With an aim to provide affordable healthcare to its citizens, the US government has had to subsidize the healthcare cost through different approaches. Medicare and Medicaid are just some of the approaches that have gained national prominence over time. Each of the above provisions has specification unique to itself with regards to aspects taken care by the provision in different demographics and eligibility. Although both of the above health benefits have had a great impact on healthcare acquisition by many Americans, there are different challenges inherent in them, especially in connection with reimbursement of nurse leaders. The above aspects are previewed with the use of Florida, a state which in this case acts as a spectrum through which Medicaid as well as Medicare specifications in other states can be viewed.
There are notable differences between Medicare and Medicaid in Florida. For Medicaid, one must be a US citizen who is over 65 years. Even though, in Florida, individuals can be registered a few months before they attain this age. Besides this age-specific requirement, younger individuals with certain disabilities are also eligible. Also, people who suffer from specific kidney disease, sometimes referred to as ESRD are also legible for Medicare (Events, n.d.).
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Medicare, on the other hand, allows the qualified person to access a variety of healthcare services. Part A, B, C and D, all of which are categories inherent in Medicaid-related services encompass different specifications. Part A is hospital insurance, B medical insurance, C advantage plans and D covers prescribed medication. In part C, the advantages are varied and could be acquired from private and healthcare organizations or other benefits specific to Medicare as a program ("What Medicare covers | Medicare.gov", n.d.).
Also, Medicare in Florida differs from Medicare for a few specifications that are not covered by Medicare. First of all, eligibility is depended on the income level of an individual as well as their citizenship status. Other than meeting the basic requirements above, one is then considered under special circumstances. Such individuals considered include women who are pregnant, children, parents, those who have been under foster care before, children’s guardians, people living with disabilities individuals with emergency medical needs that might not be Florida residence or US citizens in general(Miller, Edward ,& William, 2004).
There are services provided for each of the above individuals, all of which are not covered by Medicare. For pregnant women, they receive prenatal care and antenatal care two months after delivery. These women must, however, be having a low income that is not sufficient enough to cater for such medical needs. On the other hand, children who are not living with their parents receive medical care such as health-related checkups, dental screening, immunization as well as much more that children need regarding healthcare. For the elderly assisted living is waived, home-related care provided among others ("What Medicare covers | Medicare.gov", n.d.).
There are several challenges that nurses leaders face, especially in regards to reimbursement by both Medicare and Medicaid. These problems are evident both at the federal as well as national level. One of the biggest challenges is although these individuals are required to provide the best care under insurance by these programs, the budget or the amount they get is fixed while they are expected to perform exceptionally. These leaders, hence, face a challenge on how they are to motivate their juniors to do their best without enough money. On the federal level, some hospitals are qualified to offer some services and reimbursed by such programs but they have not been approved. Due to the requirement by law for individuals to receive emergency healthcare, some of these individuals end up not being in a position to pay such bills, yet Medicare and Medicaid could have easily taken care of that.
References
Events, L. How To Apply For FL Medicaid | florida-assistance.org . Florida-assistance.org . Retrieved 31 March 2018, from https://florida-assistance.org/florida-health-services/medicaid-in-florida/how-to-apply-for-medicaid-in-florida.html?gclid=EAIaIQobChMInI2Vq5iP2gIVDLjACh22nQZIEAAYASAAEgKK2PD_BwELinks
Miller, E. A., & Weissert, W. G. (2003). Strategies for integrating Medicare and Medicaid: Design features and incentives. Medical Care Research and Review , 60 (2), 123-157.
What Medicare covers | Medicare.gov . Medicare.gov . Retrieved 31 March 2018, from https://www.medicare.gov/what-medicare-covers/index.html
