Term
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Definition
| Essentially health insurance that is managed by the federal government that you become eligible for when you turn 65; "Medicare is a social insurance program like social security that offers health coverage to eligible individuals, regardless of income or health status. People pay into medicare throughout their working lives and generally become eligible for Medicare when they reach the age of 65, although younger adults can also qualify if they have a permanent disability" |
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Term
| When was it passed, by who, and what title is it in the Social Security Act? |
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Definition
| Passed in 1965 by President Johnson--it is title XVIII of the SSA |
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Term
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Definition
hospital insurance; hospitals stay, emergency care, hospice
Medicare is a major payer to hospitals; 30-50% of hospital budgets comes from Medicare |
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Term
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Definition
| Medical insurance; doctors appointments, outpatient care, some preventative care |
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Term
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Definition
| medicare advantage plan; offered by private insurance companies, way to get benefits; combines A, B (and sometimes D) |
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Term
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Definition
| prescription drug coverage |
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Term
| Things that are not covered by Medicare |
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Definition
Long term care (nursing home)
Routine Dental
Routine Vision
Hearing Aids |
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Term
| Percentage of the money for entitlements that goes to medicare; how much money was that in 2012; how many people received medicare in 2012? |
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Definition
| 15% of the entitlement funding goes to medicare; 550 billion dollars was spent on Medicare in 2012; approximately 50 million people received Medicare benefits in 2012 |
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Term
| Original Medicare vs. Medicare Advantage |
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Definition
Original Medicare is essentially part A and part B (you can add part D if you want); you can also decide if you want medigap coverage (supplemental coverage)
Medicare Advantage combines A, B, and D (like an HMO or PPO) |
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Term
| Characteristics of Medicare recipients |
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Definition
| 50% live below 200% of the FPL; 40% are also eligible for Medicaid; Most have 3 or more chronic diseases; in summary, they are low income people that are sick--80% of health care costs are spent in the last 5 years of life |
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Term
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Definition
| Aging population; increasing health care costs; fewer workers paying into Medicare; spending is unsustainable |
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Term
| Our entitlement programs are unsustainable. How will be change this? |
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Definition
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Term
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Definition
| A health and social service program that is a partnership between the federal government and the states |
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Term
| When was it passed, by who, and what title is it in the Social Security Act? |
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Definition
| Medicaid was passed in 1965 by president Johnson; it is title 19 of the SSA |
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Term
| FMAP statistics-nation wide and in Oregon |
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Definition
Federal Medical Assistance Percentages; each state receives between 50-83% of the Medicaid budget from the federal government, and the state pays the rest--national average that the federal government matches; 57%
Oregon is a low-income state so it receives a higher amount of matching funds than the national average (62%) |
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Term
| Costs of Medicaid nation wide and in Oregon/where does the money come from (federal and state) |
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Definition
Nationwide: 400 billion dollars per year; income tax, corporate taxes
Oregon: 4.4 billion; provider tax (hospitals, nursing homes etc) |
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Term
| How many people nationwide receive medicaid and how many in Oregon; people receiving Medicaid (who and how many) |
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Definition
Oregon: 800,000 (as a result of the Affordable Care Act)
Nationwide: 67 million low income Americans; 32 million children, 18 million adults, 6 million seniors, and 11 million people with disabilities |
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Term
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Definition
Medicaid is means tested/coverage is low in the average state
Coverage is limited to parents that live at 61% of the federal poverty line |
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Term
| Medicaid; working or not? |
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Definition
| Medicaid works pretty well; costs are rising more slowly and health outcomes are better--only problem is expansion is expensive (Obamacare will cost 950 billion more) |
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Term
| Waiver that was approved for Oregon's medicaid program (name) |
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Definition
| Community and Family Fee Waiver |
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Term
| Community and Family Fee Waiver; when was it approved, and what did it do |
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Definition
It was approved by the federal government in 1982
It allowed Oregon to use Medicaid funds to create community-based programs for people with developmental disabilities |
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Term
| Initial focus of the Community and Family Fee Waiver |
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Definition
The first programs to be funded were to remove individuals with developmental disabilities from nursing homes
First Model Project 1985: took 2 women from a nursing home/gave them an apartment with non-24 hour care
Second 1986: 7 individuals from nursing home/created a home with 24-hour care
Third 1986: 1 man from State Hospital/gave him home in Eugene |
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Term
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Definition
| Oregon was charged with a violation of health and safety and right to treatment; Feds temporarily withdrew Medicaid funds |
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Term
| How did we fix this problem? Who fixed it? What fund was approved by the Legislature? |
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Definition
Governor Goldschmidt created a blue ribbon commission to develop a plan to restore Medicaid funding
Legislature approved a $30 million “Mental Retardation Fund” to be used for Match money |
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Term
| What was the plan developed by Governor Goldschmidt (2 parts)? What did the Fed allow Oregon to do? |
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Definition
The plan (negotiated by Oregon Senators Bob Packwood and Mark Hatfield) called for improving the institution by removing up to 1,000 residents
The development of community group homes would serve both the Fairview clients and selected community clients
The Feds allowed Oregon to use Medicaid money for community programs |
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Term
| What happened as a result of Goldschmidts plan? |
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Definition
Between 1987 and 2000, Oregon removed all of the clients from Fairview
Community-based group homes and independent living centers were created using Medicaid money |
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Term
| What did other states do to mimic Oregon? |
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Definition
Numerous other states followed the Oregon model and closed their institutions
All states now utilize Medicaid for group homes |
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Term
| What does it mean for services to be medicaided? |
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Definition
A broad range of services are eligible for Medicaid funding; this means that Medicaid funding is providing for many of the services needed by low-income people
New uses of Medicaid have expanded the eligibility to previously non-Medicaid eligible persons
Medicaid is the fastest growing part of both the state and federal health and social service budget |
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Term
| Who is calling for Medicaid to become a block grant and what is his position |
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Definition
| Paul Ryan--the Chairman of the House Budget Committee |
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Term
| What was Medicaid initially intended for? |
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Definition
| Initially it was supposed to fund health care and residential care for people with developmental disabilities and elderly with low income--original plan was to fund nursing home and combine the care of the elderly and the disabled |
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Term
| Why doesn't Medicaid cover many of the prevention programs? |
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Definition
It is all up to the states to determine which services are eligible for funding
Prevention services have not proven to be effective in preventing the above outcomes
States are allowed to innovate and experiment with prevention-type services, but positive outcomes need to be produced in a short period of time to continue the services |
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Term
| What does a Medicaid waiver do? |
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Definition
| A Medicaid waiver allows states to provide non-institutional services to Medicaid eligible and non-Medicaid eligible persons |
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Term
| How did Oregon pioneer the waiver in the 70's, 80's, 90's and 2012? |
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Definition
70's: in-home supports to seniors
80's: small group home services to persons with developmental disabilities (Community and Family Fee Waiver)
90's: health care to the working poor (OHP)
2012: Coordinated Care (part of the Affordable Care Act) |
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Term
| How does the Medicaid waiver work? |
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Definition
| Allows Federal Funds to be used by the states for specific purposes; states can request a "waiver" of their rights and priveges--in return they are given flexibility in the administration or implementation of a given program--gives state the responsibility to meet the goal of the entitlement program |
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Term
| What is the motivation behind applying for a waiver? |
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Definition
| It allows a state to use unique, flexible and possibly innovative eligibility criteria or service arrangements to better provide services to meet a state goal (they can implement services however they want to whoever they want) |
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Term
| Who created a group to reform the Child Welfare system, what was their position, and when? |
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Definition
| Governor Barbara Roberts of the Oregon Republican Party in the 1990's |
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Term
| What was the focus of the Children's Care Team" |
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Definition
| the prevention of child abuse and neglect |
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Term
| Legislation passed in 1993--what was it for? How much did it cost? What was the outcome? |
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Definition
Legislation was passed to create a state wide system of Relief Nurseries Healthy Start Programs in the Counties
The legislation used 20 million in Title 20 block grant funds
Relief Nurseries and Healthy Start programs would be developed in 8 counties/it also created the Commission on Children and Families in each county |
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Term
| What happens when Kitzhaber takes office? |
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Definition
He declares that health care reform (OHP) will be his top priority
The prevention of child abuse and neglect will have to be restricted and delayed
Bureaucracy proposes that they remove the funding from the child abuse and neglect legislation |
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Term
| What were the conditions that allowed the funds to be removed from title 20 and the prevention program to be reduced to a minimum? |
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Definition
The leaders of the house and senate are now democrats and follow kitzhaber’s lead
The Republicans who passed the legislation are no longer in power |
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Term
| How did Kitzhaber push his OHP agenda through? |
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Definition
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Term
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Definition
Provided preventative care and proven medical care to the working poor
Stopped funding procedures that were ineffective or did not materially improve the quality of life to recipients (traditional Medicare covers end of life--Kitzhaber took this away and he was called Dr. Death |
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Term
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Definition
Expanded medical coverage to “working poor” who otherwise would not be eligible for Medicaid
Identified a list of 688 medical treatments based on whether they were medically proven and enhanced the quality of life for the patient
Prioritized the 688 procedures and only funded 485 of them |
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Term
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Definition
Oregon was able to expand medical coverage from 240,000 to 360,000 citizens
The list of priority treatments led to charges that Governor Kitzhaber as “Dr. Death”
Medicaid was shown to be a good mechanism for expanding medical treatment to persons otherwise not eligible due to higher incomes |
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Term
| What is the new CCO Waiver? |
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Definition
| Oregon’s new Medicaid waiver forms and organizes Coordinated Care Organizations (CCO): was approved in July 2012. This will give recipients a more comprehensive coverage that will bring different care organizations together to do so |
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Term
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Definition
| How far does CCO go? People are concerned it will reach into the social areas of peoples needs--not just their health care |
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Term
| What funding does CCO get from the federal government and what are the conditions Oregon must adhere to to receive the money? |
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Definition
Oregon gets 1.9 billion over 5 years
In return, Oregon has to reduce medical costs per capita by 2 percentage points by the end of the second year of the waiver |
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Term
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Definition
Established CCO's as the delivery system of Medicaid
State can use Medicaid for flexible services
Uses a non-traditional health care worker
Includes the training of 300 community health workers by 2015 |
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Term
| Issue Number 1 with the ACA |
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Definition
Difference in opinion about that role of government; i.e. the Free Market System
Liberals: believe that the government should provide services that free market can't/won't
Conservatives: believe that the free market should be allowed to provide services |
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Term
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Definition
Social Insurance: Social insurance is an agreement amongst all people that we will pool resources to protect against an unpredictable event that might happen to some (to cover them)
Liberals: everyone contributes and everyone benefits
Conservatives: expensive and unfair because high income people receive the same benefits |
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Term
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Definition
| What Americans want for their health care system: everyone agrees that they should have complete choice of doctors/services--they do not want to be managed |
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Term
| How many states are expanding Medicaid, how many are considering it, and how many are not expanding medicaid? |
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Definition
28--expanding (including D.C.)
3--considering it
20-not considering it |
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Term
| Individual Mandate of ACA: When did it pass? What is the penalty for not following the mandate? |
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Definition
Mandate passed on March 31, 2014
Individuals must purchase health insurance, or pay a penalty
Penalty for not paying start at $95 or 1% of income
33 million more people will be covered, mostly by Medicaid expansion |
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Term
| Who will be covered by Medicaid and who will be given tax credits to help pay for insurance? |
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Definition
People below 138% of the FPL will be covered by Medicaid
People between 138% and 400% of the federal poverty line will receive tax credits to help pay for insurance |
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Term
| What is the penalty for employers with 50 or more full time employees that do not offer affordable insurance plans? |
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Definition
| 2000-3000 dollars a year. Many are opting to pay this instead of offer insurance because it is probably cheaper than paying for their employees insurance |
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