You have a patient who
only has Medicare Part A and B. She has a limited income, most of which is used
to pay for Medicare Part B. She is in dire need of placement into a nursing
home as she can no longer care for herself at home. You gleaned from your
reading that long-term care needed by low-income elderly people is paid for by
Medicaid, and you feel your patient meets the criteria. What are the steps you
would take to advocate for your patient while she is still in the acute care
setting? Who are some of the other health care professionals you would
collaborate with to ensure your patient receives the additional healthcare
coverage she needs? Analyze the role Medicaid plays in supporting long-term
care for the elderly and disabled.
OVERVIEW:
Throughout the course, you have explored topics about advocacy
and healthcare policy, discussed the current healthcare system in the United
States and the impact of healthcare reform especially on the uninsured. You
have articulated the significance of collaboration among nurses and other
healthcare professionals in leading change and ensuring that all patients
receive culturally competent, cost-effective, quality healthcare. In addition,
you have explored healthcare from a global perspective and have articulated
issues that may impact vulnerable populations in the future.
This week’s module explores two major payers of healthcare:
Medicare and Medicaid. You will examine how the Centers for Medicare and
Medicaid Services (CMS) greatly influences healthcare finances as these payers
move from the traditional fee-for-service payment model to the more
patient-centered, quality driven, value-based reimbursement model. Further, you
will gain a clear understanding of how the ACA impact Medicaid and Medicare
recipients.
GOALS:
After completing this
module, students will be able to do the following:
Understand the history of
Medicare and Medicaid enactment and how both have evolved in the United
States since their enactment under the presidency of Lyndon B. Johnson.
Discuss the changes in Medicare
and Medicaid coverage since the implementation of the ACA.
Explain why all people living in
poverty do not qualify for Medicaid coverage under current health care
system.
Describe some of the differences
between states in the administration of their Medicaid programs.
Examine the role that regulations
and federal mandates play in improving the quality of Medicaid and
Medicare services for all beneficiaries.
Learning Materials
Required Resources:
Nickitas, D. M., Middaugh, D. J.,
& Feeg, M. D. (2019). Policy and politics for nurses and other
health professionals: Advocacy and action. (3rd ed.). Jones and
Bartlett Publishers. Read chapters 11 & 12.
Additional Resources:
Amadeo, K. (2019) Federal poverty
level guidelines and chart.
