Medicaid HMOs

HMOs or health maintenance organizations are big insurance businesses that carry and offer a certain kind of health insurance coverage. These insurance companies were planned and conceptualized based on ideas of controlling expenses and saving a person a lot of money. An individual can get hold of health insurance directly through a private HMO company, by employer-subsidized programs or benefits, or by means of government funded programs such as Medicaid HMOs.

Since one of their main commitments is to manage health care features, HMOs are frequently described as managed care organizations. There are some doctors and health practitioners though who have disapproved of Medicaid HMOs participation with a patient’s treatment. Besides the fact that there are groups of people who are questioning these HMOs, they have become a well accepted way of presenting health insurance to individuals. They have become so popular, that there are certain states that have subcontracted Medicaid or Medicare insurance operations to private HMOs. These HMOs are the ones who make health insurance coverage available to qualified individuals and they also directly administer the care of these individuals. This in turn helps the government decrease its expenditures federally funded insurance programs.

To control expenses for health care services that are compensated by Medicaid health maintenance organizations, they have set restrictions regarding which forms of medical care can be availed by an individual. A Medicaid HMO would normally require a person who has qualified to only go to doctors who are part of the HMOs accreditation. These doctors have agreed to an arrangement with the Medicaid HMOs. They work closely with the HMO, and they normally charge lower professional fees as part of the agreement they had. They can also help keep costs lower by giving some form of special consideration or assistance to clients of Medicaid HMOs.

Other forms of guidelines that are generally followed by clients of Medicaid HMOs are that they must first get hold of a referral letter or form from the HMO before going to doctor or specialist, except if they want to pay for the expenses by themselves. The referral letter or forms can be acquired by going to primary care physicians who are part of the HMOs network. After consulting with the HMO doctor, they will be passed on to an accredited specialist.

As well as putting up guidelines on how to and which doctors to visit, Medicaid HMOs also oversee other aspects of health care. HMO doctors and patients usually have to get authorization for specific kinds of tests, procedures or treatments. To decide if the main insurance agency will cover the procedures or means of treatment, Medicaid HMOs have doctors in their own staff that evaluates requests and treatment proposals.

The enrollment in Medicaid HMOs has generally increased from 24 percent in 1996 to 40 percent in 2002. Although in 1998, these numbers decreased to 14 percent and has continued to go down slowly as private HMOs did not rejoin Medicaid programs.

Studies have shown that although Medicaid HMOs clients have increased over the past 20 years, this has not produced noteworthy improvements to cost or ease of access of medical care.


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