• Medicaid and Medicare are two governmental programs that provide medical services to specific groups of people in the United States.

• Although the two programs are very different, they are both managed by the Centers for Medicare and Medicaid Services (division of the U.S. Department of Health and Human Services).

Medicare• One of most popular and successful programs• Signed into law by President Lyndon Johnson

on July 30, 1965.

The legislation remains an important legacy of LBJ’s “Great Society” society initiative.

President Johnson explains his vision…

• No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles, and their aunts.

Before Medicare

• Before the enactment of Medicare, only 50% of seniors had health insurance and 35% lived in poverty.

• Even a minor illness or injury could bankrupt older Americans and their families.

• Therefore, the elderly often chose to die because they did not want to be a personal or financial burden on their families.

Supporters…• "thanks to Medicare,"

75% fewer seniors are in poverty, and most have health coverage

Opponents…

• “Programs such as Medicare are responsible for rapidly rising health-care costs”

• “The system was better before Medicare - communities worked together to make sure most people received needed medical attention”

• “Doctors and hospitals often went unpaid for their efforts, or accepted baked goods or chickens in partial payment”

Criticism of the Medicare prescription drug plan

Who is eligible for Medicare?

• An individual must either be at least 65 years old, under 65 and disabled, or any age with End-Stage Renal Disease (permanent kidney failure that requires dialysis or a transplant).

• In addition, eligibility for Medicare requires that an individual is a U.S. citizen or permanent legal resident for 5 continuous years and is eligible for Social Security benefits with at least ten years of payments contributed into the system.

Who pays for services provided by Medicare?

• Payroll taxes collected through FICA (Federal Insurance Contributions Act) and the Self-Employment Contributions Act are a primary component of Medicare funding.

• The tax is 2.9% of wages (usually half paid by the employee and half paid by the employer.) Money are set aside in a trust fund that the government uses to reimburse doctors, hospitals, and private insurance companies.

• + Additional funding for Medicare services comes from premiums, deductibles, coinsurance, and copays.

How does the program work III.

• The program consists of two main parts for hospital and medical insurance (Part A and Part B) and two additional parts that provide flexibility and prescription drugs (Part C and Part D).

• Watch the video…• http://www.youtube.com/watch?

feature=player_embedded&v=FsAlXRV1yx0

Insurance Card

Medicare's 47th AnniversaryIn 2012 and nearly 50 million Americans are receiving benefits through the Medicare program regardless of their medical condition or income. This includes:41 million Americans age 65 and above, and9 million disabled Americans receiving Social Security benefits.

Medicare’s Future

• Patient Protection and Affordable Care Act (PPACA) = Obamacare (2010)– Amended by Health Care and Education

Reconciliation Act of 2010– Aims:

• to insure more Americans (30 million)• To lower health care costs

– National Federation of Independent Business v. Sebelius• SCOTUS confirms constitutionality of PPACA

• Funding• Health Insurance Exchange

Medicaid

• The largest source of funding for medical and health-related services for people with limited income in the United States.

• Social welfare (or social protection) program that serves about 40 million people

• costs about $330 billion, or 2.4% of GDP• Jointly funded by the state and federal

governments• Managed by the States

State level

• Establishes its own eligibility standards,• Determines the type, amount, duration, and

scope of services,• Sets the rate of payment for services, and• Administers its own Medicaid program.

Different States

• California: Medi-Cal• Maine: MaineCare• Massachusetts: MassHealth• Oregon: Oregon Health Plan• Oklahoma: Soonercare• Tennessee: TennCare

Services providedRequiered

• Inpatient hospital services• Outpatient hospital services• Prenatal care• Vaccines for children• Physician services• Nursing facility services for persons aged 21 or

older• Family planning services and supplies

• Rural health clinic services• Home health care for persons eligible for skilled-

nursing services• Laboratory and x-ray services• Pediatric and family nurse practitioner services• Nurse-midwife services• Federally qualified health-center (FQHC) services

and ambulatory services• Early and periodic screening, diagnostic, and

treatment (EPSDT) services for children under age 21

Services ProvidedOptional

• Diagnostic services• Clinic services• Intermediate care facilities for the mentally retarded (ICFs/MR)• Prescribed drugs and prosthetic devices• Optometrist services and eyeglasses• Nursing facility services for children under age 21• Transportation services• Rehabilitation and physical therapy services• Home and community-based care to certain persons with

chronic impairments

So who is entitled for Medicaid

• Medicaid serves more than 40 million enrollees (as of 2007)

• Each state sets its own Medicaid eligibility guidelines.• The program is geared towards people with low

incomes.• Eligibility depends on meeting other requirements

based on age, pregnancy status, disability status, other assets, and citizenship.

Examples

• Children under age 6 whose family income is at or below 133% of the Federal poverty level (FPL).

• Pregnant women with family income below 133% of the FPL.

• Children born after September 30, 1983 who are under age 19 and in families with incomes at or below the FPL.

Who pays for services provided by Medicaid?

• Medicaid does not pay money to individuals, but operates in a program that sends payments to the health care providers.

• Each State is reimbursed for a share of their Medicaid expenditures from the Federal Government.

• Richer states receive a smaller share than poorer states, but by law the FMAP must be between 50% and 83%.

Sources

• http://www.medicalnewstoday.com• http://www.medicare.gov• http://www.ncpssm.org• http://chronicle.augusta.com• http://www.medicalnewstoday.com/info/medi

care-medicaid/