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 federal health insurance program in the United States for people age 65 or older and younger people with disabilities,including those with end stage renal disease and amyotrophic lateral sclerosis. It was begun in 1965 under the Social Security Administration (SSA) and is now administered by the Centers for Medicare and Medicaid Services (CMS).
The Centers for Medicare &Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid,the Children's Health Insurance Program (CHIP),and health insurance portability standards. In addition to these programs,CMS has other responsibilities,including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA),quality standards in long-term care facilities through its survey and certification process,clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments,and oversight of HealthCare.gov. CMS was previously known as the Health Care Financing Administration (HCFA) until 2001.
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.
AHIP is an American political advocacy and trade association of health insurance companies that offer coverage through the employer-provided,Medicare Advantage,Medicaid managed care,and individual markets.
In the United States,Medicare fraud is the claiming of Medicare health care reimbursement to which the claimant is not entitled. There are many different types of Medicare fraud,all of which have the same goal:to collect money from the Medicare program illegitimately.
The Accreditation Commission for Health Care (ACHC) is a United States non-profit health care accrediting organization. It represents an alternative to the Joint Commission and CHAP,The Community Health Accreditation Program.
Medicare Advantage is a type of health plan offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage. 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.
Andrew M. Slavitt is an American businessman and healthcare advisor who served as the acting administrator of the Centers for Medicare and Medicaid Services from March 2015 to January 2017 and as a temporary Senior Advisor to the COVID-19 Response Coordinator in the Biden administration. A leader of the team that helped to repair the healthcare.gov website after its initial rollout,he was nominated by Barack Obama to run CMS in July 2015. In January 2021,Slavitt accepted a temporary role as Senior Pandemic Advisor to President Joe Biden’s COVID-19 pandemic response team. He stepped down from that role in June 2021.
The Oklahoma Health Care Authority (OKHCA) is an agency of the government of Oklahoma responsible for providing health insurance benefits for the state's SoonerCare members. The authority is the state-level counterpart to the federal Centers for Medicare and Medicaid Services.
Blue Cross and Blue Shield of Alabama (BCBSAL) is a nonprofit health insurance company headquartered in Birmingham,Alabama. The company was founded in 1936,provides coverage to more than 3 million people and is a member of the Blue Cross and Blue Shield Association (BCBS). BCBSAL employs nearly 5,000 people,which includes almost 3,500 people at its corporate headquarters in Birmingham. The company also operates Cahaba Government Benefit Administrators and Cahaba Safeguard Administrators,both headquartered in Birmingham. It commands over 90 percent of the health insurance market in Alabama,a state with half a million uninsured people,one of the highest uninsured rates in the nation at 10 percent of the population.
Stephen L. Ondra is the chief medical adviser for the MITRE Corporation’s work as operator of the CMS Alliance to Modernize Healthcare federally funded research and development center. Ondra advises all HHS organizations to advance private insurance markets,Medicare and Medicaid,value-based payments,and healthcare quality. Ondra was most recently CEO of Cygnus-AI Inc.,a company specializing in artificial intelligence and clinical decision support tools for diagnostic radiology. He was also founder and chief executive officer of North Star Health Care Consulting,and served on the board of directors of Triple-S Management and electroCore. A neurosurgeon and neuroscientist,Ondra has also served in senior positions in the Federal government,having a role in health reform efforts and the implementation of the Affordable Care Act. He advises corporations,provider organizations and early-stage start-ups on the transition to value-based care and health IT strategy.
The Center for Medicare and Medicaid Innovation is an organization of the United States government under the Centers for Medicare and Medicaid Services (CMS). It was created by the Patient Protection and Affordable Care Act,the 2010 U.S. health care reform legislation. CMS provides healthcare coverage to more than 100 million Americans through Medicare,Medicaid,the Children’s Health Insurance Program (CHIP),and the Health Insurance Marketplace.
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.
HealthCare.gov is a health insurance exchange website operated by the United States federal government under the provisions of the Affordable Care Act or ACA,commonly referred to as "Obamacare",which currently serves the residents of the U.S. states which have opted not to create their own state exchanges. The exchange facilitates the sale of private health insurance plans to residents of the United States and offers subsidies to those who earn between one and four times the federal poverty line,but not to those earning less than the federal poverty line. The website also assists those persons who are eligible to sign up for Medicaid,and has a separate marketplace for small businesses.
Don Irvin Wortman was a U.S. federal government administrator who served 27 years in senior-level executive positions in many federal government agencies. He was Acting Commissioner of the Social Security Administration (SSA) from December 13,1977,to October 4,1978. In early 1977,while working at the Department of Health,Education and Welfare (HEW)—precursor to the Department of Health and Human Services—he was Chairman of the task force for implementing the reorganization of HEW. This reorganization included the merging of the Medicare and Medicaid programs into a new agency;this agency was named the Health Care Financing Administration. He became the first Administrator of the Health Care Financing Administration. On two occasions—6 months in 1975 and the first 3 months of 1977—he was Acting Administrator of the Social and Rehabilitation Services,the agency which,at that time,administered the Medicaid program and the Aid to Families with Dependent Children program.
Steven Pearson is an American physician,bioethicist,and the Founder and President of the non-profit health policy and comparative effectiveness research organization Institute for Clinical and Economic Review in Boston,MA. He conducts research on cost-effectiveness analysis and healthcare technology assessment. He is also a lecturer in Harvard's Department of Population Medicine and a member of the National Institutes of Health (NIH) Comparative Effectiveness Research Steering Committee.
Seema Verma is a General Manager and Senior Vice President at Oracle Corporation. She is the 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.
Enhanced Direct Enrollment (EDE) is a provision in the United States that allows certain private entities,including insurance carriers and web-brokers,to directly enroll consumers in Qualified Health Plans through the Health Insurance Marketplace without redirecting consumers to Healthcare.gov. Approved EDE partners may access a suite of APIs which allow them to directly submit and update applications on the federal exchange.
Chiquita W. Brooks-LaSure is an American healthcare policy official who is the administrator for the Centers for Medicare and Medicaid Services in the Biden administration since May 2021.
