)
  • However, a large amount of the increase in Medicaid enrollment is likely due to the Medicaid Maintenance of Eligibility (MOE) requirement included in the Families First Coronavirus Response Act. (ahip.org)
  • This policy brief is one of six commissioned by the Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation on Medicaid eligibility policies for long-term care benefits. (hhs.gov)
  • Amendment D will amend the South Dakota Constitution to expand Medicaid eligibility to help provide medical coverage for low-income people in designated categories. (keloland.com)
  • More and more hospitals in rural parts of the U.S. are being forced to close for lack of funding, and many are in states that haven't yet expanded Medicaid eligibility. (commonwealthfund.org)
  • We included live births in Oregon from 2012 to 2015 and used individually-linked birth certificate and Medicaid eligibility data. (bvsalud.org)
  • Kentucky's new governor, Matt Bevin, has proposed dramatically altering the state's Medicaid program, by requiring low-income, non-disabled adults to pay premiums and work in order to qualify for coverage, and making vision and dental benefits contingent on health activities or volunteer work. (scienceblogs.com)
  • If the waiver request is approved, Pence would become the eighth Republican governor to expand his state's Medicaid program. (politico.com)
  • RALEIGH, N.C. - Proposed budget cuts will hit the state's Medicaid program pretty hard. (wral.com)
  • 9. Michigan Gov. Rick Snyder became the sixth GOP governor to recommend an expansion of the state's Medicaid program to include individuals slightly above the poverty line. (beckershospitalreview.com)
  • As the rest of the health care industry transforms, what does this change mean for Medicaid beneficiaries and Medicaid agencies? (deloitte.com)
  • Smart medical devices will be in the hands of all Medicaid beneficiaries, empowering them to manage their own health and wellness. (deloitte.com)
  • In the year 2040, all Medicaid beneficiaries will have smart medical devices, both at home and on the go. (deloitte.com)
  • These expenditures include payments for care provided to Medicaid beneficiaries, such as base payments directly to providers for services rendered, and supplemental payments, which are not tied to care for individual beneficiaries, but may help offset any remaining costs of care for Medicaid beneficiaries. (gao.gov)
  • Therefore, it is important to pay attention now to the amount of resources that Medicaid beneficiaries with intellectual and developmental disabilities (IDD) have, to be certain that the resources (assets) do not exceed the allowable Medicaid limits. (constantcontact.com)
  • Since the 1993 enactment of the Omnibus Budget Reconciliation Act (OBRA 93), federal law has required states to recover Medicaid spending on behalf of beneficiaries from their estates after death. (hhs.gov)
  • The program sets compensation so far below prevailing market prices that doctors often lose money when they treat Medicaid beneficiaries. (wnd.com)
  • A survey of Medicaid beneficiaries found that overall, they're very happy with the services they get and have no problems finding doctors. (npr.org)
  • And it would change Medicaid from an open-ended program that pays for all the care beneficiaries need, to one that offers states a set amount of money each year based on the number of people who qualify for Medicaid in that state. (npr.org)
  • Under a new federal initiative, states are trying to improve the health care of so-called "dual eligibles," people who qualify for both Medicare and Medicaid. (stateline.org)
  • Here you will find CLASP's comments to states and the Centers for Medicare and Medicaid Services (CMS), along with reports, briefs, and blogs that speak to Medicaid waivers. (clasp.org)
  • This stipulation, and other requirements for plan members, was included in the plan under a waiver with the Centers for Medicare and Medicaid Services. (eurekalert.org)
  • 7. Healthcare spending on Medicare and Medicaid has grown slower than many have predicted, and the most recent report from the Congressional Budget Office showed federal spending for the two programs was 5 percent lower than it estimated in March 2010. (beckershospitalreview.com)
  • 15. Six lawmakers from both sides of the aisle released a report outlining recommendations from more than 160 stakeholders on methods to combat fraud and abuse in the Medicare and Medicaid programs . (beckershospitalreview.com)
  • MANCHESTER, N.H. - Americans for Prosperity-New Hampshire (AFP-NH) released the following statement following the Centers for Medicare and Medicaid Service's announcement that it would allow states to move forward with work requirements for able-bodied adults under Medicaid. (americansforprosperity.org)
  • The researchers looked at survey data collected by the Centers for Medicare and Medicaid Services from more than 270,000 people who were enrolled in Medicaid in 2013. (npr.org)
  • Include health insurance obtained through employment or purchased directly as well as government programs like Medicare and Medicaid that provide medical care or help pay medical bills. (cdc.gov)
  • In general, Medicaid recipients must be U.S. citizens or qualified non-citizens, and may include low-income adults, their children, and people with certain disabilities. (wikipedia.org)
  • Research shows that existence of the Medicaid program improves health outcomes, health insurance coverage, access to health care, and recipients' financial security and provides economic benefits to states and health providers. (wikipedia.org)
  • Under managed care, Medicaid recipients are enrolled in a private health plan, which receives a fixed monthly premium from the state. (wikipedia.org)
  • Kent Conrad's North Dakota constituents may grill him about legislation that would push Medicaid recipients 50.1 percent higher, from 51,890 to 77,890. (nypost.com)
  • If approved by CMS, they would have a profound negative impact on Medicaid recipients and their families. (clasp.org)
  • The Trump administration has taken a major step in allowing states to impose work requirements on Medicaid recipients for the first time. (abcactionnews.com)
  • The guidance notes that some Medicaid recipients may have trouble meeting these requirements because of frail health, substance abuse or high unemployment in their areas. (abcactionnews.com)
  • Many Medicaid recipients are already employed. (abcactionnews.com)
  • Medicaid recipients are known to experience lower access to care than privately insured patients. (nber.org)
  • Potential explanations for the difficulties faced by Medicaid recipients in accessing care include their more complex medical needs, low Medicaid reimbursement rates, payment delays, or other difficulties with the Medicaid billing process. (nber.org)
  • In The Impacts of Physician Payments on Patient Access, Use, and Healt h (NBER Working Paper 26095 ), researchers Diane Alexander and Molly Schnell present evidence that reimbursement rates are an important determinant of access to care, health care utilization, and health status among Medicaid recipients. (nber.org)
  • In addition, the same $10 increase in payment per visit reduced reported school absences among primary school-aged Medicaid recipients by 14 percent, a finding that the researchers corroborate using administrative data from the National Assessment of Educational Progress. (nber.org)
  • Overall, their findings imply that changing financial incentives for providers could play an important role in improving access to care for Medicaid recipients. (nber.org)
  • 14. Kansas moved its Medicaid recipients at the start of this year onto a flat-fee managed care program called KanCare , in hopes the switch would lower costs or slow growth in spending for its Medicaid population. (beckershospitalreview.com)
  • New Hampshire's state budget requires the state to enact work requirements for the Medicaid expansion population by April 30th, or the state must notify expansion recipients that the program will terminate on December 31st. (americansforprosperity.org)
  • To be eligible for Medicaid long-term care, recipients must have limited incomes and no more than $2,000 (in most states). (elderlawanswers.com)
  • The study, published as a research letter in the July 10 issue of JAMA Internal Medicine, also shows that 84 percent of Medicaid recipients felt they were able to get all the medical care they needed in the last six months. (npr.org)
  • If the State has established an SCHIP program that is not a Medicaid expansion, the children who are enrolled are considered insured and do not qualify for VFC vaccine. (cdc.gov)
  • Racial disparities in cancer care have been reduced by Medicaid expansion, suggest new nationwide data. (medscape.com)
  • They come from a cross-sectional cohort study of patients with gastrointestinal (GI) cancers and show that the gap in mortality rates was reduced in Medicaid expansion states compared to non-expansion states. (medscape.com)
  • The findings of this study provide a solid step for closing the gap, showing that the Medicaid expansion opportunity offered by the Affordable Care Act, which allows participating states to improve healthcare access for disadvantaged populations, results in better cancer outcomes and mitigation of racial disparities in cancer survival," commented Julie Gralow, MD, chief medical officer and executive vice-president of ASCO. (medscape.com)
  • Our study provides compelling data that show Medicaid expansion was associated with improvement in survival for both Black and White patients with gastrointestinal cancers. (medscape.com)
  • Additionally, it suggests that Medicaid Expansion is one potential avenue to mitigate existing racial survival disparities among these patients," Manisundaram concluded. (medscape.com)
  • Cite this: Medicaid Expansion Closing Racial Gap in GI Cancer Deaths - Medscape - May 25, 2023. (medscape.com)
  • The Medicaid expansion that Reid is ushering through the Senate as a component of ObamaCare would impose an unfunded mandate on Nevada that likely would require yet another round of tax hikes," says Geoffrey Lawrence, the Nevada Policy Research Institute's fiscal policy analyst. (nypost.com)
  • The proposed 82.1 percent expansion in Nevada's Medicaid-eligible individuals could require more than $1 billion annually in additional expenditures. (nypost.com)
  • AP Chad Latch with his daughter Ruby Latch, in their home in North Little Rock, Arkansas, is among more than 210,000 low-income residents who became eligible for health insurance under the state's "private option" model for Medicaid expansion under the Affordable Care Act. (stateline.org)
  • The expansion of Medicaid under the Affordable Care Act has spurred states to redouble their anti-fraud efforts. (stateline.org)
  • Although insurance coverage doesn't automatically translate to services and resources to care for adults with multiple chronic conditions, it's worth noting that three of the states with above-average MCC prevalence estimates -- Alabama, Maine, and Mississippi -- haven't accepted the ACA's Medicaid expansion . (scienceblogs.com)
  • If you want to know more about the Medicaid expansion, check out the posts listed below. (scienceblogs.com)
  • As for the state with the highest MCC prevalence, Kentucky's previous governor, Steve Beshear, accepted the Medicaid expansion. (scienceblogs.com)
  • Medicaid enrollment is surging, but states shunning Obamacare's huge Medicaid expansion are getting left behind, according to data released Wednesday by HHS. (politico.com)
  • As we've seen for months, growth was more pronounced in states that adopted the Medicaid expansion," wrote Cindy Mann, director of the federal Medicaid program, in a blog post announcing the new numbers. (politico.com)
  • In addition, New Hampshire recently embraced Medicaid expansion, but it won't take effect broadly there until next year. (politico.com)
  • Medicaid enrollment has increasingly become a political weapon for Democrats, who argue that governors turning down the expansion are denying health care to as many as 6 million people. (politico.com)
  • About a dozen Republican governors have embraced versions of Medicaid expansion, although some have been stymied by opposition from Republican legislatures. (politico.com)
  • Republicans say the Obama administration can't be trusted to fulfill promises to generously fund Medicaid expansion over the long term. (politico.com)
  • The broadening of Medicaid to low-income adults under Obamacare -- roughly 11 million have gained coverage under the health reform law's Medicaid expansion provision -- further spurred GOP efforts. (abcactionnews.com)
  • Yet the Obama administration labeled his move a "Medicaid coverage expansion. (politico.com)
  • He intends to cover the state's share of Medicaid expansion costs using revenue from an existing cigarette tax and an assessment on hospitals. (politico.com)
  • In a closely watched and controversial decision, Gov. Sean Parnell announced Friday that Alaska will not participate in Medicaid expansion under the Affordable Care Act, describing it at a news conference as a "failed experiment. (adn.com)
  • I believe a costly Medicaid expansion especially on top of the broken Obamacare system is a hot mess," Parnell told reporters at a news conference in Anchorage called to announce his decision. (adn.com)
  • They wanted the governor to "remember the poor and the struggling families of Alaska when he makes his announcement today regarding Medicaid expansion," said the Rev. Julia Seymour of the Lutheran Church of Hope. (adn.com)
  • image: Key findings from the study of primary care appointment availability in Michigan in the year after Medicaid expansion are shown. (eurekalert.org)
  • The study, published in The American Journal of Managed Care , builds on a previous U-M study that looked at what happened in the first four months after Medicaid expansion. (eurekalert.org)
  • One year after Medicaid expansion in Michigan, primary care appointment availability for new Medicaid patients increased, even though enrollment in the program almost doubled," says lead author Renuka Tipirneni, M.D., M.S., a clinical lecturer in the Division of General Medicine at the U-M Medical School. (eurekalert.org)
  • For those who said they had Medicaid, 49 percent of clinics offered an appointment before the expansion and 55 percent offered an appointment after expansion. (eurekalert.org)
  • Overall, wait times for the first available appointment for all patients stayed the same as before the Medicaid expansion took effect, at about a week. (eurekalert.org)
  • Before Medicaid expansion, 8 percent of new Medicaid patients and 11 percent of privately insured patients would have seen a nurse practitioner or physician assistant at their first appointment at their new primary care site. (eurekalert.org)
  • Some of these newly enrolled individuals are due to the expansion of Medicaid coverage in three states during the PHE (Nebraska, Missouri, and Oklahoma), while others are due to worsening economic conditions during the pandemic. (ahip.org)
  • The move surprised and disappointed the governor's point man on Medicaid expansion, David Patton, executive director of the Utah Department of Health. (sltrib.com)
  • The Medicaid expansion enacted by the Affordable Care Act -- which made everyone with income below 138 percent of the poverty level eligible, including able-bodied adults -- cost nearly a quarter-trillion dollars more than initially estimated, according to a 2016 report from The Mercatus Center. (wnd.com)
  • The Legislative Research Council's Fiscal Note for Amendment D says Medicaid expansion would cover 42,500 new individuals for a cost of $297 million, which would cost the state $32.5 million and give $63.5 million in general fund savings. (keloland.com)
  • Medicaid expansion will be a crucial opportunity for farmers and ranchers across South Dakota to accept affordable healthcare coverage for the first time," Doug Sombke, President of South Dakota Farmers Union, said in a news release. (keloland.com)
  • Proponents of Medicaid expansion say it will return more federal tax money to the state and allow South Dakota to use more federal funds on residents' health. (keloland.com)
  • Opponents to Medicaid expansion in South Dakota have said expanding health care will impact the state's budget in the future. (keloland.com)
  • States that participate in the Affordable Care Act's expansion of Medicaid have experienced an increase in overall cancer diagnoses, particularly early stage diagnoses, compared with states that rejected expansion, researchers found. (upi.com)
  • We found that states that participated in Medicaid expansion experienced much greater increases in cancer detection," said Soni, a doctoral candidate at the Indiana University School of Business in Bloomington. (upi.com)
  • However, it did not affect Medicaid expansion under Obamacare. (upi.com)
  • The researchers found that Medicaid expansion has been tied to a 6.4 percent increase in early stage cancer diagnoses, or about 15 additional cancers detected for every 100,000 people. (upi.com)
  • The study did not include people who got Medicaid through the Affordable Care Act expansion or people in nursing homes. (npr.org)
  • The bill being considered by the Senate would slowly roll back the expansion of Medicaid benefits to many poor, non-disabled adults, that happened as part of the Affordable Care Act, or Obamacare. (npr.org)
  • A new video shows how Medicaid expansion could help community hospitals stay afloat. (commonwealthfund.org)
  • Impact of Medicaid expansion in Oregon on access to prenatal care. (bvsalud.org)
  • Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) has the potential to improve reproductive health by allowing low- income women access to healthcare before and early in pregnancy . (bvsalud.org)
  • The aim of this study was to examine the effects of Oregon 's Medicaid expansion on timely and adequate prenatal care . (bvsalud.org)
  • We estimated the overall effect of Medicaid expansion on prenatal care utilization using probit regression models. (bvsalud.org)
  • Additionally, we assessed the impact of Medicaid expansion on prenatal care utilization via pre- pregnancy Medicaid enrollment using bivariate probit models. (bvsalud.org)
  • Pre- pregnancy Medicaid enrollment increased following Medicaid expansion (ß = 0.55, p prenatal care (ß = 0.14, p (bvsalud.org)
  • Using two years of post-ACA data we found that Medicaid expansion had significant positive associations with Medicaid enrollment prior to pregnancy , which subsequently increased receipt of timely and adequate prenatal care . (bvsalud.org)
  • Medicaid would be responsible for providing necessary vaccination for EPSDT-eligible persons 19-20 years of age. (cdc.gov)
  • However, it is necessary to become a Medicaid provider in order to receive payment from Medicaid for vaccine administration services provided to Medicaid eligible children. (cdc.gov)
  • Can a State require Medicaid providers to become VFC program registered providers, in order to ensure that Medicaid eligible children receive vaccine under the VFC program? (cdc.gov)
  • in states that make that choice, income limits may be significantly lower, and able-bodied adults may not be eligible for Medicaid at all. (wikipedia.org)
  • ObamaCare's parameters would boost the average state's Medicaid-eligible population by 36.6 percent. (nypost.com)
  • Of the 25 states that already have expanded Medicaid under the Affordable Care Act, all but Arkansas, Iowa and Michigan simply added newly eligible adults to their existing Medicaid programs. (stateline.org)
  • High procedural disenrollment rates are concerning because many people who are disenrolled for these paperwork reasons may still be eligible for Medicaid coverage. (kff.org)
  • In addition, technical problems in federal and state enrollment systems have caused delays in determining who is eligible for Medicaid. (politico.com)
  • About 17,000 Alaska Natives would have been among the newly eligible for Medicaid. (adn.com)
  • We will continue to work with states for as long as needed to help prevent anyone eligible for Medicaid … from being disenrolled. (startribune.com)
  • More than 70 percent of the 7.4 million workers with pre-pandemic employer-based insurance through industries now vulnerable to high rates of unemployment were found to be eligible for some assistance with health insurance (Medicaid or marketplace subsidies) if they lost their jobs. (rwjf.org)
  • A bill to amend title XIX of the Social Security Act to make all children eligible for Medicaid from birth until age 19, to require States to automatically enroll children under age 19 in the State Medicaid program, and for other purposes. (govtrack.us)
  • By Aug. 1, the governor is expected to apply to CMS for a waiver from Medicaid's rules - challenging the administration's policy against linking Medicaid coverage to a work requirement. (scienceblogs.com)
  • The investigators noted that Medicaid coverage was a key component in access to care through the Affordable Care Act. (medscape.com)
  • Medicaid was established in 1965 and was significantly expanded by the Affordable Care Act (ACA), which was passed in 2010. (wikipedia.org)
  • Some low-income patients still needing mental health care will be covered by states, including Minnesota, that expanded Medicaid under the Affordable Care Act. (stateline.org)
  • The Affordable Care Act initially provides 100 percent of the cost of increasing Medicaid coverage to all people whose income is 138 percent of the federal poverty level. (adn.com)
  • The authors hope that the full year's worth of data will help inform debates in the 19 states that have not expanded Medicaid under the Affordable Care Act. (eurekalert.org)
  • Expanded Medicaid is an initiative under the Affordable Care Act (ACA) and provides Medicaid benefits to any person over 18 and under 16 if their income is at or below 133% of the federal poverty level, plus 5% of the federal poverty level for the classified family size. (keloland.com)
  • Poor married women are more likely to be uninsured than poor unmarried women, in part because they are less likely to have Medicaid coverage. (cdc.gov)
  • In most states, anyone with income up to 138% of the federal poverty line qualifies for Medicaid coverage under the provisions of the ACA. (wikipedia.org)
  • Medicaid covers healthcare costs for people with low incomes, while Medicare is a universal program providing health coverage for the elderly. (wikipedia.org)
  • More than 500,000 people across 11 states have lost their Medicaid coverage since the unwinding of a policy that allowed people to stay in the program throughout the pandemic. (stateline.org)
  • In these states, thousands of adults fall into the "coverage gap," with household incomes too high to qualify them for traditional Medicaid and too low to qualify for subsidized marketplace insurance. (scienceblogs.com)
  • Pence, like Ohio Gov. John Kasich and New Jersey Gov. Chris Christie before him, announced a major push Thursday to expand Medicaid under the health care law and follow 26 states that have extended coverage to a larger share of their low-income residents. (politico.com)
  • States this year have been resuming coverage redeterminations in Medicaid, the state-federal program providing health insurance coverage for about 1.5 million lower-income and disabled state residents in Minnesota. (startribune.com)
  • Nonetheless, the larger push for coverage redeterminations - the so-called "unwinding" of Medicaid - is ongoing. (startribune.com)
  • Estimates have suggested that anywhere from 255,000 to 375,000 state residents could lose coverage in roughly a year's time with the resumption of Medicaid renewals. (startribune.com)
  • People who have lost jobs due to COVID-19 and live in states that haven't expanded Medicaid are at a disadvantage when it comes to accessing affordable health insurance coverage. (rwjf.org)
  • This MOE provision required states to provide continuous Medicaid coverage to receive an enhanced 6.2% Federal Medical Assistance Percentage (FMAP). (ahip.org)
  • The Salt Lake Tribune Gov. Gary Herbert addresses the media as he releases his detailed Healthy Utah plan, which is an alternative way to expanding health care coverage for the poor without technically expanding Medicaid. (sltrib.com)
  • Consider a 2010 Cancer study comparing throat cancer patients who had Medicaid coverage and those who had no insurance at all. (wnd.com)
  • Medicaid coverage was no help. (wnd.com)
  • 11. Cleveland-based safety-net health system MetroHealth was approved to operate a Medicaid waiver program that will allow up to 30,000 Ohioans who fall under 133 percent of the federal poverty line to obtain free healthcare coverage. (beckershospitalreview.com)
  • The state now spends a quarter of its general fund on Medicaid coverage - and more than $7 billion annually overall. (michigandaily.com)
  • An ElderLawAnswers member attorney has written the book on Pennsylavania's rules for obtaining Medicaid coverage of nursing home care. (elderlawanswers.com)
  • Two ElderLawAnswers member attorneys have produced a remarkably lucid description of the various ways to qualify for Medicaid coverage of long-term care while protecting the maximum of assets. (elderlawanswers.com)
  • A new study released by Harvard's Chan School of Public Health shows that people enrolled in Medicaid are overwhelmingly satisfied with their coverage and care. (npr.org)
  • The analysis issued by the Congressional Budget Office last month estimates spending on Medicaid would be $770 billion less over ten years under the Senate bill than under current law and that 15 million people would lose Medicaid coverage by 2026. (npr.org)
  • New research predicts that ObamaCare will swell the Medicaid pop ulation by nearly 16 million individuals. (nypost.com)
  • Interestingly enough, when the Heritage Foundation documented how Medicaid populations would grow in all 50 states, this phenomenon was most pronounced in Nevada and Montana, the respective homes of Democratic Leader Harry Reid and Finance Chairman Max Baucus, the Senate's two loudest ObamaCare advocates. (nypost.com)
  • Heritage scholar Ed Haislmaier inspected June 2008's Medicaid-population data in his paper "Does ObamaCare Turn Your State into a Medicaid Monster? (nypost.com)
  • ObamaCare would invite childless, non-elderly adults into Medicaid for the first time and extend benefits to those earning 133 percent of the federal poverty line: $29,326 for families of four, or $14,403 for individuals. (nypost.com)
  • Our State covers children 19 and 20 years of age under the Medicaid EPSDT program. (cdc.gov)
  • How does a VFC program registered provider, who is not already a Medicaid provider, file for Medicaid reimbursement for the vaccine administration? (cdc.gov)
  • A VFC program registered provider is not required to become a Medicaid provider in order to receive publicly purchased vaccine. (cdc.gov)
  • Yes, your State Medicaid agency does have the option to require participation in the VFC Program. (cdc.gov)
  • It is to the benefit of the Medicaid agency to require provider participation in the VFC program because of reduced vaccine costs. (cdc.gov)
  • If the State has chosen the option of expanding its' Medicaid program under SCHIP, the children are Medicaid-enrolled and may be served by the VFC program as are all other Medicaid-enrolled children. (cdc.gov)
  • Medicaid Control and Prevention (CDC) Get Smart: Know When is a US health insurance program that covers 58 million Antibiotics Work campaign for appropriate antimicrobial low-income persons and families ( 6 ). (cdc.gov)
  • In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. (wikipedia.org)
  • As for Medicaid, the plan aims to cut as much a $1 trillion from the low-income program by routing federal money to large block grants. (thedailybeast.com)
  • The resources on these pages cover important topics in Medicaid program integrity. (cms.gov)
  • CLASP monitors requests from states to modify their Medicaid program through waivers. (clasp.org)
  • This website will provide you with the most up-to-date information, trainings, and contact information for successful participation in the School-Based Medicaid Program (SBMP). (mass.gov)
  • About 65 million people were enrolled in Medicaid and the closely related Children's Health Insurance Program at the end of April, 6 million more than had been enrolled in the months leading up to Obamacare's Oct. 1 launch. (politico.com)
  • Republicans have long wanted to add work requirements to the Medicaid program, which covers nearly 75 million low-income children, adults, elderly and disabled Americans. (abcactionnews.com)
  • We are encouraged by Indiana and Gov. Pence's commitment to helping cover more of the state's uninsured population through the Healthy Indiana program and look forward to seeing his proposal," said Emma Sandoe, a spokeswoman for the Centers for Medicare & Medicaid Services. (politico.com)
  • Depending on the specifics of the program, states could lower their Medicaid costs with that flexibility," said Kim. (cbsnews.com)
  • This report, based on past work, describes ways states pay for their share of Medicaid, a program that finances health care for certain low-income people and others through a federal-state partnership. (gao.gov)
  • Since designating Medicaid as a high-risk area in 2003, GAO has made at least 55 recommendations related to the appropriate use of program dollars. (gao.gov)
  • and A Case Study of the Massachusetts Medicaid Estate Recovery Program. (hhs.gov)
  • Since nursing home spending is the program component that is the focus of Medicaid estate recovery, when analyzing and evaluating collection data, it may be more relevant to express collections as a percentage of Medicaid nursing home spending. (hhs.gov)
  • Anne Hopp, the nursing supervisor for a home health care agency, said deep cuts in Medicaid last year have already crippled the program. (wral.com)
  • This is unsustainable," said Paul Reinhart, who directs the state Medicaid program. (michigandaily.com)
  • Medicaid is the publicly funded insurance program for the poor. (upi.com)
  • The survey results come just as Republicans in the Senate are debating a complete overhaul of the Medicaid program, and they counter some of the major arguments for those changes. (npr.org)
  • Barnett, the study's author, says the new data is the first that shows what Medicaid users think of the program. (npr.org)
  • Note: The annual cost includes medical costs paid by state Medicaid Program. (cdc.gov)
  • Local Education Agencies (LEAs), such as municipal (cities and towns) school districts, regional school districts, regional vocational/technical schools, or public charter schools, may seek reimbursement for Medicaid-covered services and associated administrative expenses. (mass.gov)
  • Each $10 increase in Medicaid reimbursement per visit generated a 0.3 percentage point increase in the probability that a Medicaid recipient reported a doctor visit in the past two weeks. (nber.org)
  • States have historically set their own Medicaid reimbursement rates, and those rates have varied widely. (nber.org)
  • This dramatic geographic dispersion in reimbursement rates, however, was substantially reduced in 2013 by a federal mandate that required Medicaid reimbursement rates for certain primary care services to match Medicare rates. (nber.org)
  • The figure shows that, for every $10 increase in Medicaid reimbursement per visit, parents were 0.5 percentage points more likely to report no difficulty finding a provider for their Medicaid-insured children, a 25 percent change relative to the mean. (nber.org)
  • However, the researchers find little evidence that Medicaid reimbursement changes had any offsetting impact on privately insured individuals, suggesting that providers had scope to increase the number of patients they saw. (nber.org)
  • 5. The state Senates in both Oklahoma and Utah agreed to extend hospital provider fees, which have raised hundreds of millions of dollars in extra Medicaid reimbursement. (beckershospitalreview.com)
  • The annual cost of care will vary state to state depending on state approved Medicaid benefits, as well as the state specific care costs. (wikipedia.org)
  • Medicaid spent $215 billion on such care in 2020, over half of the total $402 billion spent on such services. (wikipedia.org)
  • Of the 7.7 million Americans who used long-term services and supports in 2020, about 5.6 million were covered by Medicaid, including 1.6 million of the 1.9 million in institutional settings. (wikipedia.org)
  • The Medicaid continuous enrollment provision, which had halted Medicaid disenrollments since March 2020, ended on March 31, 2023. (kff.org)
  • The researchers conclude that, when it comes to primary care office visits, "closing the gap between private insurance and Medicaid - a $45 increase in Medicaid payments for the median state - would close over two-thirds of disparities in access for adults and would eliminate such disparities among children. (nber.org)
  • The state nibbled at the problem last year, cutting some Medicaid services, such as dental care, podiatry, hearing aids and chiropractic programs for adults. (michigandaily.com)
  • The Medicaid Enrollment and Unwinding Tracker presents the most recent data on monthly Medicaid disenrollments, renewals, overall enrollment and other key indicators reported by states during the unwinding of the Medicaid continuous enrollment provision. (kff.org)
  • Medicaid officials sometimes refer to auto-renewals as "ex parte" renewals. (startribune.com)
  • 2023). S. 2816 - 118th Congress: Medicaid for Every Child Act. (govtrack.us)
  • As of 2017, the total annual cost of Medicaid was just over $600 billion, of which the federal government contributed $375 billion and states an additional $230 billion. (wikipedia.org)
  • Cite this: Medicaid Cuts Hurt Us All - Medscape - Jul 20, 2017. (medscape.com)
  • There are ways to handle excess income or assets and still qualify for Medicaid long-term care, and programs that deliver care at home rather than in a nursing home. (elderlawanswers.com)
  • Applying for Medicaid is a highly technical and complex process, and bad advice can actually make it more difficult to qualify for benefits. (elderlawanswers.com)
  • Consult your State Medicaid agency for further details. (cdc.gov)
  • Consult your State Medicaid agency about the procedures necessary to become a Medicaid provider. (cdc.gov)
  • Some state agencies do not specifically require Medicaid providers to register as VFC providers, but they may refuse to cover the cost of vaccines that are obtained through private sources. (cdc.gov)
  • Logistic regression analyses with robust estimation, Medicaid patients with acute respiratory tract infections adjusting for state-level clustering, were used to identify filledprescriptionsforantimicrobialdrugsin2007.Factors factors associated with antimicrobial drug prescriptions associatedwithlowerlikelihoodofusewerehighercounty- levelavailabilityofprimarycarephysiciansandstate-level for ARI visits. (cdc.gov)
  • Inappropriate use of antimicrobial drugs in Medicaid ed in a state that was funded by the Centers for Disease programs is a potentially serious problem ( 4 , 5 ). (cdc.gov)
  • State Medicaid leaders and policymakers are hungry to know what the future of health care holds, so they can prepare their programmes for the changes ahead. (deloitte.com)
  • The unwinding data are pulled from state websites, where available, and from the Centers for Medicare & Medicaid Services (CMS). (kff.org)
  • One of the things that states have told us time and time again is that they want more flexibility to engage their working-age, able-bodied citizens on Medicaid," Verma told a conference of state Medicaid directors in November. (abcactionnews.com)
  • It's not an exaggeration to say that the survival of Medicaid as it stands today will be in the hands of the state and federal officials we elect this fall. (aarp.org)
  • Federal law imposes requirements around the use of provider and local government funds to finance the nonfederal share of a state's Medicaid expenditures, but in some cases, the nonfederal share of a particular Medicaid payment can be financed entirely by local government or by using funding from taxes levied on providers with no contribution from state general funds. (gao.gov)
  • State Medicaid programs are administered within broad federal guidelines and are financed jointly by states and the Federal Government. (hhs.gov)
  • Recoveries may not exceed the total amount spent by Medicaid on the individual's behalf, nor the amount remaining in the estate after the claims of other creditors delineated in state law have been satisfied. (hhs.gov)
  • Dunnigan, who accompanied Herbert to Washington two times as the governor negotiated with the U.S. Department of Health and Human Services, blasted the feds for not allowing a higher match rate if the state expands Medicaid only to those whose incomes are at or below poverty levels. (sltrib.com)
  • Between 1988 and 2018, state spending on Medicaid jumped from $1.1 trillion to $2 trillion -- a cost increase over three times bigger than population growth. (wnd.com)
  • 4. Fourteen hospitals across Texas asked the state Supreme Court that the Texas Health and Human Services Commission recalculate Medicaid reimbursements for fiscal years 2008 and 2009. (beckershospitalreview.com)
  • Even as state tax revenues fell the past four years, Medicaid caseloads shot up 27 percent and costs rose 40 percent. (michigandaily.com)
  • The stock market, tax cuts, prison spending, the sluggish economy and Medicaid have all contributed to the state deficit. (michigandaily.com)
  • Medicaid is the elephant in the room," said Stuart Paterson, a senior research associate for the Citizens Research Council of Michigan and former state Medicaid director. (michigandaily.com)
  • Yet another $200 million shortfall is projected for this year's state budget, and half of that is because of the mounting Medicaid caseload. (michigandaily.com)
  • But Granholm acknowledged that if she can't convince the Legislature to go along with "sin tax" proposals, the state will need to make deep and painful cuts in Medicaid. (michigandaily.com)
  • We applaud CMS's decision to allow states like New Hampshire to help able-bodied individuals on Medicaid move toward a life of independence through the dignity of work," said Greg Moore, AFP-NH State Director. (americansforprosperity.org)
  • We also monitor federal and state changes to Medicaid policy and evaluate their effects on access to care and health equity. (commonwealthfund.org)
  • Gov. Mike Easley's budget cuts $41 million in Medicaid reimbursements to health care providers, which means people like Greene may see their services cut. (wral.com)
  • During the COVID-19 public health emergency (PHE), Medicaid enrollment increased by 28.5% (20.2 million individuals). (ahip.org)
  • Although data are limited, children accounted for roughly four in ten (38%) Medicaid disenrollments in the 21 states reporting age breakouts. (kff.org)
  • Medicaid's mission may still be to improve the health of people with disabilities and lower incomes so they can get the health care services they need, but the way Medicaid accomplishes this will change. (deloitte.com)
  • GAO provides a primer describing the most common types of arrangements used by states to finance the nonfederal share of state's Medicaid expenditures. (gao.gov)
  • In these cases, the arrangement can shift responsibility for financing Medicaid expenditures to local governments, providers, and the federal government. (gao.gov)
  • The federal government and states share responsibility for financing Medicaid expenditures. (gao.gov)
  • The Centers for Medicare & Medicaid Services (CMS), the agency within the Department of Health and Human Services (HHS), which oversees Medicaid, matches each state's Medicaid expenditures for health care services with federal funds according to a statutory formula. (gao.gov)
  • The arrangements states use to finance the nonfederal share of Medicaid expenditures have implications for federal spending. (gao.gov)
  • GAO was asked to provide information on different arrangements states have used to finance the nonfederal share of Medicaid expenditures. (gao.gov)
  • The U.S. Centers for Medicare & Medicaid Services in Baltimore, Maryland provides federal oversight. (wikipedia.org)
  • Beginning in the 1980s, many states received waivers from the federal government to create Medicaid managed care programs. (wikipedia.org)
  • A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. (cms.gov)
  • However, they will not be allowed to use federal Medicaid funding to finance these services. (abcactionnews.com)
  • Under the current system, the federal government picks up 57 percent to 60 percent of Medicaid costs, with the states absorbing the rest. (cbsnews.com)
  • We found that through certain financing arrangements, states can lower their contribution and shift Medicaid costs to the federal and local governments and care providers. (gao.gov)
  • Congressional Democrats are looking to put billions more federal dollars into Medicaid as part of their plan to fight COVID-19. (wnd.com)
  • 16. HHS Secretary Kathleen Sebelius stressed federal funding for states that expand their Medicaid programs to include more poor residents will be protected from budget battles. (beckershospitalreview.com)
  • In a 2016 bill that President Barrack Obama vetoed, the Republican House majority again tried to shift at least part of the Medicaid burden to the states. (cbsnews.com)
  • Whenever additional information is available pertaining to the ending of the PHE and Medicaid redeterminations, The Arc of New Jersey will distribute it. (constantcontact.com)
  • Americans on Medicaid would jump 15.9 million - from 43.5 million to 59.4 million. (nypost.com)
  • The numbers reflect a big spike in April, when 1.1 million additional people were enrolled in Medicaid compared to March. (politico.com)
  • The 6 million total came overwhelmingly from 25 states that had expanded their Medicaid programs under the health care law by April. (politico.com)
  • As shown in the table below, estate recovery collections are dwarfed by the overall Medicaid spending for nursing homes -- $45,835.6 million in 2004. (hhs.gov)
  • LANSING, Mich. (AP) - Michigan is struggling with Medicaid, its health care insurance plan for about 1.35 million poor people. (michigandaily.com)
  • Medicaid is our nation's largest insurer, covering 72 million Americans. (commonwealthfund.org)
  • Similar to Medicaid Programs most prescription claims data, Medicaid drug claims do not list a diagnosis that corresponds to the indication for treatment. (cdc.gov)
  • A nationwide database of Medicaid and health care data will exist, visible to all health care stakeholders, including Medicaid patients. (deloitte.com)
  • For the new study, Soni and her colleagues examined cancer registry data from 2010 through 2014 to estimate changes in county-level cancer diagnosis rates in states that expanded Medicaid. (upi.com)
  • Along with Medicare, Tricare, and ChampVA, Medicaid is one of the four government-sponsored medical insurance programs in the United States. (wikipedia.org)
  • In compliance with House Enrolled Act 1194, the Office of Medicaid Policy and Planning has developed and will maintain an electronic storage system for all information regarding the Disproportionate Share Hospital (DSH) and Upper Payment Limit (UPL) programs. (in.gov)
  • Because Texas has one of the largest Medicaid programs, and because of the limited number of states reporting, Texas has a disproportionate impact on the share of children disenrolled. (kff.org)
  • Another investigation published in the American Journal of Public Health found that colorectal cancer Medicaid patients had higher mortality rates than their privately insured counterparts. (wnd.com)
  • As of 2022[update] 45% of those receiving Medicaid or CHIP were children. (wikipedia.org)
  • The Social Security Amendments of 1965 created Medicaid by adding Title XIX to the Social Security Act, 42 U.S.C. §§ 1396 et seq. (wikipedia.org)
  • There are also dual health plans for people who have both Medicaid and Medicare. (wikipedia.org)
  • Even Trump himself has been nebulous about what he's going to do, previously saying on the Dr. Oz show that he would provide Medicaid to people who couldn't afford private health insurance. (cbsnews.com)
  • The vast majority of people on Medicaid are families with children, but Medicaid spending is driven by seniors and people with disabilities," he said. (cbsnews.com)
  • For 53 years, Medicaid has served as a safety net for millions of people who needed assistance as their ability to care for themselves declined. (aarp.org)
  • Medicaid is particularly vulnerable, says David Certner, AARP's legislative policy director, "because it services populations such as low-income seniors and people with disabilities, who don't have as strong a voice. (aarp.org)
  • It's not clear exactly why states aren't receiving information from so many people, but Medicaid officials say there are likely multiple factors. (startribune.com)
  • In Minnesota, Medicaid enrollment during the COVID-19 public health emergency grew by more than 360,000 people. (startribune.com)
  • People enrolled in NJ WorkAbility Medicaid are also permitted to have a retirement account (e.g. (constantcontact.com)
  • Medicaid is government health insurance that helps many low-income people in the United States to pay their medical bills . (medlineplus.gov)
  • So if children who can't get vaccines because of Medicaid cuts get measles , that means your child is exposed. (medscape.com)
  • Medicaid offers elder care benefits not normally covered by Medicare, including nursing home care and personal care services. (wikipedia.org)
  • Bevin's alternative hinges on approval from the Centers for Medicare & Medicaid Services. (scienceblogs.com)
  • 2 This amount, while substantial, represents only a small percentage of the total Medicaid spending for nursing home services in 2004. (hhs.gov)
  • At a minimum, states must recover amounts spent by Medicaid for long-term care and related drug and hospital benefits, including any Medicaid payments for Medicare cost sharing related to these services. (hhs.gov)
  • At their option, states may recover costs of all Medicaid services paid on the individual's behalf. (hhs.gov)
  • As a result, average Medicaid payments for these services rose by 60 percent, but there was substantial variation across states in the magnitude of the payment increase. (nber.org)
  • Question: How should I bill New York Medicaid for services provided by non-hospital employee clinicians in emergency department settings? (hfma.org)
  • Our study provides evidence that expanding Medicaid has positive effects on women 's use of healthcare . (bvsalud.org)
  • The enrollment number comes overwhelmingly from 25 states that expanded Medicaid. (politico.com)
  • U.S. Attorney Preet Bharara announces Medicaid fraud charges against more than a dozen Russian diplomats and their spouses living in New York. (stateline.org)
  • Spouses of Medicaid nursing home residents have special protections to keep them from becoming impoverished. (elderlawanswers.com)
  • Gillibrand: Would boost NY's Medicaid cohort by 20 percent. (nypost.com)
  • The 14.5 percent of the nation on Medicaid today would climb to 19.9 percent. (nypost.com)
  • Amid New York's $3.1 billion deficit, Kirsten Gillibrand might reconsider endorsing a measure that would boost her state's Medicaid cohort 20 percent - or by 829,000 - from 4,139,582 to 4,968,582. (nypost.com)
  • Can Michael Bennett defend legislation that would boost Colorado's Medicaid population 70 percent from 407,160 to 692,160? (nypost.com)
  • Those states saw a 15 percent surge in sign-ups - led by Oregon, West Virginia and Nevada, where Medicaid rolls climbed more than 40 percent. (politico.com)
  • Last December, Medicaid hours for health care were slashed 25 percent. (wral.com)
  • The overall cancer diagnosis rate increased by 3.4 percent, compared against states that didn't expand Medicaid under the ACA. (upi.com)
  • For example, a Journal of Health Care study found that children covered by Medicaid who suffer from asthma have much longer hospital stays and worse health outcomes than those on private insurance. (wnd.com)
  • And an Archives of Internal Medicine investigation of the Kentucky Medicaid population found substantially lower survival rates for breast, lung, and prostate cancer. (wnd.com)
  • If it works, we can always advance it further and cover more," Dunnigan said, winning the votes of the Republicans on the task force who said they worry about the long-term costs of extending Medicaid benefits. (sltrib.com)
  • If steps aren't taken to protect the Medicaid recipient's house from the state's attempts to recover benefits paid, the house may need to be sold. (elderlawanswers.com)
  • 3 The percentage of Medicaid nursing home spending recovered in 2004 was 0.789%, an increase from 0.693% recovered in 2002. (hhs.gov)
  • Stripping Medicaid could potentially adversely affect all children, including those who are insured. (medscape.com)
  • To build a picture of what the Medicaid world might look like two decades from now, we gathered a group of subject matter specialists with deep knowledge of the larger health care and Medicaid ecosystem. (deloitte.com)
  • Medicaid enrollment related to the health care law has been difficult to pinpoint, in part because states report their enrollment numbers at different times and using different criteria. (politico.com)
  • As the next president begins to plan for America's future health care needs, including the Medicaid safety net that catches and takes care of the poor, Donald Trump might be called the new kid on the "block. (cbsnews.com)
  • Medicaid is now the primary funder of long-term care. (cbsnews.com)
  • If physicians face capacity constraints, an increase in care for Medicaid patients would imply a decline in care to other patients. (nber.org)
  • Greene has diabetes and relies upon Medicaid to pay for home health care. (wral.com)
  • In addition to nursing home care, Medicaid may cover home care and some care in an assisted living facility. (elderlawanswers.com)
  • Is Medicaid the best health care possible? (npr.org)
  • The results applied across the board to those in traditional Medicaid, Medicaid managed care plans and among the elderly and disabled . (npr.org)