B3.086 Medicare and Medicaid Flashcards
who is categorically eligible for Medicaid in Kansas
children
pregnant women
adult parents and caregivers
seniors/disabled
discuss Medicaid financial eligibility in KS
<46% FPL
discuss the “gap” between Medicaid and ACA in KS due to not expanding Medicaid
FUCK YOU SAM FUCKING BROWNBACK YOU FUCK
0-46% AND categorically eligible = Medicaid
46-100% FPL = NOTHING
100-400% FPL = ACA tax credit
what is a sustainable amt of monthly income to spend on health insurance?
9-10%
why is not expanding medicaid stupid?
federal taxes are still being paid into Medicaid, but being allocated to other states instead
what are the federal financial provisions for Medicaid expansion
100% of cost covered by federal government until 2020
90% covered by federal government after
how many people are covered by Medicaid?
70 mil
with Medicaid expansion, who should be covered?
nearly all non-elderly adults with income at or below 138% FPL
who was excluded from Medicaid prior to the ACA?
low income adults
how many uninsured poor adults fall into a coverage gap due to non-expansion of Medicaid in some states?
4 million
what is the source of the coverage gap?
ACA provided Medicaid eligibility for low income adults, so it does not provide financial assistance to purchase Marketplace insurance for those under 100% FPL
BUT if states didn’t expand Medicaid, those people get fucked because they don’t actually get Medicaid and they don’t get ACA financial assistance (between 46-100% FPL and not categorically eligible under old Medicaid rules)
mandatory Medicaid services
hospital services (in and outpt) physician services screening/treatment for kids up to 21 lab and xray services family planning FQHC and RHC services freestanding birth center services nursing facility services for those over 21 home health tobacco cessation for pregz non emergent transportation to medical care
selected optional Medicaid services
prescription drugs dental durable medical equipment personal care home and community services
how is access to care in Medicaid?
Medicaid beneficiaries fare much better than uninsured on key measures of access to care, utilization, unmet need, and financial protection
how much does Medicaid spend on services per year
440 bil
acute vs long term care financial burden?
2/3 acute
1/3 long term
what is the historical cost sharing structure between state and federal govts in medicaid
federal govt matches state Medicaid spending at least dollar for dollar
who does Medicare cover?
55 million people over 65 or younger people with disabilities
Part A medicare coverage
inpatient hospital stays
skilled nursing facility stays
home health
hospice
Part A medicare costs to beneficiaries
deductible
coinsurance amts for extended inpatient stays
Part B medicare coverage
physician visits
outpatient services
preventive services
home health
Part B medicare costs to beneficiaries
deductible
20% coinsurance (except on annual wellness visit or for preventive service rated A or B)
Part C medicare
Medicare Advantage
private health plan comprising of Plan A, B, and D benefits
Part D medicare coverage
outpatient prescription drugs
private plans that contract with medicare
voluntary enrollment
Part D medicare costs to beneficiaries
deductible
monthly premiums and cost sharing for prescriptions
5% of total drug cost after reaching catastrophic threshold
downsides to Part C coverage
less choice on physicians, smaller networks since its private
requires prior authorization for discharge, can create logistical issues
upsides to Part C coverage
cheaper than Plan A&B + Plan D extra benefits (dental, vision, hearing)
