Chapter 15 Medicaid

Front 1

Medicaid Eligibility is limited to people who fall into what categories?

Back 1

Medically needy, categorically needy, and special groups

Front 2

What does Medicaid provide?

Back 2

Medical and health related services to individuals and families with low incomes

Front 3

Spousal Impoverishment Protection Legislation of 1989

Back 3

Prevents married couples from being required to spend down income and other liquid assets before one of the partners is declared eligible for nursing facility care coverage

Front 4

Medically necessary services are not performed for what?

Back 4

Convenience

Front 5

TANF

Back 5

Temporary Assistance to Needy Families

Front 6

When does Medicaid cut off?

Back 6

Immediately after the patient's 19th birthday.

Front 7

TANF makes cash assistance available for what circumstances?

Back 7

A parent's absence, death, incapacity and unemployment

Front 8

What was TANF previously known as?

Back 8

AFDC (Aid to Families with Dependent Children)

Front 9

SCHIP

Back 9

State Children's Health Insurance Plan

Front 10

SCHIP allows states to do what?

Back 10

Create or expand existing insurance programs and provides more federal funds to states to allow for the purpose of expanding Medicaid eligibility to include a greater number of children who are currently uninsured

Front 11

What is Medi-Cal?

Back 11

California's equivalent to Medicaid

Front 12

When did Medicaid begin?

Back 12

1965

Front 13

What does the Surveillance Utilization Review System do?

Back 13

It safeguards against unnecessary or inappropriate use of Medicaid services or excess payments and assesses the quality of those services

Front 14

States are required to provide Medicaid to whom?

Back 14

People who receive federally assisted income maintenance payments

Front 15

Preauthorization guidelines include what?

Back 15

Elective patient admission

Front 16

States may require what for the services performed?

Back 16

Coinsurance, copayments and deductibles

Front 17

When services can be covered by both Medicaid and Medicare, which goes first?

Back 17

Medicare first and Medicaid pays the difference

Front 18

In many cases, Medicaid eligibility depends on what?

Back 18

The patient's monthly income

Front 19

Medicaid is jointly funded by what?

Back 19

State and federal governments

Front 20

Each states administers its own Medicaid programs, but who monitors them?

Back 20

CMS

Front 21

Categorically needy Medicaid eligibility groups are not necessarily entitled to what?

Back 21

Nursing services for individuals under the age of 21

Front 22

The BBA allows states to provide how many months of continuous Medicaid?

Back 22

12

Front 23

Medicaid operates under what kind of payment system?

Back 23

Vendor and fee for service

Front 24

Medicaid covered services must be recognized as what?

Back 24

The prevailing standard and consistent with generally accepted professional medical standards of the provider's peer group

Front 25

Providers receive reimbursement from Medicaid on what kind of basis?

Back 25

Lump sum basis - several claims are paid at one time

Front 26

Retroactive eligibility is sometimes granted to patients who had what?

Back 26

High medical expenses before filing for Medicaid

Front 27

Emergency and family planning services are exempt from what?

Back 27

Copayments

Front 28

There is a limit on the amount that a non contract provider, physician or other entity can what kind of participant?

Back 28

PACE

Front 29

Medicaid Eligibility Verification System

Back 29

Allows providers to electronically access the states eligibility file

Front 30

States must provide home health services to who?

Back 30

Beneficiaries who are entitled to receive nursing facility services

Front 31

Federal Medical Assistance Percentage

Back 31

The portion of the Medicaid program paid by the federal government.

Front 32

Dual Eligible

Back 32

Refers to individuals to Medicare and eligible for some type of Medicaid services

Front 33

The federal government reimburses what percentage of costs of services provided through facilities of the Indian Health service?

Back 33

100%

Front 34

EPSDT

Back 34

Routine pediatric checkups for all children enrolled in Medicaid

Front 35

Mother/baby claim

Back 35

Refers to services provided to a baby under the mother's ID number

Front 36

PACE

Back 36

Alternative care for people 55 or older who require nursing facility level care

Front 37

Community spouse

Back 37

spouse who is not in a nursing home

Front 38

Voided claim

Back 38

a deduction is taken from the lump-sum payment made to provider

Front 39

Medicaid Remittance Advice

Back 39

Shows current status of all claims

Front 40

MCCA

Back 40

Prevents married couples from being required to spend down