Pre-Screening for Medicaid Health Policy Paper essay example
Abstract
Over the last six years there has been more debate about our health care system than any other political issue. The reason for this is because the United States has a very broken system. Many individuals have brought forward ideas to help improve the system but there had been no cure all. Due to the fact that there are so many options when it comes to insurance it seems as those who cannot afford or do not work for an employer who offers insurance coverage the only other option is Medicaid. A better system does need to be put in place, the first step to that better system is to do mandatory drug screening for all individuals who apply for state aided coverage. Especially after the ACA expansion mandate.
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The ACA has had many questions surrounding who should qualify for state aid, and at what point does the government refuse care. The specific area of the ACA that addresses issues surrounding Medicaid and who qualifies has had much back lash. So much so that it has been called into question as to whether it is constitutional or not. The ACA Medicaid expansion mandate states that and “mandates non-poor persons to purchase medical insurance if they are not otherwise adequately covered. The federal government will subsidize these purchases for persons with incomes of 100 to 400% of the federal poverty level” (Cohen, 2012). The mandate also “requires that state Medicaid plans, starting in 2014, cover all persons under 65 years of age with individual or family incomes up to 133% of the federal poverty level” (Cohen, 2012). Many people question why it is fair for individuals to receive free state/ federal aid while others are taxed if they opt out of coverage for the year. Many wonder how the government can make the people pay for something that should be optional, especially if some people are getting free medical care. The other side of this argument is focused on poverty level individuals that qualify for Medicaid but use drugs such as heroine and abuse prescription drugs. These individuals use the system to get free health care for their methadone maintenance and access to free opioids. Essentially tax payers are funding legal drug use. For many people in the United States this is a preposterous theory and are shocked this passed any part of the law-making process. The questions remain, why are drug users allowed access to free care, are drug seekers being punished, and why does Medicaid cover “legal” drug use.
Some ides that come to mind helping with the issues at hand include: lock-in program, drug screening prior to acceptance into the Medicaid program, and not allow for methadone maintenance be covered by Medicaid. “Lock-In programs, common to all Medicaid and some commercial insurance plans, typically function by creating a prescription gatekeeper for beneficiaries who are deemed to have potential for misuse of their prescription benefits based on their prescription and medical services utilization history” (Keast, 2015). This allows anyone who were to slip through the cracks during drug screening to be watched. These people would be monitored for when they see a doctor, how often they are asking for opioid medications, and if they go to see other doctors asking for the same prescription. In a way it deters and limits polypharmacy. Pre-Screening for Medicaid Health Policy Paper essay example. I also feel drug screenings would play a huge role in deterring those who only use the system for free care and allow extra money for the purchase of drugs. If individuals have to pay for their health care they may choose to allocate money into their family’s needs rather than place it in the bottomless pit of drug use. Lastly, I feel methadone clinics should not be an option for care with those who strictly have Medicaid. By allowing this we allow those to get free drugs essentially. Methadone allows for heroin addicts to use under a medical premise in order to stop using heroine. This is great in theory, but there is no limit to how long you are treated at the clinic. Most individuals go to the clinic three times a week and are able to feel the same high but “under medical care”.
A few major difficulties I see with implementing these three policies include: Drug users not applying funds to health care after denial for Medicaid due to failure to pass drug screen, not having in-network doctors communicate about visits from flagged patients, plans being put in place to help those who are using, and methadone clinics allowing users to treat at the clinic because it is safer than using street heroine. “Effective January 2008, state Medicaid plans may reimburse for screening and brief intervention for alcohol and drug misuse…. State Medicaid implemented Healthcare Common Procedure Code System codes and pay for screening and brief intervention” (Fussell, 2011). This means appointments will be covered as long as intervention is complete and steps are taken to become drug free. The road block for denial is hard too because of the fact that “Medicaid eligibility status each month was determined from each state’s Medicaid Management Information System. Pre-Screening for Medicaid Health Policy Paper essay example. A client was considered eligible in any month if enrolled for 15 or more days” (Deck, 2009). In-network clinics can be difficult when it comes to communication between one or more facilities. Without the cooperation of all doctors that accept Medicaid it would be hard to follow when and where a person sees a doctor. By the time the information goes back to billing it is likely that the individual would have already seen multiple doctors and filled prescriptions with all of them. At that point notification could be sent to an individual’s home stating they owe back pay for doctors’ visits and medication. It’s likely these letters would be ignored, and the opioids would be obtained in another fashion. The last problem lies with methadone clinics. It is hard to turn someone away knowing if they leave the clinic to get a “fix” they may not be alive the next day. Heroine is a very aggressive drug and it can easily be over dose on. It is even more dangerous when it is in its solids state known as “black tar”. This type of heroine is normally shot up using a needle and putting it straight into the vein. Methadone clinics do save lives, but it does not in any way stop the addiction. Individuals just keep coming back for their free fix costing the average tax papers dollars to go down the drain. Pre-Screening for Medicaid Health Policy Paper essay example.
While there are many issues surround the state of the ACA there is no catch all solution to fix everything. There are steps that can be taken to ensure better care for each American. The ACA expansion mandate allowed for more individuals to qualify for free Medicaid programs which in turned allowed for the system to be used more than the prior years by thoughs who may not have qualified. To bring down the cost for tax payers it is imperative that we stop offering free methadone clinics to those on Medicaid., ensure all in network doctors are able to view notes to avoid polypharmacy, and lock down opioid use. Lastly, deny individuals who cannot pass a drug test the use of state and federally funded programs such as Medicaid. It is not fair to law abiding citizens that they are taxed for not having insurance but those who break the law get free health coverage with no penalty Pre-Screening for Medicaid Health Policy Paper essay example.
References
Cohen, I. G., & Blumstein, J. F., L.L.B. (2012). The constitutionality of the ACA’s Medicaid-expansion mandate. The New England Journal of Medicine, 366(2), 103-4. Retrieved from https://nuls.idm.oclc.org/login?url=https://search-proquest-com.nuls.idm.oclc.org/docview/915675314?accountid=25320
Deck, Wiitala, McFarland, Campbell, Mullooly, Krupski, & McCarty. (2009). Medicaid Coverage, Methadone Maintenance, and Felony Arrests: Outcomes of Opiate Treatment in Two States. Journal of Addictive Diseases, 28(2), 89-102.
Fussell, H. E., Rieckmann, T. R., & Quick, M. B. (2011). Medicaid reimbursement for screening and brief intervention for substance misuse. Psychiatric Services, 62(3), 306-9. Retrieved from https://nuls.idm.oclc.org/login?url=https://search-proquest-com.nuls.idm.oclc.org/docview/862454265?accountid=25320
Keast, S., Nesser, N., & Farmer, K. (2015). Strategies aimed at controlling misuse and abuse of opioid prescription medications in a state Medicaid program: A policymaker’s perspective. The American Journal of Drug and Alcohol Abuse, 41(1), 1-6. Pre-Screening for Medicaid Health Policy Paper essay example