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In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding.
Medicare is a government national health insurance program in the United States, begun in 1965 under the Social Security Administration (SSA) and now administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the SSA, including people with end stage renal disease and amyotrophic lateral sclerosis.
A Federally Qualified Health Center (FQHC) is a reimbursement designation from the Bureau of Primary Health Care and the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. This designation is significant for several health programs funded under the Health Center Consolidation Act.
Medigap refers to various private health insurance plans sold to supplement Medicare in the United States. Medigap insurance provides coverage for many of the co-pays and some of the co-insurance related to Medicare-covered hospital, skilled nursing facility, home health care, ambulance, durable medical equipment, and doctor charges. Medigap's name is derived from the notion that it exists to cover the difference or "gap" between the expenses reimbursed to providers by Medicare Parts A and B for services and the total amount allowed to be charged for those services by the United States Centers for Medicare and Medicaid Services (CMS).
The American Health Care Association (AHCA) is a non-profit federation of affiliated state health organizations that represents more than 14,000 non-profit and for-profit nursing homes, assisted living communities, and facilities for individuals with disabilities. The organization's president and CEO is Mark Parkinson, a former governor of Kansas. The National Center for Assisted Living (NCAL) is a part of the AHCA.
The Massachusetts health care reform, commonly referred to as Romneycare, was a healthcare reform law passed in 2006 and signed into law by Governor Mitt Romney with the aim of providing health insurance to nearly all of the residents of the Commonwealth of Massachusetts.
The Arizona Health Care Cost Containment System is the state agency that administers Arizona’s Medicaid program. Medicaid was created to provide healthcare to individuals who qualify by financial need. The $14.6 billion dollar program covers the behavioral and physical health care services for more than 1.9 million Arizonans. In 2019, AHCCCS covers approximately 48% of Arizona’s children and 54% of babies born in the state.
Thomas Andrew Scully is an American lawyer and former government official. He was the administrator of the Centers for Medicare and Medicaid Services (CMS) from 2001 to 2004 under President George W. Bush. Scully is currently a general partner at Welsh, Carson, Anderson & Stowe, a private equity investment firm, where he focuses on health care investments. Scully is also principal at Federal Health Policy Strategies and a partner at its affiliated law firm Scully, Roskey & Missmar, where he focuses on health care regulatory and legislative matters, as well as on advising clients on health policy and strategies for health care delivery.
The Balanced Budget Act of 1997 was an omnibus legislative package enacted by the United States Congress, using the budget reconciliation process, and designed to balance the federal budget by 2002. This act was enacted during Bill Clinton's second term as president.
The Oregon Health Plan is Oregon's state Medicaid program. It is overseen by the Oregon Health Authority.
Health care in Australia operates under a shared public-private model underpinned by the Medicare system, the national single-payer funding model. State and territory governments operate public health facilities where eligible patients receive care free of charge. Primary health services, such as GP clinics, are privately owned in most situations, but attract Medicare rebates. Australian citizens, permanent residents, and some visitors and visa holders are eligible for health services under the Medicare system. Individuals are encouraged through tax surcharges to purchase health insurance to cover services offered in the private sector, and further fund health care.
In the United States, health insurance helps pay for medical expenses through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.
Medicare Advantage is a capitated program for providing Medicare benefits in the United States. Under Part C, Medicare pays a sponsor a fixed payment. The sponsor then pays for the health care expenses of enrollees. Sponsors are allowed to vary the benefits from those provided by Medicare's Parts A and B as long as they provide the actuarial equivalent of those programs. The sponsors vary from primarily integrated health delivery systems to unions to other types of non profit charities to insurance companies. The largest sponsor is a hybrid: the non profit charity AARP using UnitedHealth.
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965.
Following the signing of the Children’s Health Insurance Program (CHIP) into law on August 5, 1997, as Title XXI of the Social Security Act, Utah started looking at how to implement the Federal program under the Center for Medicare and Medicaid Services.
Health care finance in the United States discusses how Americans obtain and pay for their healthcare, and why U.S. healthcare costs are the highest in the world based on various measures.
As of 2017, approximately 1.4 million Americans live in a nursing home, two-thirds of whom rely on Medicaid to pay for their care. Residential nursing facilities receive Medicaid federal funding and approvals through a state health department. These facilities may be overseen by various types of state agency.
HealthShare Exchange (HSX) is a membership-dues-supported nonprofit health information exchange formed in 2009 and incorporated in 2012 by Greater Philadelphia's hospitals, health systems, and healthcare insurers.[1][2] It links the electronic medical record (EMR) systems of different hospital health systems and other healthcare providers — and the claims data of healthcare insurers — to make this information accessible at inpatient and outpatient points of care (including medical practice offices) and for care management. HSX services provide recent clinical care information, and alert providers and health plans to care events.[2] Health information exchange makes patient care more informed and coordinated, and reduces unnecessary care and readmissions. HSX serves the greater Delaware Valley region, including southeastern Pennsylvania and southern New Jersey.[2]
Seema Verma is a General Manager and Senior Vice President at Oracle Corporation. She is former administrator of the Centers for Medicare & Medicaid Services in the Donald Trump administration. During her tenure, she was involved in efforts to repeal the Affordable Care Act, as well as reduce Medicaid benefits and increase restrictions on Medicaid. She was embroiled in ethics and legal controversies related to her use of taxpayer money while in office.
Health Partners Plans (HPP) is a non-profit hospital-owned health maintenance organization which provides Medicaid and Medicare to central and southeastern Pennsylvania residents. Health Partners Plans has over 262,000 members throughout Pennsylvania and provides healthcare to low income residents in the counties of Bucks, Chester, Delaware, Lancaster, Lehigh, Montgomery, Northampton and Philadelphia.
References
- ↑ "A Guide to Pennsylvania's Medicaid HealthChoices Health Plans" (PDF). healthpartnersplans.com. Retrieved 1 September 2019.
- ↑ "Keystone First Rated Among the Top Medicaid Plans in Pennsylvania". businesswire.com. 18 December 2015. Retrieved 1 September 2019.
- ↑ Zorrilla, Monica (2019-02-23). "Looking for affordable eyeglasses? Here's 11 ways to find them in Philly". Billy Penn. Retrieved 1 September 2019.
- ↑ Bate, Dana (2019-08-09). "The high cost of being broke: Dental care". WHYY. Retrieved 1 September 2019.
- ↑ Jones, Ayana (31 May 2019). "AmeriHealth Caritas executive educates consumers about health coverage options". The Philadelphia Tribune. Retrieved 1 September 2019.