Case Study Medicare Managed Care

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1. Why does the Medicaid program receive a great deal of attention each year in the state of Florida? From legislators? From providers? From health plans?

The Medicaid program of the government plays a critical role in the reduction of the uninsured by expanding eligibility to include nearly all low income adults with incomes at or below 138% of the federal poverty level, but not limited to children and parents, individuals with diverse physical and mental conditions and disabilities, and seniors. The expansion, which was made optional in 2012, offsets the gap in the program. However, only 27 states, including Washington, D.C. are implementing the expansion and some other states may follow suit.

The reason for the incessant clamor to the
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Should Medicaid and Medicare entitlement programs be run by the government or by private managed care organizations? Why do you think Medicaid managed care has been mandated in many states? Why do you think Medicare managed care has not been mandated?

With all the challenges looming around Medicaid and Medicare, have more confidence that a private entity would spearhead the management of funds with stringent regulations from the government to guarantee the quality and access of the targeted group. I suppose they would be able to use the funds allocated without any political pressures from legislators and stakeholders respectively. In addition, private managed care organizations have effective models of person-centered and coordinated care already in use, as well as effective payment systems that is steered towards quality and cost.

Medicaid managed care has been mandated in most states for the purpose of modernizing the Medicaid regulatory structure. By doing so, it would simplify and reinforce the initiatives of improving the health outcome of the population with emphasis on cost management. Medicare, on the other hand is federally funded and regulated therefore managed care is not obligatory to the

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