Healthcare Policies: Medicare and Medicaid

Medicare and Medicaid

The evolution of policies has influenced the reimbursement changes in healthcare. For example, the Center for Medicare and Medicaid Services is now indemnifying hospitals, as per their HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys score. The HCAHPS is a value-based system designed to encourage patient-centered services in healthcare facilities. Initially, the project was an additional incentive program for acute care settings. However, it later evolved to include long-term care and hospice healthcare settings into the reimbursement program.

Medicaid Policy Amendment

The state of New Jersey has a specific procedure for the services covered by the Medicaid program. Among many, the services include family planning, physician services, inpatient and outpatient services, lab tests, disease prevention screening, home care, nurse-midwife services, and nursing services for people aged twenty-one and older (“New Jersey Medicaid,” n.d.). The program does not cover costs for smoking cessation drugs and rehabilitative drugs.

One of the Healthy People initiatives is to improve the mental and physical wellbeing of the LGBT community. The organization reports that LGBT individuals are susceptible to discrimination, substance use, violence, and mental health issues (“Lesbian, Gay, Bisexual, and Transgender Health,” 2020). Although the Center for Medicare and Medicaid Services is responsible for the program’s national administrative oversight, each state has autonomy and independence over the eligibility criteria and the services covered by the program. I would change the Medicaid eligibility criteria to cover all New Jersey residents with income below a certain threshold. The Healthy People initiative recommends promoting access to behavioral interventions and counseling services for the LGBT community (“Lesbian, Gay, Bisexual, and Transgender Health,” 2020). The policy change will involve incorporating all social services within the mandatory services covered by Medicaid. The inclusion would reduce the out-of-pocket spending of the LGBT community and improve access to essential healthcare services. Social workers should strive to help their clients reduce expenditures in healthcare costs (Acker, 2010). Managed care interventions aspire to reduce healthcare costs while sustaining the quality of healthcare.


The Medicare and Medicaid Stakeholders in New Jersey include community members, patients, healthcare facilities, healthcare providers, and community organizations. Other Stakeholders include advocacy groups, public health agencies, professional organizations, public advisory boards, commissions, and councils (“New Jersey Medicaid,” n.d.). Public advisory boards can review standards of care and healthcare costs and, subsequently, advise the department of human health services in New Jersey. Professional organizations can liaise with healthcare professionals to provide insightful data that can inform the advisory boards and councils. The public, patients, and advocacy groups can advocate for funding of the program.


Acker, G. M. (2010). How social workers cope with managed care. Administration in Social Work, 34(5), 405–422. Web.

Lesbian, gay, bisexual, and transgender health (2020). Web.

New Jersey Medicaid. (n.d.). State of New Jersey: Department of Medical Assistance & Health Services. Web.

Healthcare Policies: Discussion 2

Factors Contributing to the Vulnerability of Minority Groups in Medicaid Policy

The reimbursement levels of Medicaid can cause the healthcare needs of minority groups to be overlooked. The amount of indemnification a healthcare setting receives influences the prioritization of health services. The differences in Medicaid reimbursements differ on a state’s income capita basis and not the complexity of patients’ needs or diagnoses. Because of limited funding, the use of healthcare services essential to minority groups can be deemed as unnecessary. When health needs of the minority are overlooked, it makes them vulnerable to health disparities.

Lack of representation during the development of Medicaid policies can also increase the vulnerability of minority groups. Holistic care involves addressing the biomedical, social, economic, and physical health needs of patients. Without the LGBT community’s involvement, the healthcare system cannot know how to adequately meet their needs. Providing inadequate care to patients can lead to negative outcomes such as fragmentation of care.

Why These Groupings May Not Have a Voice during the Policy-Making Process

Oppressive and discriminatory practices against minority groups result from ignorant health policies. Concannon (2009) attributed the ignorance to the lack of involvement of the LGBT community in health policy development. Their inclusion in the establishment of health policies can increase awareness and have a transformative impact on legislation. Given that the LGBT are a minority group, they may not have enough representatives to help give credibility to their grievances – large numbers increase the probability of the community’s success.

Organized Self-Help and Citizens’ Groups

AGE Concern is a British LGBT community that aims to address the health issues experienced by the community by raising awareness of the needs of the population. The Agency for Healthcare Research and Quality also promotes the health of the minority by conducting community-based research to identify healthcare disparities among this population (“Mental health,” 2018). The latter advocates for patient-centered policies that respect the identity and uniqueness of each individual (Concannon, 2009). The organization also promotes the needs of the LGBT community by including them in focus groups and boards that directly deal with policymaking.

Senior Action in a Gay Environment Group (SAGE)

SAGE is an American organization that directly advocates for the rights of the LGBT community and elders. The establishment has made significant changes in how LGBT groupings are treated in the United States (Concannon, 2009). It strives to improve access to quality social services and a safe and caring environment for the community. The organization has been a source of support and a resource for mental health services, bereavement services, and legal matters for the LGBT group.

How These Bodies Can Impact the Medicaid policy Amendment

The function of advocacy groups is to ensure that their clients’ opinions and needs are heard and addressed by the government. Given the groups’ socio-economic power, they can influence, persuade, and pressurize the government to change the policy. The lobbying groupings can increase awareness of the health disparities caused by the Medicaid policy through communication and public education. The groups can use campaigns, protests, press releases, and media coverage to get the attention and response of key stakeholders.


Minority health (2018). Agency for Healthcare Research and Quality. Web.

Concannon, L. (2009). Developing inclusive health and social care policies for older LGBT citizens. The British Journal of Social Work, 39(3), 403–417. Web.

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