Medicaid Policy Research Paper

Select a current or proposed health care policy that is designed to improve a specific population’s access to quality, cost-effective health care. In a paper include the following:

Explain the policy and how it is designed to improve cost-effectiveness and health care equity for the population. Is the policy financially sound? Why or why not? How does the policy account for any relevant ethical, legal, and political factors and the nursing perceptive one must consider when implementing it?
To what state, federal, global health policies or goals is this particular policy related? How well do you think the policy is designed to achieve those goals?
Finally, discuss the advocacy strategies you would employ on behalf of your population to ensure they have access to the benefits of the policy. Explain, from a Christian perspective, the professional and moral obligation of advanced registered nurse to advocate for and promote health and prevent disease among diverse populations.

 Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Description of Policy

The Medicaid policy was designed to improve the health coverage of Americans specifically targeting vulnerable groups such as low-income adults, children, pregnant women and people with disabilities. Medicaid Policy Research Paper. The policy is administered by each state based on the federal requirements and thus funded by both the state and federal government (Medicaid.gov, n.d.). Regarding cost-effectiveness, the Medicaid program has been successful in providing comprehensive packages for vulnerable populations compared to private insurance.

Cost-Effectiveness

The cost sharing aspect of the program is quite extensive, with states having the option to charge premiums and establish requirements on out of pocket spending. Out of pocket spending includes copayment, coinsurance and deductibles. Although the maximum someone can pay for out of pocket spending is limited, states can impose higher charges for specific groups (Medicaid.gov, n.d.). Children and pregnant women are considered vulnerable and hence exempted from the cost sharing efforts.

Another cost effective benefit of Medicaid program is that out of pocket costs are not imposed on emergency services, pregnancy related services and family planning services. This makes it easier for such vulnerable groups to access essential services. Terminally ill individuals, children, and those residing in an institution are also exempted from out of pocket costs to limited nominal amounts (Ooka et al., 2017). The Medicaid program allows states to use out of pocket charges to promote cost-effectiveness use of prescription drugs. Still, states may also establish copayment methods to encourage the use of lower cost drugs and generic variables included in the preferred drug list.

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Healthcare Equity for the Population

The Medicaid program attempts to promote equity of care by improving access to care for vulnerable groups. Of note, children and low income adults are able to access high quality care which they would have access to without the program. This bridges the gap of access care and ensures that the socioeconomic determinants of health are addressed. Some program benefits include special protections such as provider network and payment methods that ensure eligible members can afford healthcare services (Stadhouders et al., 2019). Preventive services also ensure that minority populations stay healthy to avoid emergency and costly care. Medicaid Policy Research Paper.

Ethical Issues

Although the Medicaid program has realized multiple achievements and benefits to vulnerable groups, the laws outlined by the program raise ethical and legal issues. Notably, understanding the fairness exceptions to Medicaid program is essential in addressing the ethical concerns noticed when caring for elders. Although majority of the population lean towards reduced income taxes, depriving a Medicaid recipient of dignity and self-esteem is inhumane and raises ethical concerns. Thus, long term nursing care should be available without making the recipients pay for the services (Grabowski & Mor, 2020). Fairness exceptions in the Medicaid program strikes the balance between the elderly paying for their long term nursing care and preserving enough to help their loved ones.

Nursing Role in Implementing Medicaid

Like any other financing scheme, nurses are integral in sustaining the implementation of the Medicaid program. Nurses can work with legislators, administrators and policy maker to design the program and ensure it meets the health needs of vulnerable patients such as pregnant women and children (Chisolm et al., 2019). Nurses can play a key role in closing the increasing gap between funding of the Medicaid Trust and the stability of the insurance plan over long term.

Medicaid and State, Federal and Global Goals

The Medicaid program aligns with the federal health goals. The program addresses health goals such as increased community safety, reducing healthcare costs, and increasing insurance coverage among the majority of uninsured American population. Thus, healthcare providers serving Medicaid beneficiaries in long term nursing care homes should be vigilant in addressing the healthcare needs of such groups. Due to eligibility and enrollment dynamics, the Medicaid program creates possibilities for stronger partnership between the care providers and the policymakers (Cleveland et al., 2019). Medicaid Policy Research Paper. The partnership ensures that the program is designed to meet the healthcare needs of the vulnerable population. Still, the collaboration of care providers and the policymakers streamline healthcare cost and access.

One of the federal health goals is reforming and strengthening the nation’s healthcare system. This aligns with the objectives of the Medicaid program which strives to promote affordable healthcare (HHS.gov, 2020). The program strives to strike a balance between healthcare spending on premiums, deductables and affordability of care costs. By improving access to healthcare for vulnerable groups, the program aligns with the global health goals which focuses on expanding safe and high quality care while encouraging innovation and evidence based practice.

Poor health status relate to reduced physical and behavioral functionality of individuals. The nation, through the Medicaid program, strives to improve the population health. The Department of Health and Human Services partners with Medicaid program, public and private agencies to make healthcare services affordable, high quality and accessible to diverse populations. The healthcare spending is on the rise due to the growth of medical prices (HHS.gov, 2020). Nonetheless, people with health insurance coverage through private plans such as employer-sponsored insurance and government sponsored efforts such as Medicaid are going to benefit significantly.

Advocacy Strategies for Target Population

Advocating for my Population

As a nurse practitioner, I would collaborate with other professionals in the healthcare system to address the socioeconomic determinants of health that increases the susceptibility of my population to poor access to healthcare services. Along with the HealthyPeople 2020 initiative, addressing the socioeconomic determinants of health improves the health outcome of vulnerable groups by ensuring they promptly access quality care at affordable rates (Cleveland et al., 2019). In addressing such determinants, I will carry out training and educate my population on the benefits of Medicaid program and how they can meet the eligibility criteria.

Addressing policy issues will ensure that my population benefits from the Medicaid program. As a nurse advocate, I will collaborate with other care providers and Medicaid policy makers to ensure that my state implements a policy program that meets the specific needs of my population (Cleveland et al., 2019).Medicaid Policy Research Paper.  With healthcare services evolving to be individual based, modifying Medicaid policies to meet my population needs will ensure that they greatly benefit from the provision.

Christian Perspective of Health Promotion

As a nurse practitioners, an individual is obligated to ensure improved population health. Advanced registered nurse can participate in health promotion by educating patients on lifestyle changes that promotes their health and wellbeing. With the rise of mental health issues, nurse practitioners are obligated to address mental health challenges by referring patients for counseling or therapeutic sessions to promote their physical and emotional health. Moreover, an advance registered nurse can promote health of vulnerable groups by championing for their improved access to healthcare services (Heward-Mills et al., 2018). This can involve working with policymakers to ensure that their needs are included in the design of healthcare policies

From a Christian perspective, an advance registered nurse is morally obligated to provide clinical care with empathy and compassion. The Christian faith fosters love, empathy and compassion which can only be expressed by addressing holistic care to patients. Imperatively nurses can promote heath and wellbeing by addressing the emotional and physical needs of their patients (Heward-Mills et al., 2018). Patients with low health literacy levels should be educated on issues such as medication adherence and lifestyle changes to improve their health. Medicaid Policy Research Paper.

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References

Chisolm, D. J., Brook, D. L., Applegate, M. S., & Kelleher, K. J. (2019). Social determinants of health priorities of state Medicaid programs. BMC health services research, 19(1), 1-7.

Cleveland, K., Motter, T., & Smith, Y. (2019). Affordable care: Harnessing the power of nurses. Online Journal of Issues in Nursing, 24(2).

Grabowski, D. C., & Mor, V. (2020). Nursing home care in crisis in the wake of COVID-19. Jama, 324(1), 23-24.

Heward-Mills, N. L., Atuhaire, C., Spoors, C., Pemunta, N. V., Priebe, G., & Cumber, S. N. (2018). The role of faith leaders in influencing health behaviour: a qualitative exploration on the views of Black African Christians in Leeds, United Kingdom. The Pan African Medical Journal, 30. Medicaid Policy Research Paper.

HHS.gov. (2020, April 2). Strategic goal 1. https://www.hhs.gov/about/strategic-plan/strategic-goal-1/index.html

Medicaid.gov. (n.d.). Medicaid. Medicaid.gov: the official U.S. government site for Medicare | Medicaid. https://www.medicaid.gov/medicaid/index.html

Ooka, K., Connolly, J. J., & Lim, J. K. (2017). Medicaid reimbursement for oral direct antiviral agents for the treatment of chronic hepatitis C. American Journal of Gastroenterology, 112(6), 828-832.

Stadhouders, N., Kruse, F., Tanke, M., Koolman, X., & Jeurissen, P. (2019). Effective healthcare cost-containment policies: a systematic review. Health Policy, 123(1), 71-79. Medicaid Policy Research Paper.