Medicare Case Solution And Analysis, HBR Case Study Solution & Analysis of Harvard Case Studies

Medicare Case Study Solution

The assignment draws on material from the lectures, from the readings and chapters, including assigned readings that may not have been covered in detail in class.

Submit completed assignment to the dropbox on ICollege by 5:00p.m.onSunday 2/9/2020.

Answer the following questions and limit each response to less than 300 words, excluding title and/or references. Please use the following documents to assist you: HB 1628 (Congress), Gov. Kemp’s Medicaid (1115 Waiver) proposal, ACA bill prior to 2014, 2019 healthcare notice from Ga legislators.

COMPARE and CONTRAST the differences between the Medicare program and the Medicaid program for the following categories; list ONE example of how the programs are the SAME; list ONE example of how they are DIFFERENT.

a). Funding (discuss the difference in how programs are funded) (5 pts)

Benefits design (what services are covered and the difference between programs) (5 pts)
Eligibility (who is covered by each program) (5 points)
Reimbursement (how is payment made and difference between hospitals/doctors) (5pts)

Medicare and Medicaid programs are government-sponsored healthcare insurance programs designed to provide the people of the United States with assistance to acquire medical and health coverage for older individuals and people with disabilities, and low-income households respectively. (Koba, 2011)The funding for Medicare mainly comes from payroll taxes collected by FICA and the SECA whereas Medicaid is primarily funded by the general revenues of state and local government. (LaPointe, 2017)The healthcare services provided by Medicare (fee-for-service health plan) is divided into two parts i.e. hospital insurance - home health care, hospice care, skilled nursing facility care, and inpatient care, and medical insurance - many preventive services, DME, home health care, outpatient care, and services from health care providers and doctors. In contrast, the Medicaid services include vision and dental care for children, necessary medications, mental health care, preventive care, prenatal and maternity care, inpatient and outpatient hospital services, laboratory and x-ray services, and others. (Officials, 2019)

The eligibility in Medicare program includes an individual of at least 65 years of age, under 65 years old but with a disability, any age with either permanent kidney failure or end-stage renal disease, and must be a U.S. citizen whereas eligibility in Medicaid program includes: children under 18 years of age, pregnant women with low income, people receiving SSI, people in the category of being provided cash assistance by the state. ((DCD), 2017)Medicare reimbursement is referred to as the payment received by hospitals and doctors based on the provision of patient services that are covered under medicare whereas a doctor is paid less for the provision of the same service under Medicaid. The reimbursement in both Medicare and Medicaid program payments are sent to the healthcare provider based on the ‘fee-for-service’ agreement. (LaPointe, 2017)

Please read the recent 1115 Waiver (in text form) for Georgia Medicaid which may be used as a reference for this exam. This was the Governor’s bill presented and has recently been voted on by the legislators.
a) What is the federal government’s purpose in giving the 1115 waiver to the State of Georgia. (10pts)...............................

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