SOCW 6351 Wk 9 Discussion 1. Need Responses.

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SOCW 6351 Wk 9 Discussion 1. Need Responses.

Respond in one of the following ways:

· Describe two factors that might make minority groups especially vulnerable in the Medicaid policy your colleague cited. Explain why these groups may not have a voice in the policy-making process.

· Offer examples of organized self-help and citizens’ groups as both support mechanisms and potentially powerful lobbies. Describe how these lobbying bodies can help in amending the policy your colleague described.

Support your response with specific references to the resources. Be sure to provide full APA citations for your references.

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Medicaid is a medical assistance program developed specifically for low income individuals of any age, unlike Medicare, which is designed for those over 65 and have no income requirements (“Difference between Medicare and Medicaid”, n.d.). When health care policies are change, they affect programs such as Medicaid and Medicare. For example, when the ACA (Affordable Care Act) was implemented, it led to an increase of enrollment as it made the process easier and reached more individuals and it expanded Medicaid eligibility to low-income adults (Wachino, Artiga & Rudowitz, 2014).

In the state of Pennsylvania, a Medicaid policy that I would amend would be the Healthy PA policy, which was a Medicaid expansion that included drug and alcohol services (IRETA, 2015). The issue is the length of time it takes for someone to be admitted into a program. Whether it’s getting into an inpatient or outpatient program, the process needs to be expedited and more streamlined. Many who are suffering from substance abuse disorders struggle with finally getting themselves into a program and delaying the process could result in someone hesitating and deciding not to move forward with treatment that is crucial (IRETA, 2015).

In Pennsylvania, stakeholders include a steering committee, which is made up of hospitals, health care providers, consumers, foundations and academic institutions (“HIP”, 2019). This committee comes up with ways to improve population health and control health cost including Medicaid and Medicare. They developed a plan for heathcare delivery that will improve the quality of life for everyone, without limitations on income or background (“HIP”, 2019). This committee has 5 work groups that develop implementation plans for the goals that were developed by the committee and focus on specific aspects such as payment, price and quality transparency, population health, healthcare transformation and health information technology (“HIP”, 2019).

 

References:

HIP stakeholders. (2019). Retrieved from https://www.health.pa.gov/topics/Health-Innovation/Pages/Stakeholders.aspx

IRETA. (2015). Pennsylvania’s Medicaid expansion smooths the road to addiction treatment, but barriers remain. Retrieved from https://ireta.org/resources/pennsylvanias-medicaid-expansion-smooths-the-road-to-addiction-treatment-but-barriers-remain/

Wachino, V., Artiga, S. & Rudowitz, R. (2014). How is the ACA impacting Medicaid enrollment? Retrieved from https://www.kff.org/medicaid/issue-brief/how-is-the-aca-impacting-medicaid-enrollment/

What is the difference between medicare and Medicaid? (n.d.). Retrieved from https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html

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Major health policy creations or changes are based on health care reforms and this has been a global issues over many years as the United States has seen proposals for multiple reforms (Manchikanti, Helm, Benyamin, & Hirsh, n.d.). The main goal of health care reform is to expand services to more people, improve access, decrease the cost, and improve quality. At the beginning of the 20th century, the United States was influenced by progressivism due to many European countries passing the first welfare acts and government-run health care programs (Manchikanti, Helm, Benyamin, & Hirsh, n.d.). In 1933, Franklin D. Roosevelt included publicly funded health care programs in his provisions resulting in private insurers starting to emerge such as Blue Cross. Then, in 1951, the IRS ruled that group premiums paid by employers is a tax-deductible business expense, which solidified third party insurance companies as the primary providers of access to health care (Manchikanti, Helm, Benyamin, & Hirsh, n.d.). The passage of the Affordable Care Act has also influenced Medicaid policies today. 

Because Medicaid is federally funded and guidelines are broad, states have a great deal of flexibility in designing and administering their programs, so eligibility and benefits vary widely across the states (Policy Basics: Introduction to Medicaid, 2019). In the state of Wisconsin, a policy that should be amended is the BadgerCare Plus Prenatal Plan. Under this, health care coverage is provided to women who are not eligible for the general BadgerCare Plus because of their immigration status or because they are in prison or jail (BadgerCare Plus Prenatal Plan, 2019). This should be amended because while someone under this plan receives prenatal care, doctor and clinic visits, prescription drugs such as vitamins, and labor and delivery, there are no services provided after the pregnancy ends. This can be amended by extending services into post-partum for a period of time to insure there are not later difficulties such as post-partum depression or difficulties adjusting to a new baby especially because of the populations that this policy aims to serve is already at-risk. 

Stakeholders involved in the Medicaid and Medicare health care policy include a group called WCHQ or Wisconsin Collaborative for Healthcare Quality. A few stakeholders that have collaborated within this group are Wisconsin Department of Health Services, Delta Dental, U.S. Health Resources and Services Administration (HRSA), and Security Health Plan to name a few (WCHQ, 2019). Their goal is to improve on better care for patients with multiple chronic diseases, better care coordination with fewer resources which would result in improved efficiency, higher patient satisfaction, better outcomes, and lower costs for the patients, employers, and payers (WCHQ, 2019). They work towards a commitment to ensure all patients receive high-quality, safe care. These stakeholders could play a role in policy development in amending the BadgerCare Plus Prenatal Plan by advocating that safe care includes post-partum care in those specific populations. 

Resources:

BadgerCare Plus Prenatal Plan. (2019, April 12). Retrieved from https://www.dhs.wisconsin.gov/badgercareplus/prenatal-plan/index.htm

Policy Basics: Introduction to Medicaid. (2019, April 01). Retrieved from https://www.cbpp.org/research/health/policy-basics-introduction-to-medicaid

Manchikanti, L., Helm, S., II, Benyamin, R. M., & Hirsch, J. A. (n.d.). Evolution of US Health Care Reform. PAIN PHYSICIAN20(3), 107–110. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edswsc&AN=000398732100023&site=eds-live&scope=site

Wisconsin Collaborative for Healthcare Quality. (2019). Retrieved from https://www.wchq.org/index.php

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The evolution of health care policy has had a significant influence on Medicaid and Medicare. Medicaid was started as an aftermath to Medicare and has since evolved to become the largest insurer in the country from being an adjunct to state welfare initiatives. In America, the ever-increasing cost of healthcare has influenced changes in Medicaid and Medicare programs. The main aim of the government is to increase the population of insured people. Further, Medicaid and Medicare programs have been nationalized to offer response to the high demand for medical services, which created the need to expand the health insurance industry. Significant efforts to achieve universal medical coverage also influenced health care policy. Texas Health Steps periodic health screening for preventive care or what is commonly referred to as the Early and Periodic, Diagnostic, and Treatment (EPSDT) should be amended. Making an amendment to the Medicaid program would require the input of the state’s legislature and advanced input from the public. EPSDT should be revised to focus on all health care services for children from birth through 35 years. This will help increase awareness of the prevailing medical services via informing and outreach efforts. It would ensure the recruitment of qualified medical experts to enhance the provision of health care services to the young population. The first stakeholder with involvement in Medicaid and Medicare programs in Texas is the state’s government. The government help in policy formulation, implementation, and financing. Lawmakers are responsible for policy approval that includes making changes to the policy. Also, the national government helps in financing the programs (Acker, 2010). Others are social workers who interact with patients on a daily basis. Together with other human service workers, they ensure that patients get the best care. The general output of service providers like social workers determines the effectiveness and efficiency of medical amenities.

References

Acker, G. M. (2010). How social workers cope with managed care. Administration in Social Work34(5), 405-422. doi: 10.1080/03643107.2010.518125

Texas Department of State Health Service (n.d). About Texas Health Steps. Retrieved from https://www.dshs.texas.gov/thsteps/about.shtm

 

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