Long-Term Care Reimbursement

Background Information

Long-term care has been the top priority of the United States of America government. This was evidenced when the 2008 presidential candidates campaigned on the platform of reforming the health care system. When President Barrack Obama was elected the president of the USA, the health care reform system was top of his priorities. He (President Obama) introduced the Patient Protection and Affordable Care Act (PPACA) that sought to make health care affordable to all Americans irrespective of economic status. The act had several provisions that concerned long-term care. The previous long-term care did not put into consideration the elderly population. Other weaknesses included reimbursement-driven and unequally distributed services and hence reforming it was long overdue. PPACA seeks to expand the Medicare and Medicaid options to ensure they are affordable (Healthcare Reform, 2011).

Medicare and Medicaid services

Medicaid is a medical program that is managed by the state that is aimed at assisting small income people and families to access medical health. To be eligible for Medicaid one should come from a group that is recognized by the state or federal laws. The operation of Medicaid does not involve giving out money directly to the beneficiaries but it remits it to the medical services provider. Depending on one’s state and in exceptional circumstances an arrangement called co-payment is recognized where the beneficiary may be asked to pay part of the medical bill. Medicare specifically provides medical care (Centers for Medicare and Medicaid Services, 2011).

Medicare on the other hand is a health insurance program that is universally provided by the government of the USA to a certain category of its population. This category includes people over 65 years, people who are 55 years and above but with disabilities, and any citizen who suffers from end-stage renal disease.

Medicare services include hospital insurance which covers patient care in hospitals and hospices and which most people don’t pay premiums, medical insurance that covers doctors’ services and outpatient care, and other medical services not covered by hospital insurance but require people to pay premiums. Another service is prescription drug coverage which helps lower drug costs.

Population covered under Medicaid and Medicare

Medicaid does not cover all poor persons in the United States of America but has special considerations only applicable during emergency moments. It is available to those people who have are low-income earners. Medicaid eligibility depends on age, whether one is pregnant or not, disability and financial worth. One’s child may be eligible if he/she is a US citizen. Specific groups covered by Medicaid are pregnant women whether married or single. In this situation, their children will be automatically covered. The second groups are children or teenagers, this applies to children who are 18 years or younger and their family income is limited. The third group is the aged, the blind or the disabled or those who have huge medical bills (Centers for Medicare and Medicaid Services, 2011).

Medicare is available to three categories of people. Those over the age of 65 years, people suffering from end-stage renal disease, and those individuals who are 55 years and above but disabled.

The services of long-term care covered under Medicare and Medicaid including the restrictions placed on them

Long-term care services include aging and disability. These people may require assisted living, home health care and sub-acute care. These people require food, transportation, and financial assistance. These services are not adequately covered by Medicare or Medicaid due to competition from the private world (Pratt, 2009) and the massive resources required, this calls for regulation in administering long-term health care (Social Security, 2011).


Centres for Medicare and Medicaid. (2011). Medicare Providers. Centres for Medicare and Medicaid. Web.

Healthcare Reform. (2011). Implications for Long Term Care Providers. Healthcare Reform Policy. Web.

Pratt, J. (2009). Long-term care: Managing across the continuum, (3rd Ed.). New York, NY: Cengage Learning.

Social Security. (2011). Social security website. Web.

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