Healthcare Program
The USA federal government has presently elaborated and introduced many programs that ensure the access of low-income families and different social classes, irrespective of their ethnic affiliation, to high-quality care services. In this regard, being at the forefront of healthcare delivery, nurses play an integral role in achieving established objectives and anticipated outcomes stipulated by a particular program. Moreover, they are regarded as essential stakeholders that help researchers and designers develop, adjust, and improve healthcare policies by providing valuable feedback concerning current requirements and issues. Thus, this paper aims at discussing the nurse’s role in designing and implementing the Children’s Health Insurance Program (CHIP) and determining the members of a healthcare team most needed to implement it.
The Description of CHIP
CHIP is the program that delivers low-cost health coverage to children aged 18 from poor and near-poor families with income both not enough for private insurance and too high to qualify for Medicaid. The program was administered by the US Department of Health and Human Services through Medicaid and signed into law in 1997 as part of the Balanced Budget Act (“Program history,” n.d.) The CHIP operates as a block program in the states possessing the right to implement these programs as separate programs, as Medicaid expansions, or as composite programs. Due to this reason, CHIP benefits differ in each state. However, all states ensure full coverage, including doctor visits, prescriptions, routine check-ups, inpatient and outpatient hospital care, emergency services, dental and vision care, immunizations, and laboratory and x-ray services (“The Children’s Health Insurance Program,” n.d.). In addition, the insurance suggests affordable care for Americans with substance use and mental health disorders, forbidding discriminatory practices that restrict the coverage for behavioral health services and treatment.
Concerning health service costs, regular visits to the doctor and dentist for a healthy child are free under the CHIP program. Nevertheless, some states charge copayments for other services and a monthly fee or premiums for CHIP coverage, accounting for no more than 5 percent of the family’s income for the year (“The Children’s Health Insurance Program,” n.d.). Besides, premiums cannot exceed the sum provided by Medicaid for families with earnings of 150 percent or less Federal Poverty Level (FPL) (“CHIP Cost Sharing,” n.d.).
Target Population
As has been indicated above, CHIP is intended for children aged under 19, residing in destitute families with income that does not allow them to receive private insurance and fall under the Medicaid category. The additional eligibility requirements for CHIP assume that an individual should be a resident of a particular state or meet immigration requisites. Children who are patients of a psychiatric institution, inmates of a public institution, and who obtain health coverage under a state health insurance program are not eligible for CHIP. Besides, specific CHIP eligibility levels vary by state and range from 170 percent to 400 percent FPL (“Eligibility,” n.d.). As of the 2018 fiscal year, almost 46 million children were ever enrolled in Medicaid and CHIP, from which 9,6 million children were recorded in CHIP (“Reports & Evaluations,” n.d.). In some states, the CHIP coverage expands for adults, namely pregnant women and parents of children enjoying benefits from both Medicaid and SCHIP. In this respect, states can allow insurance that includes prenatal, delivery, and postpartum care for low-income non-insured pregnant women.
The Nurse’s Role in the Design of Healthcare Program
Nurses belong to the primary contributors to the healthcare program design since they are probably the most aware and experienced among healthcare providers regarding the patients’ demands due to their direct interaction with them. Therefore, they can give practical suggestions while developing healthcare programs in collaboration with other health professionals and senior members of the medical hierarchy. For instance, nurses can provide information about nurse staffing and training problems since this factor significantly influences the program’s outcomes. For example, the study by Neves et al. (2020) concluded that adequate nursing care quality and safety require an appropriate nurse staffing level, both in competency and number aspects. Furthermore, nurses can inform the researchers and policymakers about the primary children’s needs and administrative issues that hinder easy access to the program.
An Advocate for the Target Population
While caring for children, nurses gain a holistic picture of a child’s health-related information and domestic setting and issues that need urgent consideration. The nurse should represent and advocate for the best patient’s interests to support the patient’s dignity throughout treatment and care. For example, nurses can provide recommendations concerning the range of the principal services for children from low-income families, which the program should provide. In this regard, the program can expand the number of affordable services that the insurance cover and that are of the highest need for children. Moreover, the suggestions can be connected with protecting patients from discriminatory practices and increasing access to health care.
The Implementation of the Healthcare Program
Implementing the healthcare program is an essential part of the nursing workflow. First of all, a nurse should provide understandable clarification of different CHIP-related issues the patients face while attempting to access the program. In particular, in case of need, a patient should be informed about eligibility requirements and program benefits, rights, and cost comprehensively. In addition, the active involvement of a nurse in teamwork also promotes the successful realization of the program. In this regard, nurses should facilitate exchanging useful information regarding patients’ needs and regulatory legal norms. Overall, nurses help the management integrate changes intended by the CHIP in the healthcare system in terms of care access and quality. The difference between design and implementation processes is that the former requires nurses to gather and provide relevant patient-related data, while the latter assumes taking personal responsibility for conveying the program’s objectives to reality.
The Members of the Healthcare Team
The first group of critical stakeholders includes nurses, physicians, and allied health staff since the program’s success depends on input information obtained from clinicians during the planning process. Another stakeholder is office staff and managers because they are accountable for collecting billing, contact, and demographic data of all the patients and providing it to vendors. Moreover, they deliver information about potential threats and improvements that relate to the plan. The third stakeholder is the administration or board members since they may perform a central role in developing a valid application strategy. Besides, they make financial and operational decisions concerning the program project.
In conclusion, the paper has outlined the nurse’s role in designing and implementing the Children’s Health Insurance Program (CHIP) and identified the members of a healthcare team most relevant to the program application. In particular, nurses can give practical suggestions while developing healthcare programs in collaboration with other healthcare staff since they are at the forefront of healthcare delivery. Regarding the target population, nurses should represent and advocate for the best patient interests to support the patient’s dignity throughout treatment and care. In terms of implementation, the nurse’s role is in providing a clear explanation of different CHIP-related issues for patients and active participation in teamwork. Finally, the healthcare team may include nurses, physicians, allied health staff, office staff and managers, and the administration or board members.
References
CHIP cost sharing. (n.d.). Medicaid.gov.
Eligibility. (n.d.). Medicaid.gov.
Neves, T. M. A., Parreira, P. M. S. D., Graveto, J. M. G. N., Freitas, M. J. B. D. S. D., & Rodrigues, V. J. L. (2020). Nurse managers’ perceptions of nurse staffing and nursing care quality: A cross‐sectional study. Journal of Nursing Management, 28(3), 625-633.
Program history. (n.d.). Medicaid.gov.
Reports & Evaluations. (n.d.). Medicaid.gov.
The Children’s Health Insurance Program (CHIP). (n.d.). Healthcare.gov.