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Government Involvement in Health Care

Government Involvement in Health Care. Part Two. Medicaid. State Govt. Fed Govt. Title XIX of the Social Security Act Health Care program for certain low income persons (NEED based program) Administered by each state Federal mandates State options Funded by Federal and State Government.

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Government Involvement in Health Care

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  1. Government Involvement in Health Care Part Two

  2. Medicaid State Govt Fed Govt • Title XIX of the Social Security Act • Health Care program for certain low income persons (NEED based program) • Administered by each state • Federal mandates • State options • Funded by Federal and State Government

  3. Medicaid State Govt Fed Govt • Groups Eligible – Mandatory • Children < 6, pregnant women, family income ≤ 133% FPL (FPL on next slide) • Supplemental security income (SSI) • Aged Needy, Blind Needy, Disabled Needy • Children <19, income ≤ FLP • Some foster care children • Certain Medicare beneficiaries, ≤ 74% FPL • Many states are expanding eligibility (SCHIP)

  4. Fed Govt 2005 HHS Poverty Guidelines

  5. Mandatory Services Hospital services (inpatient and outpatient) Physician services Diagnostic services Skilled nursing facility services Rural Health Clinic services Prenatal care/vaccines-child Family planning Nurse practitioner services Optional Services Clinic services Dental Eye glasses Intermediate care facilities-mentally retarded Physical therapy Prescription drugs Rehabilitation services Transportation services Some home/community services Medicaid State Govt Fed Govt

  6. Medicaid State Govt Fed Govt • Federal Government pays 50-83% of costs depending on the state • Federal Match in Nebraska is ~ 60% (61% for fiscal year 2005) • 64.5% of recipients are children, low incomes • < 26% of the dollars go here • 27% of recipients are aged or disabled • Consume 66% of the dollars • Largest Medicaid expenditure–long term care

  7. NE Medicaid Expenditures2003 State Govt www.hhs.state.ne.us/med/reform/expenditures.htm (Accessed 9/3/05)

  8. U.S. Medicaid Expenditures2003 Fed. Govt. www.kff.org/medicaid/upload/7334%20Medicaid%20Primer_Final%20for%20posting-3.pdf (Accessed 9/3/05)

  9. U.S. Expenditures Compared to Number of Enrollees- Medicaid (2003) Fed. Govt. - www.kff.org/medicaid/upload/7334%20Medicaid%20Primer_Final%20for%20posting-3.pdf (Accessed 9/3/05)

  10. Other major Federal Health Coverage Plans Fed. Govt. • Veterans Administration • Dept. of Defense (Military Services) & Tri-Care [Formerly CHAMPUS] (Military Dependents) • Federal Employee Plan • Indian Health Service / U.S. Public Health Service • State & Local Plans for poor and uninsured.

  11. Government Involvement in Health Care This concludes Part Two

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