How Medicaid Programs are Combating Antibiotic-Resistant Bacteria

Antibiotic resistance is a growing cause of concern in the United States and is attributed to the misuse of antibiotics. To address this, the Centers of Disease Control (CDC) has enacted the Get Smart campaign for Medicaid programs in all states, including New York, to ensure that antibiotics are administered only when they are absolutely necessary and used as prescribed. This program will not only combat levels of antibiotic-resistant bacteria, which are fueled by ineffective antibiotic treatments, but also improve the well being of all Medicaid patients.

According to 2013 Medicaid claims data, 55 percent of provider visits across 11 New York counties resulted in antibiotics being prescribed for upper respiratory conditions despite that the drugs are considered to be ineffective against such viral diseases. Some providers had attributed the high prescription rate to the pressure placed on them by their patients who would in turn deliver poor satisfaction reviews if denied the medication.

The New York Department of Health (DOH) collaborated with the CDC to address the issue by educating the Medicaid providers on illness circumstances in which antibiotics do not have to be prescribed. Antibiotics are inefficient as treatment in instances of cold and runny nose, bronchitis or chest colds (in otherwise healthy adults and children), flu, sore throat (except strep) and fluid in the middle ear (otitis media with effusion).

New York Medicaid’s efforts follow the White House’s action plan to combat antibiotic-resistant bacteria. The CDC estimates that drug-resistant bacteria cause two million illnesses and approximately 23,000 deaths each year in the United States alone.

According to E Medicine Health, aside from the antibiotics not helping patients with viruses feel better, cure the illness or prevent others from catching the infection, they may also cause side effects such as nausea, diarrhea, stomach pain, allergic reactions or swelling of the large intestine or colon.

Medicaid is a federally-funded program run by the state and the county, which provides medical insurance and long-term care for middle-to low-income persons, including the elderly and disabled. P&P Medicaid Consulting Inc., specializes in preparing applications for Medicaid eligibility, guiding you through the document-acquiring process and will appear on your behalf at all interviews with the Department of Social Services (Medicaid).

If you are interested in learning more about applying for Medicaid or any of our addition services, call (516) 541-4770 or visit

Long Island Medicaid Reborn During Its Golden Anniversary

In the midst of Medicaid reaching its 50-year milestone in July, New York is hosting its own renaissance for the federal-state health insurance program. Transformation ignited in 2011 when Governor Andrew Cuomo created a Medicaid Redesign Team and began passing policies to slow annual spending growth.

Why was Medicaid chosen as the golden goose? According to 2006 New York State Spending Budget, Medicaid accounts for 37 percent of the overall budge at a whopping $57 billion. Under Cuomo, New York has a plan to invest $9 billion to implement a Medicare rebirth in the form of its Delivery System Reform Incentive Payment program.

New York aims to utilize the Delivery System Reform Incentive Payment program to spend less by delivering more care to Medicaid patients outside the hospital, keeping expensive emergency room costs down. The goal stands at a 25 percent reduction in avoidable hospital use over five years.

Major reforms will change the way healthcare providers are paid. According to the Centers for Medicare and Medicaid services (CMS), instead of being paid based on the number of services or tests conducted, Medicaid healthcare professionals will increasingly be paid based on the quality of work they do and how well it helps their patients.

Additionally, New York will implement 25 new delivery networks called preforming provider system (PPS) to coordinate Medicaid patient care. This system targets the issue that enrollees are going to multiple doctors and receiving duplicate or ineffective treatment.