Help Answer Peer Question & Answer Guide (With Explanation)

Students often encounter this when studying fundamental concepts.

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How to Approach This Question

Structure your response with introduction, analysis, and conclusion.

Key Explanation

This topic involves help answer peer. A strong answer should include explanation, application, and examples.

Original Question

help me answer my peer about her discussion post with full references at the bottom Medicaid is a federally mandated program which provides medical services to individuals of low incomes. The money that is is funding this program comes from both federal and state assistance. Each state government administers the program within their state. Its also important to note that one needs to fit the qualifications to be eligible to take part in the program. The Center for Medicare and Medicaid services are responsible to run the program within the law. How would be eligible for Medicaid? This is not so simple because a person may be eligible in one state but not in another, or a service may be covered and provided in one state under Medicare and not in another. So its important to understand that states have the right to change Medicaid eligibility requirements. Requirements for eligibility include citizenship or residency, being a resident of the state they will be receiving care, and according to our text there are eligibility limits in age, pregnancy, parenting status (Green, 2024). There are also individuals who can be eligible if they are blind, have a disability, or are over the age of 65. Their determination for eligibility comes from SSI. Once someone has been approved for Medicaid there are certain coverages that are mandatory coverages this includes transportation to medical care, laboratory and x-ray services and family planning services to name a few. There are also other services that the state can add to Medicaid benefits in their state like dental services, physical therapy and occupational therapy(Green, 2024). This is important to understand that not all states give out the same services to Medicaid users. A portion of the Medicaid program in all states is paid by the federal government this is called the Federal Medical Assistance Percentage (Green, 2024). The next source of funding for Medicaid comes from the states taxes and fees. The states have a responsibility to fund services that are under their own state plans (Green, 2024). Most states pay medical service through fee for service or managed care arrangements. Coinsurance, copayments and deductibles are permitted. Hospitals that service areas that have a lot of uninsured or Medicaid users also receive Disproportionate share hospital payments. One of the difficult obstacles our text touched upon that Medicaid users can run into is having to travel long distances to receive care. This was an issue with indigenous Americans who had to travel off reservation in order to receive care from Medicaid providers. The affordable care act helped expand Medicaid and all more choice for individuals dealing with this type of obstacle (Green, 2024). With all the complexities of Medicaid pros and cons are experienced by providers who accept this in their offices. Based off of what we read in our text I would say that the first con for a provider is the payment that they receive will not be as high as it would for a private insurance claim. The administrative side there needs to be a lot of understanding of the program and what coverage is had. Training new people on this I think would take some time. A Pro is that they are providing a service for those who need it so there would always have patients coming in. But then a con could be a lot of traffic into the office. Reference: Green, M. A. (2024). Understanding Health Insurance: A Guide to billing and reimbursement. Cengage

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