Document Type
Presentation
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Publication Date
11-7-2024
Abstract
Medicaid is essential for health insurance coverage for low income adults, children, and people with mental, intellectual and physical disabilities. Medicaid funding is through Federal and State governments. State governments are able to administer Medicaid independently within federal guidelines. Medicaid can improve beneficiary health and help sustain its own future by embracing innovative treatment models and reimbursement for outcomes. The evolving landscape of healthcare and reimbursement is significantly influenced by various factors, including natural disasters, pandemics, and public health crises like opioid addiction. Since these factors can be unpredictable and impact Medicare beneficiaries, it is important to have mechanisms that facilitate the efficient deployment of funds to support new interventions in response to these events. There is a gap in literature outlining pathways for Medicaid reimbursement for innovative treatment models. Personal experience and a review of the literature highlighted the lack of transparency in Medicaid reimbursement. The Centers for Medicare and Medicaid Services is working to improve transparency in this area and adopted a new federal rule, Ensuring Access to Medicaid Services Final Rule.
Lay Summary
Medicaid is vital to for health insurance coverage for children and adults who are poor, and those individuals who are not able to take care of themselves due to a physical, mental or intellectual disability. Federal government and state government jointly fund Medicaid. However, states has the freedom to implement it independently. There are some federal guidelines states have to follow. Natural disasters, pandemics and rising health care costs can effect Medicaid’s future. In order to not run out of Medicaid funds, newer treatment models that cost less and improve patient outcomes must be sought after. The newer treatment models are not reimbursable to providers with the current Medicaid scope. There is a gap in literature on how to gain reimbursement for providers for these newer treatment models. Personal experience in trying to develop a document on gaining reimbursement further showed that Medicaid is not transparent with its reimbursement to providers. Center for Medicare and Medicaid services has passed a rule to improve transparency with Medicaid. The rule is Ensuring Access to Medicaid Services Final Rule. A policy proposal with recommendations to improve Medicaid transparency with Fee-For-Service component of the Final Access Rule is the goal of this paper.
Recommended Citation
Varughese, MSPT, Cini, "Bringing Transparency to Medicaid Reimbursement: A Policy Proposal" (2024). Master of Public Health Capstone Presentations. Presentation 571.
https://jdc.jefferson.edu/mphcapstone_presentation/571
Language
English
Comments
Presentation: 6:47
Poster attached as supplemental file below