Center for Medicare and Medicaid Services (CMS)-Report Card

Running head: AGENCY POLICY&nbsp&nbsp 1


Centerfor Medicare and Medicaid Services (CMS)-Report Card

October21, 2014.

ImprovingMedicaid Services

Medicaidis a social program for individuals and families living on limitedresources given as government insurance for all persons who haveinsufficient resources and children to cater for their health costs.Under the center for Medicaid and Medicare services programbeneficiaries are enrolled in private health care plan that receivesmonthly premium from the government.

Newcoverage for most vulnerable Americans (dual eligible)

MostAmericans are covered through the Medicaid health support. Thissupport covers the most vulnerable low-income seniors, children andthose with disabilities. Dual eligible are the most vulnerable andsickest individuals who use Medicaid to service Medicare premiums(Komisar,2005).These segments of the American population are more likely to bedisabled or suffering from chronic diseases such as diabetes, strokeand pulmonary diseases among others. Currently, dual eligible arefragmented, uncoordinated, unmanaged in the program. The currentsystem lacks effective care management on the comprehensive needs ofthe population, and this inhibits access to essential servicesbetween payers and providers. All these aspects lead to poor healthcare for these groups(Pear, 2013).

Newcoverage for most vulnerable Americans (dual eligible)strategywill help alter the growing disparities inefficient healthcareaffordability to the vulnerable groups in the American society. Thereis impetus to increase attention level to these vulnerable groupssince they are mostly affected by cracks that occur during healthsystem changes. These groups are vulnerable to economic conditions,geographical locations, age, health, developmental, communicationsand other unexplained vulnerabilities (Pear,2013).The new coverage plan for more vulnerable Americans wouldsubstantially reduce government budget expenditure on uncompensatedcare costs and other related programs as well as benefiting morevulnerable people.

SystemOverview the current system in Medicaid services

Inthe current Medicaid program, the government provides medical andother health related services to people with low income in the U.S.The program which is run by Center for Medicaid and Medicare servicesis funded by the Federal and state government. In this program,recipients are required to be U.S citizens or those with a permanentlegal resident. In particular, the program covers the disabled,low-income families and children’s. Dual eligible current programfocuses on special needs, program for all-care for elderly andMedicaid managed by care models (Pear,2013).

However,the program for dual eligible has failed to expand beyond reachingless than 20% of the needy dual eligible citizens. In addition, highcosts and low-quality health care is a major concern for dualeligible population(Komisar, 2005).This issue can be solved through Medicaid and Medicare programs toimprove coordination of payments and healthcare provision to thevulnerable groups(Centers for Medicare and Medicaid Services (CMS), 2014).

Planof Action:New coverage for most vulnerable Americans (dual eligible)

Healthcare system providers and the hospitals need to address barriersleading to impediment for improved healthcare delivery. Improvedcommunication and data exchanges are critical for improved careprovisions for the most vulnerable group (dual eligible). Dualeligible faces wide range of social and medical issues that may notbe covered adequately by the Medicare or Medicaid service programsand they require services that go beyond healthcare reimbursement. Amodel plan of action to adjust this problem may involve

Themajor tasks involved

Completecomprehensive assessment and reassessment of the group.

Completeassessment of the individuals under the dual eligible program isessential in adjusting care plans in accordance to patient needs.

ImplementProtocol Based Planning

Thereis a need to evaluate and employ evidence-based protocols that willenhance effective management of common conditions affecting thevulnerable populations to reduce unwarranted provider and payervariation.

Utilizea team-based care management centered on primary care

Coordinatingmedical, behavioral and long-term support services throughmultidisciplinary efforts are effective in promoting effectivehealthcare plans for the vulnerable groups.

Facilitatedata sharing and integrated information system

Mechanismsthat are necessary for data sharing is important in facilitating caremanagement for a vulnerable group. It is through effective datasharing that the government financial support for healthcare canreach healthcare providers effectively for patients’ treatment, andthis enhances care coordination. Data sharing is an effectivemechanism through which risks can be minimized and enhance efficientimplementation of the plan.

Offernon-healthcare services

Inthis case, programs that encompass wider range of social and medicalconditions are included as non-healthcare services such astransportation, appointments for assisting in cleaning and groceryshopping.

Providehome-based care

Comprehensiveplans are made for clinical assessment at home or in the office withfrequent visits to increase patient-provider contacts. This is aproven patient satisfaction method for the most eligible citizens.

Expectationsand Obstacles

Majorexpectations in this plan are to facilitate effective healthcare forthe vulnerable groups. In particular, the plan focuses onestablishing more enrolment of vulnerable groups in the Medicaid andMedicare services. In addition, the plan focuses on facilitatingeffective healthcare coordination for the dual eligible and othervulnerable groups by facilitating improved infrastructure,collaborative relationships and integration in the provision ofbetter health care services.

Majorobstacles expected in this plan may involve lack of cooperationbetween states and health care providers in facilitating patientscare. Another obstacle may be convincing the Center for Medicaid andMedicare services to widen their scope of coverage to thedual-eligible groups. However, these challenges will be minimizedthrough effective articulation of the vulnerable population needs inthe Medicaid and Medicare programs. Effective communication andenhancing cooperation between various stakeholders is key toenhancing the effectiveness of plan implementation and riskminimization.


RobertPear (May 24, 2013). States’Policies on Health Care Exclude Some of the Poorest.TheNew York Times.Retrieved October 21, 2014.

Komisar,HL. (2005). Unmet Long-Term Care Needs: An Analysis ofMedicare-Medicaid, Dual Eligible, Inquiry,42.No. 2: 171-182.

Centersfor Medicare and Medicaid Services (CMS) website. Retrieved from