Medicaid

Medicaid, which became law in 1965 as part of the Social Security Act, is a social insurance program that pays for basic medical services for the nation’s individuals and families who have the least income and resources. It is the biggest health safety net program in the United States, with more than 50 million people enrolled. It accounts for 16% of our nation’s spending on health care, at an annual cost of over $300 billion. Unlike Medicare, which was enacted into law at the same time but is federally funded and administered, Medicaid is jointly financed by the federal and state governments. It is the third largest nondefense program in the federal budget after Medicare and Social Security, with 8% of federal outlays in 2004. At the state level, Medicaid is the second largest expenditure, after K–12 education, and it accounts for 16% of state own-source spending.

Medicaid enrollees must meet various financial criteria and belong to one of the “mandatory” eligibility groups, including pregnant women,rift gold children and teenagers, parents of dependent children, seniors, and people with disabilities. Private insurance is usually unavailable to Medicaid enrollees. Low-income workers and retirees might not have access to or cannot afford insurance through their current or previous employers. Many private insurance programs also exclude people with disabilities and chronic illnesses. However, not all uninsured individuals qualify for Medicaid coverage, even if they are poor. Having assets in excess of a few thousand dollars may be enough to disqualify someone. Incidentally, although many immigrants meet various financial/asset criteria and mandatory categories, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, popularly known as “welfare reform,” prevents new immigrants from applying for Medicaid during their first 5 years in the United States.

More than 7 million Medicaid beneficiaries, or 14% of Medicaid enrollees, are low-income seniors and people with disabilities who are also enrolled in Medicare. These “dual eligibles” usually have substantial health needs, comprising 42% of total Medicaid spending. They rely on Medicare to cover basic health services such as physician and hospital care, but depend on Medicaid to pay Medicare Part B premiums for the aforementioned services and copayments to cover prescription drugs and long-term care, which are not covered by Medicare. Now prescription drug coverage for dual eligibles is covered under Medicare Part D.

Federal statutes, regulations, and policies establish broad national guidelines for Medicaid. For example, state Medicaid programs are required to cover the following basic services for the mandatory groups of beneficiaries: (1) in- and outpatient hospital services; (2) physician, midwife, and certified nurse practitioner services; (3) laboratory and X-ray services; (4) nursing home and home health care for adults; (5) early and periodic screening, diagnosis, and treatment for children; (6) family planning; and (7) rural health clinic services. However, the scope and composition of Medicaid programs varies across states. States have substantial flexibility in administering their own program and setting their own guidelines regarding eligibility standards as well as types, amount, duration, and scope of services covered. They can also offer additional services such as prescription drugs and dental care for the mandatory beneficiary groups and other populations with significant needs. The majority of “optional” spending (86%) pays for services to the elderly and people with disabilities. Medicaid is the largest payer of long-term care, public mental health services, and AIDS treatment. Funding for Medicaid is based on state spending and the statutory formula called Federal Medical Assistance Percentage. The federal government currently pays between 50% and 77% of all the state Medicaid spending with no predetermined limits, with higher matching rates for states with lower per capita incomes. The matching funds provide assistance for coverage of mandatory populations and services, as well as a wide range of optional services and broader population coverage. They also give incentives for states to invest in health care, since Medicaid is the largest source (44%) of all federal revenue to states. Reduction in state Medicaid spending will result in a substantial decrease in federal revenue. Like private health insurance, Medicaid purchases services from hospitals, physicians, health maintenance organizations (HMOs), and other providers in the private health care marketplace. Each state sets its own reimbursement rates, which have historically been lower than those paid by other insurers. Some physicians are thus unwilling to serve Medicaid beneficiaries, and some HMOs have ended their participation in Medicaid.

While each state has a Medicaid Fraud Control Unit that monitors the safety net program, some of the largest and most complex state Medicaid programs (e.g., New York) have reported cases of service providers exaggerating their billings, charging for services that never occurred, and prescribing unnecessary but expensive drugs to “patients” who sell them on the black market. Such abuse is costing the programs billions of dollars and taking away resources from patients who depend on the programs. In recent years, in addition to restricting provider payments and intensifying fraud control, many states have reduced services in response to sharp declines in state revenues and large budget shortfalls. In early 2004, the federal government, which faces an annual federal deficit of more than $400 billion,rift gold proposed to cap federal Medicaid matching payments and to enforce a state maintenance of effort requirement. Health and Human Services has also approved comprehensive waivers in the past few years that allow states to impose enrollment caps, enrollment fees, or higher copayments. Given that Medicaid is the primary source of health and long-term assistance for individuals with the most complex health care needs and the least amount of resources, some worry that any cost-cutting measure would further disadvantage the nation’s most vulnerable population.

I've got to hand it to the Rays: this club refuses to die. The Rays have had a large number of come-from-behind victories over the past three seasons, but this series with the Twins has been something else. RIFT Platinum That's twice now in three games that the Rays have entered the bottom of the ninth losing, and that's twice that they've made Joe Nathan blow a save. Of their six wins so far this season, the Rays have entered the ninth inning losing in three of them.

But I'm getting a bit ahead of myself. First things first: Jeff Niemann was actually pretty good Saturday afternoon. It's weird, though: from watching him today, I didn't think he'd pitched well until I checked the boxscore just a few minutes ago. RIFT Platinum Batters seemed to be hitting the ball decently hard against him, and he worked himself out of a couple different jams throughout the day. But despite my eyes and the recent concerns about him, Niemann had a typical Big Nyquil start: 7 IP, 3 runs, 1 walk, 6 strikeouts. It wasn't anything fancy, and Niemann did let up 8 hits and a long homerun, but it was definitely his best start of the season.

As for the Rays' offense, it was as maddening and inconsistent as always; I'm beginning to think they need to have their backs to the wall before their offense actually kicks into gear. The Rays couldn't score many runs until they got themselves into a 1-6 hole to start the season, and they've only scored four runs before the seventh inning during this series. rift gold This time, after wasting multiple scoring opportunities earlier in the game, the Rays scored three runs in the eighth and ninth inning to win the game. Confidence building? Not necessarily. Exciting? Oh heck yeah.



Game Notes:

This was the fifth straight game that Johnny Damon has had the game-winning RBI, and it was also the second game this series that he's won with a walk-off hit. I know I wasn't too exciting about Damon when he was initially signed - I figured he was aging and not exactly an impact bat - but so far he's still plenty of life left in that bat.
Matt Joyce continues to thrive hitting in the middle of the Rays order, cracking two hits including a double (which he just barely made under the tag). Rift Gold His batting average is now up to .293 (and his wOBA is above .330), although I'm still waiting on that first homerun from him.
John Jaso and Jeff Niemann make a really bad combination when it comes to baserunners. RIFT Platinum The Twins stole three bases off them today, including one by Delmon Young, even though Jaso actually made some good throws. Niemann just isn't the fastest to the plate, so I'll be curious to see if Maddon continues to match Jaso up with Niemann or if it was merely a coincidence.
Sam Fuld continues to be Sam Fuld, driving in a run on a sacrifice fly, flashing some excellent range in the outfield, and talking a walk in the ninth inning to load the bases and bring Johnny Damon to the plate. rift gold His defensive range is particularly impressive - if he can keep it up, his defense could make him worth a regular spot even when his offense regresses.
How could I forget? Ben Zobrist led off the ninth inning with a laserbeam of a homerun against Joe Nathan. RIFT Platinum He's been in a slump recently, dropping his season wOBA to .285, so hopefully BenZo starts hitting the ball hard again. I'm still hoping that his power numbers will rebound somewhat this season.

Frank Shamrock says former EliteXC matchmaker Jared Shaw's recent claim of Shamrock offering to take a dive against Kimbo Slice in the main event of EliteXC-CBS on Oct. 4, 2008 was fabricated.

"No, absolutely not," Shamrock said Monday on The MMA Hour, RIFT Platinum when asked by host Ariel Helwani about Shaw's claim. "That's some movie b.s. right there."

On the date of the infamous event, Ken Shamrock was forced out of the fight due to a cut and it's been widely known that Shamrock, an assigned commentator for the show, offered to take the fight on late notice. rift gold But on Sunday's episode of Sherdog.com's Rewind show, Shaw made a startling claim that Frank more than just offered his services to step in and replace Ken.

"Frank Shamrock pulled me in the back of a room, RIFT Platinum turned the music up and offered to work the fight against Kimbo Slice," Shaw told Jeff Sherwood.

Shamrock says he doesn't know why Shaw would make such a statement, but reasons Shaw's career in MMA is over and he's looking for a way to make money.

"It sounds like he's trying to sell a book or something, or write a movie script," Rift Gold said Shamrock before asking: "Where would I get the music at? What are you talking about here? Do I just carry a beatbox with me?"

Shamrock says he would have never "fiddled with the truth." Fighting is for himself, his art and making money.

YouTube videos on cutting and other self-injury methods are an alarming new trend, attract millions of hits and could serve as a how-to for troubled viewers, a study warns.

Many videos show bloody live enactments or graphic photos of people cutting their arms or legs with razors or other sharp objects, the study found. Rift Gold Many also glamorize self-injury and few videos discourage it, the study authors said.

They also feature haunting music and rich imagery that may attract young self-injurers and trigger the behavior, especially in those who have just started to self-injure, the authors suggest.

Canadian psychologist Stephen Lewis, a study co-author, said he found more than 5,000 YouTube videos on self-injury. The study focused on 100 videos the authors found in December 2009. Their analysis was published online Monday in Pediatrics.

The 100 videos were viewed more than 2 million times and generated many online comments.

Parents and mental health professionals should be aware of the YouTube postings and that the videos might be perpetuating the problem, said Lewis, an assistant professor at the University of Guelph in Ontario.

The study's authors also recommended that YouTube provide helpful resources or links when people enter search terms for "self-injury." A company spokeswoman said YouTube is looking into the feasibility of the suggestion.

She said the site has policies against graphic content and content that encourages dangerous activities. rift gold It relies on viewers to flag questionable videos, and a YouTube team reviews and removes those in violation of those policies. Self-injury videos are among those that have been removed.

Self-injury is most common among young people. Between 14 percent and 24 percent of teens and young adults have engaged in self-injury at least once, Lewis said. Cutting is among the most common methods.

Psychologist Tracy Knight, an associate professor at Western Illinois University in Macomb, Ill., is interviewed in a documentary-style YouTube video about cutting that has been viewed more than 14,000 times and generated more than 80 comments.

Knight said the video was done by a student and he didn't know it was on YouTube. RIFT Platinum The video's opening scenes include a young woman poking a sharp tool into her leg.

Knight said such videos may inadvertently trigger self-harm, but that YouTube also can serve a benefit by taking self-injury out of the closet and into the public realm.

"It makes it open for social discussion . . . in a way that was not possible when it was secret," he said.

Lewis said therapists who treat self-injurers should consider asking their patients if they watch these videos and counsel them about possible effects. Rift Gold Parents, too, should be aware that kids may be watching the videos and discuss the issue with them, he said.

Self-injurers typically are struggling with feelings of anger, sadness, depression or other emotional troubles, RIFT Platinum and usually don't cut deep enough to cause major harm, said Barent Walsh, a therapist and author of a book on self-injury treatment.

Self-injuring "is oddly effective in reducing emotional distress" in people who have poor coping skills, Walsh said.

He said it's well-known that photos and websites about self-injury can trigger the behavior in people who already self-injure or who are tempted to do it. rift gold But he said the study results are important and raise concerns that YouTube "may well be the most powerful influence of them all because of its nature."

Copyright 2010 The Associated Press. The information contained in the AP news report may not be published, broadcast, RIFT Platinum rewritten or otherwise distributed without the prior written authority of The Associated Press. All active hyperlinks have been inserted by AOL.

Bellator heavyweight champion Cole Konrad has been booked to face UFC and Strikeforce veteran Paul Buentello in a non-title "superfight" scheduled for Bellator 42 on April 23 in Concho, RIFT Platinum Okla.

Konrad, who made his MMA debut in 2010 and finished the year with a perfect record of 7-0, rift gold ran through Rogent Lloret, Damian Grabowski and Neil Grove during last season's Bellator tournament to win the heavyweight belt. RIFT Platinum At 27 years of age, Konrad remains a prospect in MMA off his accomplishments as a two-time NCAA wrestling champion with the University of Minnesota.

Buentello (29-13)'s last televised fight was a knockout loss to Tim Sylvia last August on pay-per-view. Rift Gold In December, Buentello bounced back with a decision over Kerry Schall at a show in the Dominican Republic.

Bellator 42 will also feature Richard Hale taking on D.J. Linderman and Tim Carpenter facing Christian M'Pumbu in the semifinals of the promotion's light heavyweight tournament

The Astros are off to a 0-4 start, and that coupled with preseason predictions of doom and gloom has already got some executives thinking about a Houston fire sale. RIFT Platinum With the lack of available arms on the market this season, one name that could make sense for other teams, according to ESPN's Jayson Stark, Rift Gold is Astros LHP Wandy Rodriguez.

Two early names the same exec nominates as potential pitching targets, just based on the probabilities their teams will be selling by July: Wandy Rodriguez and Mike Pelfrey.

Of course, this ignores a few facets of reality. One of which is that the Astros just signed Rodriguez to a long-term extension before the season. Even if Houston did change course and want to trade him, they've effectively lowered his trade value by attaching him to the 3 year/$34 million contract. rift gold Then there's the fact that Rodriguez got off to a terrible start last season and didn't look good in his first start of this year either, so if that continues, his trade value will only further erode.

It's an idea with a decent amount of sentiment behind it: the Astros probably should be looking to trade Rodriguez given where their club is positioned. RIFT Platinum But they have been bucking conventional wisdom for quite awhile now, and it's pretty unlikely that they'd give Rodriguez a new contract just to trade him five months later.

What did you do in school today?" "Who did you play with at recess?" "Did you see that article in the newspaper?" Eating together as a family is one of those things that doesn't seem like such a big deal. But it can make a big difference for your kids in terms of self-image, sense of security, self-esteem and overall sense of happiness. "Regular family meals are probably the best psychological 'daily vitamin' parents can give their children," says Carleton Kendrick, a family therapist in Millis, Mass., and author of "Take Out Your Nose Ring, Honey, We're Going to Grandma's." "They're far more powerful in the long and short term than you might think they are."

That's because family meals make kids feel good, especially when you focus on keeping the conversation positive. "Dinner can be a wonderful time to hear about everyone's day or anything else your kids want to talk about that you don't usually take the time to discuss," says Vicki Panaccione, Ph.D., founder of the Better Parenting Institute in Melbourne, Fla. It also gives kids the chance to be themselves and share their opinions within the safe confines of home, without risking the rejection of their peers. And even toddlers can begin to feel like a valued contributing member of their family when they scoot their chair up to the dinner table and start to chime in. While the peas are being passed, the open forum gives your kids the opportunity to learn about your family's history and your past -- for example, the time when you got sent to the principal because you threw peas in the lunch room. Mom threw peas?! Who knew?

It's no wonder that family meals are associated with lower teenage pregnancy rates, higher grade point averages, fewer eating disorders in teens and lower risk of depression. Moreover,rift gold the psychological benefits go both ways. A recent telephone survey of 2,008 Americans sponsored by Barilla found that adults who eat with their kids regularly with few distractions (no TV or phone) report higher overall life satisfaction. "Family meals pay off for adults and children," says William J. Doherty, Ph.D., professor of family social science at the University of Minnesota in St. Paul, who helped Barilla analyze the survey results. It's a ritual none of us really ever outgrow. The key is to start the meal tradition when your kids are young, then keep it up. "When you get your kids into the habit of family dinners, they'll keep doing it when they get older and become more independent," Doherty says. In other words, when they morph into eye-rolling teenagers.

To keep everyone coming back for more, turn off the TV and cell phone and up the fun factor.rift gold We asked moms across the U.S. to share the unique ways in which they make meals memorable and festive for the whole family.

We have picnics on the dining room floor.
"Every now and then, my family of seven eats dinner on the floor. We spread out a tablecloth or picnic blanket and eat something on the ground that's really a drag to clean up, like the rice in burritos or Chinese food. My kids think sitting on the floor is weird and fun, RIFT Platinum and even funnier that my husband and I are doing it, too. I notice that when we eat on the floor, my kids don't complain as much about the food and they can't jockey for seats or get up and wander around like they sometimes do. It breaks us out of a rut."
--Michelle Nicholasen, Somerville, Mass.

We have DIY dinners.
"At least once a week, I'll put out all the parts of the dinner separately and have my husband and son make their own version of whatever it is we're having. With taco night, for example, I'll put out corn tortillas, refried beans, Spanish rice, shredded lettuce, chopped tomatoes, cheese, salsa, meat, and cheese. My husband and son love it because they can make their own taco combos and I love it because I don't have to be the one to do all the work. Build-a-dinner works great with pasta, burritos, pizza and even dessert with company such as a make-your-own sundae bar."
--Jill Houk, Chicago

We have table talkers.
"We have a 'talk about it' bowl, an actual bowl that my kids and my husband and I can fill with conversation starters, such as an article we've seen, a photo we've ripped out of a magazine, or an object, like a funny sticker, to later talk about at the table. Rift GoldIf no one puts something in the bowl, I have a list of questions I've typed up and folded up like Chinese fortunes that are meant to stir conversation, such as: What actor/actresses would play you in the movie of your life and why? What's the funniest story you know about yourself as a baby? If you could change your name, what would it be? What activities would fit into your perfect day? Would you be willing to have nightmares every night for a year if you could be rewarded with extraordinary wealth? If you could have one superpower, what would you choose? The questions have changed as my girls, who are now teenagers, have gotten older. But over the years, we've found out some interesting stuff about each other. This game is even more fun to do with guests."
--Jeanne Muchnick, Larchmont, New York

We light candles every night.
"Eating by candlelight makes the dinner seem special and gets my three kids to slow down, have a conversation, and linger at the table to share stories from the day long after the food is gone."
--Pamela MacPhee, Encinitas, Calif.

My husband and sons do the cooking.
"Every Tuesday night, my husband and two sons plan dinner and prepare it. I love it because I have a night off, plus it's a great way for the kids to learn to cook."
Padi Selwyn
Sebastopol, Calif.

We have storybook dinners.
"When my 6-year-old son, Franklin, gets interested in a character or a historical happening, I create a meal around it. For example,RIFT Platinum he's been watching a DVD of an Australian storybook in which the characters eat pavlova (a meringue-based dessert with strawberries or kiwi) and lamington (sponge cake dipped in chocolate), so we found recipes for these desserts and made them for a little Aussie dinner party, along with shrimp on the barbie. If we center dinner around a theme, it's no problem to get everyone excited about it."
--Elura Nanos Kish, Cherry Hill, N.J.

I fix lots of finger foods.
"My boys love to dip and dunk so I often serve finger foods such as wings, ribs, celery stuffed with light cream cheese and Greek yogurt, and carrot sticks. rift gold I also fill a compartmentalized appetizer tray with sliced cucumbers, sliced peppers, pieces of strong cheese, nuts, olives, crackers, and sliced whole-grain breads along with Greek yogurt, hummus, tzatziki, even applesauce. They love to play with the combinations."
--Georgia Orcutt, Boston

My kids help make dinner an event.
"My girls, ages 8, 6, and 3, help me plan our meals for the week. They'll write the grocery list for me, drawing items if they can't spell them. Then they'll carry the list through the grocery store and check off items as we find them. I think my girls have more fun with dinner because they're included in the process. RIFT Platinum They've planned entirely green dinners--pesto chicken, broccoli, honeydew melon, and a salad. We've also had princess night in which everyone comes in costume and dinner is served on our good china."
--Christine Bolzan, Boxford, Mass.