Complete 2 Sociology Stakeholder Discussion Responses to Classmate’s Posts

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AT LEAST 200 WORDS EACH, AT LEAST 1 REFERENCE EACH, PLEASE SEPARATE EACH RESPONSE, PLEASE EXPAND ON THEIR IDEAS, DO NOT JUST SAY YOU AGREE WITH THEM

POST 1:

With health care reform two objectives were being addressed 1) being separate Medicaid from welfare making easier to qualify for Medicaid and the second is welfare policies being more restrictive to those applying (Kronebusch n.d). The basic model for Medicaid enrollment include the characteristics of the family and is based on certain qualifications such as income, family size, head of household and if the family is US citizens or not. The variables included the family’s size and how much was being brought into the home in order to qualify. The evolution of health care policy have impacted many families throughout the years as the range of income status continues to change. With the goal intended to separate welfare and Medicaid it appears more families are being offered healthcare and receiving the necessary health care coverage needed.

In the state of Nevada our current health care policy based on Medicaid is that the families have option for three choices, two in which qualify families for HMO Medicaid (Amerigroup & health plan of Nevada) based on families choice. With each HMO the family is provided a case worker to ensure the family needs are being met. The policy I would amended are the qualifications for Health Plan of Nevada as it is rarely accepted throughout the state and the families are paying a certain monthly fee but not being provided the appropriate care. I would advocate that more providers qualify to accept Health plan of Nevada and look into eligibility requirements. The stakeholders involved within that decision is the Department of Health care and financing and the Nevada Medicaid task force (NDHHS n.d).

Kronebusch, K. (n.d). Children’s Medicaid Enrollment: The Impacts of Mandates, Welfare Reform, and Policy Delinking. Journal Of Health Politics, Policy & Law, 26(6), 1223.

Nevada Department of Health and Human Services (n.d) Nevada Department of Health care and financing retrieved from https://www.medicaid.nv.gov/

POST 2:

takeholders in healthcare policy

Health care programs and policies have evolved since 1965 when legislation established Medicare and Medicaid. When Medicare and Medicaid was first established it declared that the federal government wouldn’t interfere with clinical medicine (Dewalt, et al 2005). Since then the evolution of medical care, its finances, and clinical medicine has been linked to Medicare (Dewalt, et al 2005). Congress involvement with Medicare and Medicaid begun when concerns with fraud and abuse of the system became evident. Congress still has control over Medicare and Medicaid and it continues to evolve with the Medicaid health reform act or Obama care.

Michigan has a policy called processing request 10.2 A states that a verbal prior authorization may be requested over the phone. This is only for situations that require amidated correction or diagnosis to prevent further damage. If it is after hour the provider may submit the request for authorization the following day (Michigan Medicaid manual, 2016). The change I would make to this policy is not requiring prior authorization for diagnosing or treating and issue that would create damage to a person. I feel that this could cause a delay in a lifesaving process.

References

Michigan Medicaid manual n.d. retrieved 4/27/17 http://www.mdch.state.mi.us/dch-medicaid/manuals/MedicaidProviderManual.pdf

Darren A. DeWalt, M.D., M.P.H., Jonathan Oberlander, Ph.D., Timothy S. Carey, M.D., M.P.H., and William L. Roper, M.D., M.P.H. Significance of Medicare and Medicaid Programs for the Practice of Medicine(2005.)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194929/

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