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Medicaid and Medicare Reimbursement

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Team 1 Discussion Outline i) Reimbursement Rates for Medicare and Medicaid to hospitals 1) Rates are currently below cost of providing care (underpayment) 2) Underpayments totaled $27.9 billion in 2010 a) Medicare i) 92 cents reimbursed for every dollar spent (2010) ii) 53% of hospitals received payments less than cost b) Medicaid i) 93 cents reimbursed for every dollar spent (2010) ii) 59% of hospitals received payments less than cost ii) Eligibility requirements for Medicaid in your state 1) Indiana a) Medicaid program provides medical care to nearly 1,000,000 Hoosiers b) Department of Family Resources determines eligibility and need i) Qualified parents ii) Children iii) Pregnant women with low income iv) Older adults and people with disabilities with low income c) Affordable Care Act of 2010 i) Medicaid minimum eligibility level that covers most Americans with household income up to 133 percent of the federal poverty level ii) New eligibility requirement effective January 1, 2014

2) Connecticut a) 712,350 currently enrolled in Medicaid program b) Eligible requirements i) Low income children and families ii) Low income seniors iii) Disabled iv) Children with special health care needs 3) Ohio a) Ohio resident and meet certain financial requirements based on the Federal Poverty Level b) Provided Coverage i) Children up to age 19 ii) Pregnant Women iii) Families with children younger than 19 iv) Disabled v) Older adults age 65 or…...

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