North Carolina State Assisted Health Insurance

Sandra Wilkes: Medicaid plays major role in local health care

By Sandra Wilkes

Special to the Salisbury Post

Last year Medicaid paid $163,049,159 for health care for almost 24,000 Rowan County residents, representing 17 percent of the county’s population. Breaking those numbers down, Medicaid assisted close to 17,000 parents and children and 7,000 elderly, blind and disabled adults.

With the persistently high unemployment rate, many families have had to turn to Medicaid and other public assistance programs for the first time. A federal-state health insurance program that was signed into law in 1965 by President Johnson, Medicaid has become over the years the largest publicly funded insurance program in the nation. As an entitlement program, the government must pay for covered health services of eligible Medicaid beneficiaries. Without this coverage, our most vulnerable citizens may not have medical exams and preventive check-ups, nursing home care, prescription drugs, physical therapy, mental health services and pre-natal care.

Both the number of Medicaid recipients and the cost to provide their care will increase significantly in the next two to three years, when health-care reform expands the current Medicaid coverage groups to include adults who are not responsible for minor children and who are not disabled, blind, or elderly, and whose annual gross income does not exceed 133 percent of the federal poverty level. It is expected that many low-income adults will take advantage of Medicaid when this expansion goes into effect.

Controlling costs

Medicaid cost containment is a pressing concern and has led to several statewide initiatives. Managed care is one state initiative that has very effectively improved the quality, use and cost-effectiveness of care for Medicaid recipients, especially for patients with chronic diseases. Rowan’s managed care program is Community Care of Southern Piedmont. CCSP funds a Social Services-managed care coordinator, who works to get Medicaid recipients assigned to a primary care physician. Over 20,000 of Rowan’s recipients are assigned to a primary care physician. Having a primary physician and a patient-centered medical home means the patient gets comprehensive routine and preventive care, costly medical emergencies are fewer, and the potential is reduced for recipients to go from doctor to doctor without anyone overseeing their care.

Starting An Adult Care Home Business: Businesses Providing ...

An adult care home is a for-profit assisted living facility providing long-term home care in a neighborhood. It is meant to provide care for compensation to adults who are elderly, physically disabled, or developmentally disabled. A potential adult care home owner/operator should first find out what the industry is doing because several steps must be performed before a person will be granted a license to operate an adult care home business.

In Oregon, when a county has too many adult care homes, no more licenses will be granted for that area. Calling the local State Department on Aging and inquiring about the requirements for operating an adult care home in the chosen area will supply the potential owner/operator with all the information needed. It is also possible to find what information is needed by pointing a browser to the website of the state in question (www. whateverstate .gov) and then clicking on “Human Services,” “Health Services,” “Department of Aging,” or “State Agencies.”

It goes without stating that to operate an adult care home business a person needs a house. A potential owner/operator can obtain one by simply buying a house and then remodeling it according to the stipulations set forth by the state in which the house will be located. Another option is to purchase an adult care home business from an operator who has listed the home business for sale. Some owner/operators lease their adult care homes, others lease their adult care homes with the option to buy. In either case, the house as well as the owner/operator and any employees will be inspected by the state and only after the state has issued a license can the doors be opened for business.

If the intention is to service five clients, then the house will have to be remodeled so there will be a private room for each client as well as the resident manager and the substitute caregiver. Every room in the house will have to have a smoke alarm that meets the Fire Marshall’s standards, and at least one fire extinguisher will have to be on every floor of the building. These are just a few of the requirements.

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