Briefly discuss factors that determine Medicaid el

Briefly discuss factors that determine Medicaid eligibility, and whether a procedure or service is covered.

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Health Care

INSTRUCTIONS:
Week Three Coursework-HCR 230 Claims Preparations II Medicaid • Describe Medicaid eligibility and coverage. • Explain how Medicaid covered charges are determined. • Discuss effects of the Welfare Reform Act on Medicaid eligibility. ASSIGNMENTS 1. Read Ch. 11 of Medical Insurance. 2. Checkpoint: Working with Medicaid • Resources: Ch. 11 (pp. 374-375, 385-386) of Medical Insurance and the U.S. Department of Health & Human Services Web site. • Due Date: Day 4 (THURSDAY) [to the Assignment Folder] • Refer to U.S. Department of Health & Human Services Web site at http://www.cms.hhs.gov/home/medicaid.asp • Select Medicaid Program - General Information. • Post a 250- to 300-word response to the following: o Briefly discuss factors that determine Medicaid eligibility, and whether a procedure or service is covered. o When can a provider bill a Medicaid patient directly for services? o What are the implications of simultaneous federal and state involvement in the insurance process? 3. Assignment: The Welfare Reform Act • Due Date: Day 4 (THURSDAY) [to the Assignment Folder] • Write a 750- to 1,050-word paper discussing the positive and negative implications of the Welfare Reform Act of 1996 on Medicaid. Respond to one or more of the following questions in your paper: o Did the Welfare Reform Act cause existing Medicaid beneficiaries to lose necessary coverage? o Do eligible Medicaid candidates sometimes remain un-enrolled even though they are needy as a result of the Welfare Reform Act? o Is the Welfare Reform Act effective in reducing welfare fraud and increasing personal responsibility? o Has the Welfare Reform Act been successful in meeting its intended goals? • Include a minimum of two references from the Internet or University Library. • Format your paper according to APA guidelines. • Post your paper to the Assignment Folder
CONTENT:
WELFARE REFORM ACT AND MEDICAID IN UNITED STATES Name: Grade Course: Tutor`s Name: (05, January, 2011) Welfare Reform Act and Medicaid in United States Factors That Determine Medicaid Eligibility There are various factors that are used to determine whether an individual becomes eligible for the Medicaid or and some of the factors include the following: the federal mandates that a beneficiary of the service should be referred to as being categorically needy and this include people who are characterized by low incomes and who posses few resources and it they includes individuals who are the beneficiaries of certain Medicare services with low incomes. The group of people referred as being categorically needy includes pregnant women who have low incomes, families with dependent children who often other receive financial assistance, those who are eligible of receiving supplemental security income (SSI), children and infants who meet the low-income requirements. Conditions for direct billing of Medicaid patient A provider is allowed by the federal law to bill a patient directly for services when the following conditions are met: when a patient has been informed by the physician prior to treatment that the service to be performed is not covered by the Medicaid, when the physician informs the patient in advance on the estimated cost of the procedure and the patient in turn agrees in writing to pay the stated charge and finally the physician must have an established...
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