Government Health Plans Health, Medicine, Nursing Coursework

Government Health Plans
Name
Institution
Government Health Plans
Introduction
The government of the United States and other countries around the world strive to provide quality healthcare services to the people at affordable prices. However, achieving the objective of delivering affordable quality care to people across the social divide is not an easy task. The increased demand for quality care, the rising cases of acute care patients, aging population, and organizational constraints of the health care providers are some of the factors affecting the healthcare system as they lead to increased cost of patient care. The increasing cost of healthcare thus necessitates the government’s implementation of several federal health plans to facilitate the provision and delivery of quality care to all its citizens. Government health plans, as they are commonly known, offer unique benefits to the enrolled members that are defined by the required qualifications for the particular plan. The government health plans serve to provide medical insurance covers merited by various reasons ranging from the financial capability to the existing government-beneficiary relations. In essence, the government-sponsored health insurance plans pay or reimburse the health care providers for the medical services offered to a beneficiary or an eligible member of the plan. The government health plans include Medicaid, State Children’s Health Insurance Program (SCHIP), TRICARE, and Indian Health Service (HIS). The government also engages in co-payment arrangements with the beneficiaries with private insurers through other plans such as high deductible health plans (HDHP) and the health savings accounts (HAS). Each of the government health plans has distinct reimbursement procedures whose detailed analysis reveals some of their limitations or restrictions towards the delivery of quality, affordable care to all patients.
Medicaid
Medicaid is a government-sponsored insurance program formed in 1965 established in each state to assist the low-income earners meeting a set of eligibility requirements to acquire medical services at affordable costs CITATION Ale14 \l 1033 (Alexander, 2014). The states determine the eligibility requirements under the guidance of the federal framework for the same. The federal government accounts for over 50% of the program’s expenditure for each state while the rest is funded by the individual states CITATION Ale14 \l 1033 (Alexander, 2014). In a majority of the states, the low-income earners eligible for Medicaid include individuals aged 65 years old and above, children below 19 years, expectant women, people living with disabilities, low-income parents, and adults without dependent children and in need of constant medical attention CITATION Ale14 \l 1033 (Alexander, 2014). The eligibility criteria may differ from one state to the other. Most of the Medicaid programs administered across various states offer direct payments to the healthcare providers for the medical services provided using either the fee-for-service or managed care models CITATION Ale14 \l 1033 (Alexander, 2014). The models help the states to determine the rates of reimbursement based on the amount or volume of services offered to the beneficiary. The restrictions for the Medicaid program include the fact that it leads to the exploitation of billable services by the healthcare providers. The reimbursement process further does not cover the delivery of continued care, including preventive services, counseling, and even medications in some of the states.
State Children Health Insurance Program (SCHIP)
The State Children Health Insurance Program (SCHIP) is a collaborative cover involving both the federal and state governments’ intervention to provide medical coverage to children below 18 years who have no other healthcare insurance and qualifying the definition of poor or near poor CITATION HeF13 \l 1033 (He, 2013). Children from families that are below 200% of the federal poverty level and whose income is higher than the minimum for Medicaid qualification are eligible for the program CITATION HeF13 \l 1033 (He, 2013). The reimbursement process for the program follows the managed care model of payment to the healthcare providers. The program thus limits the beneficiaries to some health care providers and thus restricting their medical options CITATION HeF13 \l 1033 (He, 2013). Seeking medical attention from health care providers outside the plan may lead to out-of-pocket spending for the beneficiaries in the form of a co-payment with the state CITATION HeF13 \l 1033 (He, 2013).
TRICARE
TRICARE is a government-sponsored health insurance plan for military personnel on active-service and their dependents, military retirees under the age of 65 years and their spouses or wives CITATION Hos17 \l 1033 (Hosek, 2017). It is under the administration of the Department of Health Affairs in the office of the A...