Running Head: MEDICAID 1
The Medicaid well-known insurance program, was rolled out in 1965 by the united states government due to Title XIX of the Social Security Act. Before the establishment of Medicaid, there as limited federal payments were made to states and submitted to healthcare facilities to provide supportive healthcare services to the as well as purchasing the services on behalf of the public assistance recipients. Medicaid programs since then have been extensively being used to provide health coverage to all low-income families as well as individuals. The program also covers doctors’ visits, long-term medical care, hospital stays custodial care, among many other health-related expenses (Martin, 2016).
A. Describe the importance of the issue to the healthcare organization.
Medicaid program has been of great help not only to the low-income earner families but also to many of the elderly individuals within the society. The program has further focused on helping the neediest individuals who suffer from serious challenges of disabilities. It is also worth understanding that individuals within the Medicaid plan have been entitled to receive medical care plans that are privately managed (Martin, 2016). It also covers nursing home care services as well as covering healthcare services for home-based services, a move that has assisted many citizens who are in dire need of the health care services.
B. Identify the key organizational stakeholders involved in the issue. Review the facts and consider whether any stakeholders are involved in the issue who may not be immediately apparent upon casual observation.
Major stakeholders that do partner with Medicaid to provided sufficiently satisfying services include the Governor’s office senior Medicaid with agency leadership, the state legislature, the provider community, the center for Medicare and Medicaid Services (CMS) together with the patient and advocacy community, patients, employers, pharmaceutical companies and the insurance company. Some of the stakeholders are not involved in the immediate causal observation include pharmaceutical, insurance, and s well as advocate community (Pressbooks, 2020).
B. Explain how key stakeholders played a role in shaping the health law and policy issues identified in the scenario.
Stakeholders play key roles by enacting laws that regulate Medicaid coverage- they establish who should be eligible beneficiaries, portfolio of insured services, and patient’s costs. They also initiate policies that ensure that there is the maximization of health services and perhaps marshal new resources for the health care services. Good to note is that key stakeholders have also helped enact laws that regulate service providers based on who can legally provide health services within their jurisdiction (Pressbooks, 2020).
C. Identify potential legal risks and malpractice issues that apply. Be sure to provide evidence or examples to support your response.
One major issue and legal risk is a medical professional liability insurance policy that widely covers property damage and liability for personal damage, such as mental anguish. Medical liability insurer suffers a lot of expenses investigating and defending such claims. For example, a medical professional liability insurance crisis in the 1990s led to high prices for policyholders, a scenario triggered by a volatile change in premium (NAIC, 2020).
E. Identify potential value conflicts among key stakeholders. Be sure to provide evidence or examples to support your response.
There has been a conflict of value by the physician as key stakeholders over their low pay. The physicians need to be recognized through reimbursement for their tedious procedural services (NCBI, 2016). For example, physicians engage in medical procedures such as surgeries, invasive, chemotherapy and diagnostic imaging procedures and yet they are not paid as well as their counterpart who only performs non-procedural related services (NAIC, 2020).
Martin, A. (2016). Pros and Cons of Medicaid | LoveToKnow. Retrieved from https://insurance.lovetoknow.com/health-insurance/pros-cons-medicare-medicaid
NAIC. (2020, June 26). Medical Malpractice Insurance. Retrieved from https://content.naic.org/cipr_topics/topic_medical_malpractice_insurance.htm
NCBI. (2016). Conflicts of Interest and Medical Practice – Conflict of Interest in Medical Research, Education, and Practice – NCBI Bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK22944/
Pressbooks. (2020, March 26). 3. Introducing the Key Stakeholders: Patients, Providers, Payors, and Policymakers (the Four P’s) – Connecting Health Information Systems for Better Health. Retrieved from https://jln1.pressbooks.com/chapter/3-introducing-the-key-stakeholders-pa