Medicaid operates in the State of Texas.

Posted: January 17th, 2023

Medicaid operates in the State of Texas.

Medicaid in Texas
Medicaid operates in the State of Texas as a health insurance program that covers the medical expenses for needy persons defined as persons with disabilities, pregnant women, families, elderly, and children whose income meet the set requirements. In fact, it targets persons below a set income level. Adults can similarly qualify for Medicaid if they are 65 years of age or older, take part in Medicaid Buy-in, care for children, or are pregnant.

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Medicaid services in the state are delivered through management care whereby Texas Health and Human Services Department contracts with managed care organizationsthat have licensure from the Texas Department of Insurance.Medicaid operates in the State of Texas. The contracted organizations are expected to coordinate health services and plans for persons who are enrollment with Medicaid. The organizations are paid a monthly fee to offer their coordination services. The health plans into which Medicaid members are enrolled with the contracted organizations also have direct contract with health care providers (such as doctors and nurses) with the intention of creating a provider network that the members can use to access all the covered medical services (Texas Human Health Services, 2019). Coverage offered by Medicaid is divided into two groups. The first group are the mandatory coverage benefits that states are obligated to cover under federal law. They include outpatient and inpatient, laboratory and x-ray, physician, home health, family planning, rural health clinic, transportation to medical care, nurse midwife, nursing facility, tobacco cessation counseling, and certified pediatric and family nurse practitioner services. The second group are optional coverage benefits that Texas State government has chosen to cover. They include prescription medication, physical therapy, occupational therapy, dental services, hospice care, prosthetics, case management, and TB related services (Centers for Medicare and Medicaid, 2019; Medicaid.gov, 2019). A review of Medicaid reimbursement wait time for Texas State reveals that the average time for Medicaid reimbursement is 75 days, slow when compared to Kansas at 37 days and fast when compared to Pennsylvania at 115 days. The Medicaid reimbursement rate for nurse practitioners is 92% that of physicians for the same service, with the rates increasing to 100% for injections, x-ray services, and laboratory services (Texas Human Health Services, 2019).Medicaid operates in the State of Texas.
Medicaid in Texas

Medicaid operates in the State of Texas as a health insurance program that covers the medical expenses for needy persons defined as persons with disabilities and children whose income meet the set requirements. Adults can similarly qualify for Medicaid if they are 65 years of age or older, take part in Medicaid Buy-in, care for children, or are pregnant (Texas Human Health Services, 2019).Thecomprehensive program coverage applied in Texas has four parts. Part A covers reactive health care services to include home health care, hospice care, inpatient care in a skilled nursing facility for long term or custodial care, and inpatient care in a hospital. Inpatient care coverage includes hospital supplies and services, drugs, general nursing, meals, and semi-private rooms, as well as mental health care, participation in research study, long-term care in medical facilities, critical access, and acute care visits. Part B covers preventive and medically necessary services. The preventive services are intended to detect the early stages of illness when treatment is most likely to be effective, or to prevent illness. The medically necessary services are supplies and services that meet the accepted medical practice standards and are required to treat or diagnose illness.Medicaid operates in the State of Texas. It specifically covers limited outpatient prescription drugs, getting a second opinion prior to surgery, outpatient and inpatient mental health care, durable medical equipment, ambulance services and clinical research. Part D is a drug cover plan that details about coverage tiers, formularies, name brand and generic drug coverage, as well as what patients are expected to pay in the plan (Centers for Medicare and Medicaid, 2019; Medicare.gov, 2019). Medicare policies require that reimbursement claims be submitted within one year of the health care being providedwith the payment made once all supporting documentation has been verified. The physicians fee schedule for Medicare includes instructions on how to calculate the reimbursements for physicians and nurses, noting that nurses should be reimbursed at a rate of 85% of what the physicians are reimbursed (Herbert, 2012).Medicaid operates in the State of Texas.

Medicaid in Texas
Medicaid operates in the State of Texas as a health insurance program that covers the medical expenses for needy persons defined as persons with disabilities and children whose income meet the set requirements. Adults can similarly qualify for Medicaid if they are 65 years of age or older, take part in Medicaid Buy-in, care for children, or are pregnant (Texas Human Health Services, 2019).Thecomprehensive program coverage applied in Texas has four parts. Part A covers reactive health care services to include home health care, hospice care, inpatient care in a skilled nursing facility for long term or custodial care, and inpatient care in a hospital. Inpatient care coverage includes hospital supplies and services, drugs, general nursing, meals, and semi-private rooms, as well as mental health care, participation in research study, long-term care in medical facilities, critical access, and acute care visits. Part B covers preventive and medically necessary services. The preventive services are intended to detect the early stages of illness when treatment is most likely to be effective, or to prevent illness. Medicaid operates in the State of Texas.The medically necessary services are supplies and services that meet the accepted medical practice standards and are required to treat or diagnose illness. It specifically covers limited outpatient prescription drugs, getting a second opinion prior to surgery, outpatient and inpatient mental health care, durable medical equipment, ambulance services and clinical research. Part D is a drug cover plan that details about coverage tiers, formularies, name brand and generic drug coverage, as well as what patients are expected to pay in the plan (Medicare.gov, 2019). Medicare policies require that reimbursement claims be submitted within one year of the health care being providedwith the payment made once all supporting documentation has been verified. The physicians fee schedule for Medicare includes instructions on how to calculate the reimbursements for physicians and nurses, noting that nurses should be reimbursed at a rate of 85% of what the physicians are reimbursed (Herbert, 2012).Medicaid operates in the State of Texas.