Respond by Day 5 to at least two colleagues in one of the following ways:

• Describe two factors that might make minority groups especially vulnerable in the Medicaid policy your colleague cited. Explain why these groups may not have a voice in the policy-making process.
• Offer examples of organized self-help and citizens’ groups as both support mechanisms and potentially powerful lobbies. Describe how these lobbying bodies can help in amending the policy your colleague described.

Colleague 1 Chana Smith RE: Discussion – Week 9COLLAPSEHow the evolution of health care policy has influenced programs such as Medicaid and Medicare.America health policy shifted from environmental concerns to individual. Over time we have moved from dispensaries, to marine hospitals, to focusing on check ups. “The federal government entered briefly into health provision during Franklin Roosevelt’s New Deal with the Resettlement Administration’s medical cooperatives” (Popple & Leighninger, 2019).  The Depression led way for prepaid programs such as, Blue Cross and Blue Shield, due to hospitals being left with unpaid hospital bills. The government stepped back in when those who were less healthy, retired, unemployed, underemployed or self employed suffered. This is when both the Democratic and Republican parties worked together to put forth proposals that would protect the senior population that was getting left out of the employer based health plans (Popple & Leighninger 2019). Hospitals were reimbursed by Medicare however, continuously rising hospital costs, resulted in the Reagan administration developing a standardized payment based on diagnosis. Medicare became their cash cow because congress was able to take advantage of the cost reduction by transferring savings in Medicare into the general deficit reduction (Popple & Leighninger, 2019).   Specific Medicaid policy in your state that should be amended, and explain how you would amend it and why.The Medicaid policy in North Carolina that should be amended is the policy that prohibits payment for diet programs in weight loss centers. Helping recipients with their goal towards weight loss could help reduce Medicaid costs. Medicaid paying for weight loss programs could result in lowered expenses towards weight related health issues such as high blood pressure, and diabeties (dhhs.gov, 2018). The stakeholders involved in the Medicaid and Medicare health care policy in your state, and explain the role of these stakeholders in policy development for this issue.The stakeholders involved in the Medicaid and Medicare health care policy include ombudsmen, providers, and consumer health advocacy groups. The provide expertise and knowledge to contribute towards identifying solutions to meet the needs the people. They then work together towards  developing the policy (Nguyen, & Miller, 2018).
Colleague 2 

Tameka Sutton RE: Discussion – Week 9COLLAPSEIn this week’s discussion, we are to communicate the development of Medicaid and Medicare with the rationalization of how they have influenced health care policies. We are to depict a Medicaid policy in our home state that has cause to be changed.  Explain a way to satisfy change, as well as why. We are to depict the stakeholders who participate in the Medicaid and Medicare health care policy in our home state and rationalize the stakeholders’ role in policy development.Discussion- the evolution of Medicaid and MedicareIn 1945, November, President Truman discussed a plan to bring the people to hospitals to receive good quality care, addressed lack of physicians, enlightened the Congress with a proposal that would mend high cost of coverage for medical care for families and individuals (“PROPOSAL, 1945”).  President Truman proposal to Congress established the development of a Social Security pitch that would offer affordable healthcare—report as being the initial step toward socialization (http://articles.chicagotribune.com/2013-09-29/site/ct-per-flash-medicare-20130929_1_affordable-care-act-health-care-health-insurance).In 1965, July 30, President Lyndon B. Johnson gave signature to the Social Security Amendment bill that became law on that day (http://www.presidency.ucsb.edu/ws/index.php?pid=27123&st1=).  This law gave life to the Medicaid and Medicare health insurance system.  It was not until 1966, July 1, that the health care policy indeed came into existence for 18 million Americans requiring programs to help establish affordable medical expertise. On this day in American history over the amount of 19 million ages (65 and older) citizens signed on to receive coverage.  This day in the history of Medicaid and Medicare programs President Lyndon B. Johnson, and his wife signed on to the Medicare plan (http://www.presidency.ucsb.edu/ws/index.php?pid=27123&1=). At this time the project had Part A (hospital coverage), and Part B (supplemental medical insurance). Medicaid health insurance covered all states with the initial date of January 1966 but was moving at a plodding pace. Amendments of additional care to the Medicare plan were – in 1967 children up to the age of 21, in 1972 the addition of long-term disabilities, in 1986 pregnant moms, the Act of Medicare Catastrophic Coverage in 1988, and in 2003 the improvement of the Medicare Drug plan that help to modernize coverage (https://revcycleintelligence.com/images/site/articles/2015/01/Medicare.jpg). In 2010, March 23, President Obama signed the Patient Protection and Affordable Care Act (ACA) that gave coverage of Medicaid to citizens in America numbering over 30 thousand uninsured patients. Citizens of lower and middle class received assistance through federal funds that help to secure private health insurance (https://revcycleintelligence.com/images/site/articles/2015/01/Medicare.jpg) .In 2012, June there was a verdict from the Supreme Court to allow each state to make the expansion of Medicaid services “voluntary” becoming a state discretionary plan. In America, 28 states participate in the development of Medicaid, that shows as being a benefit through the enticements of EHR incentive program (Medicare and Medicaid – Meaningful Use) provides providers with a financial gain for practicing and delivering significant medical assistance (http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index/html?redirect=/ehrincentiveprograms/). In 2015, January 26, there are goals set for the future of Medicaid and Medicare that demonstrate reform. Per the Department of Health and Human Services, there will be a 30% of fee-for-service Medicare payments “value-based payments” that will monitor the process of measurable recovery (http://www.hhs.gov/news/press/2015pres/01/20150126a.html).  Ultimately, the design of new payment models for a valued care system will reduce Medicare spending. Describe Medicaid policy in North Carolina that should be amended and Why?In the North Carolina Division of Medical Assistance Enhanced Mental Health and Substance Abuse Services – Medicaid and Health Choice Clinical Coverage Policy No:8-A Amended Date: April 1, 2017, has requirements for and Limitations on Coverage Sec: 5.4 – Service Orders.  This Medicaid Service policy report that there must be a service order before or on the date of service to receive payment from Medicaid to the provider. It does not matter if the client has a backdated service order, the provider will not receive payment if there is not a service order in place. For example, if the client has a service plan dated for one-year, and the client goes into a substance abuse comprehensive outpatient treatment program a day after the year expired. Medicaid would not cover the outpatient treatment program until the client receives another service order. Still, would not be able to include any of the time before the service order date. Amend – the policy should have a clause reporting that “if” the client has received the same needed treatment within the one-year service order, then Medicaid should honor 72 hours of service. The 72 hour treatment time limit will give the professionals needed time to place another order while the client is being treated.  Without the funding for treatment, the client will be turned away –not receiving help. In the 72 hour time limit the client will receive value-based service while awaiting the decision of Medicaid approval.  In this amendment, there will be the inclusion of a specific department that handles renewal for Medicaid Service orders for the Medicaid and Health Choice Clinical Coverage – Enhanced Mental Health and Substance Abuse Services Department. Describe Stakeholders involved in Medicaid/Medicare health policy in North Carolina and explain their roleThe Stakeholders involvement in North Carolina’s Medicaid and Medicare health policy is to promote critical factors of enhanced care management, adapt the needs of NC’s diverse communities and collaborating with the providers. North Carolina’s Proposal Program design for Medicaid Managed Care in August 2017 report that the stakeholder’s key role is to standardization promoting quality and value as well as implementing the strategy for value-based payment across the board for all providers to utilize (https://files.nc.gov/ncdhhs/documents/files/MedicaidManagedCare_ProposedProgramDesign_REVFINAL_20170808.pdf). 

Colleague 3

 You are correct in identifying patients as stakeholders, some of the most important ones in my opinion.  However, there are many reasons why certain groups may feel like they have no voice in the process and can’t influence decision-makers; talk more about why disenfranchised groups who have a stake in healthcare policy often don’t provide input or, as you suggest, even vote.