You have a patient who only has Medicare Part A and B. She has limited income most of which is used to pay for Medicare Part B. She is in dire need of placement into a nursing home as she can no longer care for herself at home. You gleaned from your reading that long-term care needed by low-income elderly people is paid by Medicaid, and you feel your patient meets the criteria. What are the steps you would take to advocate for your patient while she is still in the acute care setting? Who are some of the other health care professionals you would collaborate with to ensure your patient receives the additional healthcare coverage she needs? Analyze the role Medicaid plays in supporting long-term care for the elderly and disabled.

Assignment: HCA 320 Module 8 Medicare and Medicaid Sample

When it comes to advocating for acute care patients and their need for long-term care, exploring the resources at hand is crucial. Medicaid is a government-funded health insurance program intended for low-income people, such as the elderly, children, pregnant, and disabled (Currie & Chorniy, 2021). To ascertain eligibility for this program, one must communicate with the state Medicaid office and provide thorough details about the patient’s living situation, income level, family structure, and disability status (Usgov, 2023). Another option is to apply through the Health Insurance Marketplace. With an emphasis on patients with Medicare Parts A and B and low income, this essay will outline how to effectively advocate for a patient needing placement in a nursing home.

ORDER A PLAGIARISM-FREE PAPER HERE ON;Assignment: HCA 320 Module 8 Medicare and Medicaid 

Advocating for the Patient

Initiate advocacy by thoroughly evaluating the patient’s functional status, medical needs, and financial resources. This includes examining medical records, interviewing family or caregivers, and conducting a comprehensive geriatric assessment (Mitchell et al., 2023). After ascertaining the patient’s eligibility, educating them and their families on the Medicaid program, its eligibility requirements, and its long-term care services is essential. Providing written materials and contact details for local Medicaid agencies assists in the application process for patients and their families. The necessary documents for the application include identification such as a birth certificate, social security card, driver’s license, Medicare Card, and Health Insurance Card (Mitchell et al., 2023). This list underscores the importance of thorough preparation for a successful Medicaid application.

Actively guide them through completing the Medicaid application process while addressing any questions or concerns that may arise to ensure a seamless submission. Collaborate with the social worker, case manager, and other discharge planning team members to support a smooth shift from acute care to a nursing home certified by Medicaid (Mitchell et al., 2023). Confirm that the chosen nursing home can address the patient’s requirements. Expedite placing the patient in a nursing home to avoid worsening their condition. Sustain ongoing communication with the Medicaid agency and nursing home for a prompt and seamless transition.

Collaboration with other Healthcare Professionals

            Engaging in collaborative efforts with a diverse range of healthcare professionals is crucial to optimize the advocacy process. According to Giardino and Lyn (2020), this includes partnering with pivotal social workers to evaluate patient requirements, deliver psychosocial assistance, and facilitate access to community resources. Involving case managers is essential for streamlining care coordination among various providers and settings while supporting and navigating the complex Medicaid application procedure and advocating for the patient’s needs (Giardino & Lyn, 2020). Nurse practitioners or physician’s assistants offer invaluable medical care and guidance while educating patients about their Medicaid eligibility and associated benefits. Collaborating with nursing home staff is vital as they are directly responsible for administering care and services to residents eligible for Medicaid; this collaboration ensures optimal utilization of available benefits within the scope of Medicaid provisions.

Medicaid’s Role in Supporting Long-Term Care

Medicaid is crucial in providing long-term care by encompassing many services. The services include nursing home care for those needing skilled nursing or custodial care and funding for Home and Community-Based Services, enabling individuals to receive necessary assistance within their homes or communities (Mellgard et al., 2021). This support encompasses personal care assistance, homemaker services, adult day care, and respite care for caregivers. Moreover, Medicaid may extend its coverage to transportation for medical appointments and essential services alongside other long-term care amenities such as assistive technology, durable medical equipment, and respite options for caregivers.

Conclusion

Advocating for patients who need long-term care in acute care settings involves a strategic approach focused on making the best use of available resources, with Medicaid playing a crucial role. The eligibility process, whether through the state Medicaid office or the Health Insurance Marketplace, demands careful attention to all aspects. The comprehensive approach of advocacy, which involves a thorough assessment and close collaboration with healthcare professionals, underscores the importance of developing a comprehensive strategy. Medicaid’s broad coverage, which includes nursing home care and Home and Community-Based Services, as well as various support services, highlights its essential role in facilitating long-term care. In conclusion, effective advocacy requires collaborative efforts and a firm grasp of what Medicaid provides.

References

Currie, J., & Chorniy, A. (2021). Medicaid and child health insurance program improve child health and reduce poverty but face threats. Academic Pediatrics, 21(8), S146–S153. https://doi.org/10.1016/j.acap.2021.01.009

Giardino, A. P., & Lyn, M. A. (2020). Utilization management, case management, and care coordination. Medical Quality Management, 139–175. https://doi.org/10.1007/978-3-030-48080-6_7

Mellgard, G., Ankuda, C., Rahman, O.-K., & Kelley, A. (2021). Examining variation in state spending on Medicaid long-term services and supports for older adults. Home Health Care Services Quarterly, 1–11. https://doi.org/10.1080/01621424.2021.2004286

Mitchell, A., Napili, A., Binder, C., Braun, S. K., Baumrucker, E. P., & Colello, K. J. ,. (2023). Medicaid: An overview. Go.gale.com. https://go.gale.com/ps/i.do?p=AONE&sw=w&issn=&v=2.1&it=r&id=GALE%7CA740090254&sid=googleScholar&linkaccess=abs&userGroupName=anon%7E73cc9e81&aty=open-web-entry

UsaGov. (2023). How to apply for Medicaid and CHIP. Www.usa.gov. https://www.usa.gov/medicaid-chip-insurance