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| <!DOCTYPE html> | ||
| <html lang="en"> | ||
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| <head> | ||
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| <meta charset="utf-8"/> | ||
| <meta content="width=device-width, initial-scale=1.0" name="viewport"/> | ||
| <meta content="Medicaid Resources For Startups" name="description"/> | ||
| <title>How Healthcare Works</title> | ||
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| <link href="https://cdn.jsdelivr.net/npm/[email protected]/dist/css/bootstrap.min.css" rel="stylesheet" crossorigin="anonymous"> | ||
| <script src="https://cdn.jsdelivr.net/npm/[email protected]/dist/js/bootstrap.bundle.min.js" crossorigin="anonymous"></script> | ||
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| <link href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/5.15.3/css/all.min.css" rel="stylesheet"> | ||
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| <link rel="stylesheet" href="../static/css/style.css"> | ||
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| </head> | ||
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| <body class="align-items-center justify-content-center min-vh-100"> | ||
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| <div class="container"> | ||
| <div class="row justify-content-center"> | ||
| <div class="col-md-8 content"> | ||
| <table class="table table-striped"> | ||
| <thead> | ||
| <tr> | ||
| <th scope="col">Term</th> | ||
| <th scope="col">Description</th> | ||
| </tr> | ||
| </thead> | ||
| <tbody> | ||
| <tr> | ||
| <td>CBO (Community Based Organization)</td> | ||
| <td>A non-profit organization that provides services and support to a specific community, often focusing on social and health needs.</td> | ||
| </tr> | ||
| <tr> | ||
| <td>CHW (Community Health Worker)</td> | ||
| <td>A frontline public health professional who serves as a trusted link between healthcare providers and a community, often focusing on outreach and health education.</td> | ||
| </tr> | ||
| <tr> | ||
| <td>Capitated Payments</td> | ||
| <td>A payment model where healthcare providers receive a fixed amount per patient per month, regardless of the number of services provided.</td> | ||
| </tr> | ||
| <tr> | ||
| <td>Doula</td> | ||
| <td>Non-clinically trained professionals who can provide emotional, physical, and informational support and guidance during the prenatal, birth, and postpartum period | ||
| </td> | ||
| </tr> | ||
| <tr> | ||
| <td>FQHC (Federally Qualified Health Center)</td> | ||
| <td>A community-based health clinic that receives federal funding to provide primary care services in underserved areas.</td> | ||
| </tr> | ||
| <tr> | ||
| <td>Health Coaches</td> | ||
| <td>Professionals who work with individuals to set health goals, develop action plans, and provide guidance on healthy lifestyle choices.</td> | ||
| </tr> | ||
| <tr> | ||
| <td>MCO (Managed Care Organization) | ||
| </td> | ||
| <td>A type of health insurance company that contracts with healthcare providers to form a network and emphasizes preventative care and cost management. | ||
| </td> | ||
| </tr> | ||
| <tr> | ||
| <td>Managed Care</td> | ||
| <td>A type of health insurance where the insurer contracts with providers and coordinates care to control costs and improve quality. | ||
| </td> | ||
| </tr> | ||
| <tr> | ||
| <td>Medicaid</td> | ||
| <td>A government-funded health insurance program for low-income individuals and families.</td> | ||
| </tr> | ||
| <tr> | ||
| <td>Care Manager</td> | ||
| <td>A healthcare professional, often a nurse or social worker, who coordinates and manages the care of patients, especially those with complex medical needs or chronic conditions.</td> | ||
| </tr> | ||
| <tr> | ||
| <td>Case Manager</td> | ||
| <td>A professional who oversees and coordinates the comprehensive care of patients, typically focusing on ensuring continuity of care and appropriate resource utilization.</td> | ||
| </tr> | ||
| <tr> | ||
| <td>Care Coordinator</td> | ||
| <td>An individual responsible for organizing and facilitating healthcare services for patients, often acting as a liaison between patients, caregivers, and healthcare providers.</td> | ||
| </tr> | ||
| <tr> | ||
| <td>Care Plan</td> | ||
| <td>A personalized document outlining the goals, interventions, and actions required to address a patient's healthcare needs, developed collaboratively by the patient, caregivers, and healthcare team.</td> | ||
| </tr> | ||
| <tr> | ||
| <td>Transitional Care</td> | ||
| <td>A coordinated set of actions designed to ensure the safe and effective transition of patients between different levels of care or healthcare settings, such as from hospital to home or from one healthcare provider to another.</td> | ||
| </tr> | ||
| </tbody> | ||
| </table> | ||
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| <img alt="..." class="rounded mx-auto d-block" height="600" src="../../static/img/medicaid/funds_workflow.png" width="800"/> | ||
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| <h4 id="101" style="margin-top: 40px;">Breakdown (2019)</h4> | ||
| <table class="table mx-auto unique-table table-striped"> | ||
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| <thead> | ||
| <tr> | ||
| <th>Group</th> | ||
| <th> | ||
| <a href="https://www.kff.org/medicaid/state-indicator/medicaid-spending-by-enrollment-group/?dataView=0¤tTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D" rel="noopener noreferrer" target="_blank">Cost</a> | ||
| </th> | ||
| <th> | ||
| <a href="https://www.kff.org/medicaid/state-indicator/distribution-of-medicaid-enrollees-by-enrollment-group/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D#notes" rel="noopener noreferrer" target="_blank">Number of People</a> | ||
| </th> | ||
| <th>Cost Ratio (Relative to Population)</th> | ||
| <th>Weight of Cost to Population</th> | ||
| </tr> | ||
| </thead> | ||
| <tr> | ||
| <td> | ||
| <b>Seniors</b> | ||
| </td> | ||
| <td>$122,304,815,900 (21.23%)</td> | ||
| <td>8,527,000 (9.71%)</td> | ||
| <td>$14,342.34</td> | ||
| <td>0.2555</td> | ||
| </tr> | ||
| <tr> | ||
| <td> | ||
| <b>Individuals with Disabilities</b> | ||
| </td> | ||
| <td>$196,614,960,400 (34.09%)</td> | ||
| <td>10,037,600 (11.42%)</td> | ||
| <td>$19,571.25</td> | ||
| <td>0.3491</td> | ||
| </tr> | ||
| <tr> | ||
| <td> | ||
| <b>Adult</b> | ||
| </td> | ||
| <td>$56,884,386,300 (9.87%)</td> | ||
| <td>14,812,200 (16.87%)</td> | ||
| <td>$3,838.79</td> | ||
| <td>0.0683</td> | ||
| </tr> | ||
| <tr> | ||
| <td> | ||
| <b>Children</b> | ||
| </td> | ||
| <td>$100,323,192,200 (17.43%)</td> | ||
| <td>35,361,500 (40.26%)</td> | ||
| <td>$2,835.62</td> | ||
| <td>0.0506</td> | ||
| </tr> | ||
| <tr> | ||
| <td> | ||
| <b>Newly Eligible Adult</b> | ||
| </td> | ||
| <td>$99,956,643,000 (17.36%)</td> | ||
| <td>19,129,700 (21.77%)</td> | ||
| <td>$5,224.39</td> | ||
| <td>0.0933</td> | ||
| </tr> | ||
| <tr> | ||
| <td> | ||
| <b>Total</b> | ||
| </td> | ||
| <td> | ||
| <b>$576,083,997,800 (100%)</b> | ||
| </td> | ||
| <td> | ||
| <b>87,868,000 (100%)</b> | ||
| </td> | ||
| <td> | ||
| <b>N/A</b> | ||
| </td> | ||
| <td> | ||
| <b>N/A</b> | ||
| </td> | ||
| </tr> | ||
| </table> | ||
| <h5> | ||
| Legend | ||
| </h5> | ||
| <ul> | ||
| <li> | ||
| <strong>Enrollees:</strong> | ||
| Individuals who are enrolled in Medicaid at any time during the calendar year.</li> | ||
| <li> | ||
| <strong>Seniors:</strong> | ||
| Includes all people age 65 and older.</li> | ||
| <li> | ||
| <strong>Individuals with Disabilities:</strong> | ||
| Includes people under age 65 who are reported as eligible due to a disability.</li> | ||
| <li> | ||
| <strong>Adults:</strong> | ||
| Generally people age 19 to 64. Adults include a small number of people who are eligible through the Breast and Cervical Cancer Prevention and Treatment Act of 2000.</li> | ||
| <li> | ||
| <strong>Children:</strong> | ||
| Generally people age 18 and younger. However, some people age 19 and older may be classified as "children" depending on why they qualify for the program and each state's practices.</li> | ||
| <li> | ||
| <strong>Newly Eligible Adults:</strong> | ||
| Adults in the expansion group who were made newly eligible for Medicaid by the ACA Medicaid expansion.</li> | ||
| </ul> | ||
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