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Medicaid Managed Care Case Study

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Over the last few decades, managed health care has revolutionized the way medicaid beneficiaries treat essential healthcare services such as family planning and parenthood programs. The term managed care is a health insurance plan or system that allocates the provisions, quality and cost of caring for an individual. It has an significant role when it comes to providing health care services to medicaid members and the ways it’s utilized. Managed care plans create contracts with health care providers and medical institutions that help provide services at a lower and more affordable cost to their members. Additionally, managed care plans tend to pay health care providers directly so that it’s members don’t have to pay out of pocket for services …show more content…

Managed care plans are seperated into three different catergories: HMO (Health Maintenance Organization), PPO (Preferred provider organization), and last but not least, POS (Point of Service). HMOs are plans that only pay for care within a certain network of doctors. In the case of PPOs, the person covered normally pays more if they get care within the network. They also pay part of the cost if they go outside the network. Furthermore, POSs are plans that lets it’s member choose between an HMO or a PPO every time they need care.
Medicaid managed care offers members a chance to choose a medicaid program that is more equlivalently relevant to their lifestyles. It focuses primarily on preventional health care and provides members with an enviornment in which they could be stable, as well as, cared for. In the article by Mary Caffrey titled “Kaiser Report: Medicaid Managed Care Policies Can Limit Access to Long-Acting Contraception”, she elaborates on her findings in the Kaiser Reports, including their findings as well. She analyzes how medicaid managed care policies can limit the access to long-acting contraceptives, ultimately affecting low-income women. Thanks to the progression of the Affordable Care Act (ACA), more individuals qualify for …show more content…

Things such as parenting, breastfeeding and consultation programs, which arent usually provided by MCOs, are left almost entirely to low-cost insitutions, which explains the reason why most MCO plans have contracts with Planned Parenthood. Just recently with the sovereignty of the Trump administration, some members of congress are trying to block $500 million in funding for planned parenthood, in efforts to termination facilities that offer abortion next to other services. Since states have dominate control when it comes to regulating LARC and other contraceptives, the reduction of funding will impact the methods offered by MCOs, which tends to be beyond those resources avaliable for a fee. As a result, women who have lower income will not be aware of other alternative methods of reproduction. “ Most plans will only cover birth control pills for 3 months on a single prescription, despite evidence that giving women a 6- or 12-month supply reduces the risk of unintended pregnancy.” (Caffrey, 2017) This only adds to the encumbrance of women who earn lower

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“Healthcare Reform 101,” written by Rick Panning (2014), is a wonderful article that describes, in an easy-to-understand language, the Patient Protection and Affordable Care Act, signed into law March 23, 2010. The main goal of the Patient Protection and Affordable Care Act was to provide affordable, quality healthcare to Americans while simultaneously reducing some of the country’s economic problems. Two areas will be covered throughout this paper. The first section will include a summary of the major points and highlights of Panning’s (2014) article, including an introduction to the ACA, goals of the signed legislation, provided coverage, and downfalls of the current healthcare system. The second part will be comprised of a professional

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Managed Care plans are also known as prepaid health care plans. Managed healthcare plans strive to deliver high-quality healthcare, while controlling cost. Services and fees are negotiated with healthcare providers and facilities to provide access to otherwise expensive healthcare services to patients. Services under listed within the Managed Care plan monitored continuously to ensure that all services are provided in the most cost effective manner. An HMO or Health Maintenance Organization is an example of a Managed Care Plan.

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Some variability differs with the capability of providing out-of-network health providers and the services in which can be provided. By having a broad range of choices that can be provided, will cause a higher the cost for the individual that is paying. Most Medicare patients have received the managed care plans due to promises of a lower copayment amount and often medication benefits. Medicare post-acute spending has grown rapidly with the number of users between 1999 and 2007. The growth in Medicare short-term post-acute service use, in part, reflects short hospital stays and a growing demand for rehabilitation services.

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The majority of the organization’s patients depend on Planned Parenthood for their health care. They play an important responsibility in providing examinations for patients from Title X and Medicaid. Medicaid and Title X are social health care programs for families and individual with limited resources due to their financial situation. It was stated that, “60% of Planned Parenthood’s patients depends on health care, such as Medicaid and Title X in order to pay for their primary care doctor... If they did not have Planned Parenthood available, they would not be able to educate themselves and attend gynecologist appointments, regularly” (How Federal Funding Works at Planned Parenthood).

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This topic is significant because this program provides health services to about 3 million people in the country and supports services for over one million people outside the United States. Planned Parenthood is the largest single provider of reproductive health services in the United States. It provided 3.6 million contraceptive services, 4.5 million HIV and other STD related services, about 1 million breast, cervical, and other cancer related services, over 1 million pregnancy tests and prenatal services, over 300,000abortion services, and over 100,000 other services, for a total of 10.6 million discrete services. The majority of federal funding comes from Medicaid. Abortion is what is driving the defunding discussion because recent videos

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I first heard about Planned Parenthood while writing a research paper on abortion. My knowledge was also expanded at the peak of the Pro-Life movement. From unknown internet sources, I had heard that Planned Parenthood only performed abortions and was morally bad. However, when I extended my research, I found they did more than abortions, but instead had a major impact on affordable healthcare. According to Planned Parenthood’s annual report for 2018, they performed 4,712,985 STI testing and treatment, 741,352 HIV tests, 2,620,867 birth control information and services, 570,444 breast exams and pap tests, and 70,193 cancer detections (Planned Parenthood).

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