02: Medicaid and Medicare Flashcards
What are the four modes of payment for healthcare payment and reimbursement?
- Out of pocket
- Idividual private insurance
- Employment-based group private insurance
- Government financing
Which of the following is NOT a government financing option?
A. Medicaid
B. Medicare
C. ACA Exchanges
D. Veteran’s Administration
C
Title XVIII of the Social Security Act of 1965…
A. Decreased penalty for not buying insurance
B. Established a program to provide medical services for people receiving cash assistance or welfare
C. Increased Medicaid reimbursement
D. Allowed dependents to be on parents’ insurance until age 26
B
This program was called MEDICAID!
Medicaid expanded over time to include/cover all but which of the following?
A. Infants and children
B. Poor adults without dependents
C. Pregnant women
D. Individuals with mental or physical disabilities
B
One of the greatest assets of the Balanced Budget Act of 1997 was the establishment of:
A. Children’s Health Insurance Program (CHIP)
B. Medicaid
C. ACA Exchanges
D. None of the above
A
True or false: CHIP provides coverage for US citizen children only up to age 19 who are not eligible for Medicaid.
False
Includes immigrant children as well.
Which of the following is a role of Medicaid and CHIP?
A. Filling large gaps in health insurance coverage
B. Assistance to Medicare beneficiaries
C. Long-term services and support (LTSS)
D. Safety net
E. A and C
F. All of the above
F
The Healthcare and Education Reconciliation Act amended the original Patient Protection and Affordable Care Act of 2010. Which of the following is FALSE about this act?
A. Increased penalty for not buying health insurance
B. Increased Medicaid reimbursement
C. Provided more generous subsidies to low-income groups
D. Penalized companies of 50+ employees that did not offer health insurance
A
The penalty for not buying health insurance was DECREASED.
Title 1 federally prohibits denying coverage based on pre-existing conditions, dropping coverage if a patient falls ill, and extends dependent coverage to age 26.
What Act is Title 1 a part of?
A. Social Security Act
B. CHIP
C. Affordable Care Act
C
True or false: Title 2 of the Affordable Care Act prohibits denying coverage based on pre-existing conditions, dropping coverage if a patient falls ill, extends dependent coverage to age 26, and provides tax subsidies to individuals up to 400% of the federal poverty level.
False
What is described is Title 1. Title 2 refers to the Medicaid expansion to 138% of poverty level and simplified CHIP enrollment.
Who was left out of Medicaid coverage AFTER reform?
A. All adults above 100% federal poverty level
B. Adults without dependent children
C. Those who lost coverage during renewal time
D. Undocumented immigrants (less than 5 years)
D
True or false: The federal government matches at least 50 percent of Medicaid per state.
True
It is based on each states capita income.
True or false: While Medicaid is offered in every state, it is voluntary.
True
True or false: Medicaid is a government-run healthcare delivery system.
False
States pay physicians, hospitals and other providers for Medicare beneficiaries.
Medicaid offers 4 ways to manage costs. Which of the following is not a way Medicaid conserves costs?
A. Fee-for-service (FFS)
B. Managed Care Organization (MCO)
C. Primary Care Case Management (PCCM)
D. Prepaid Health Plan (PHP)
E. Managed Long-Term Services and Supports (MLTSS)
A
The following describes which Medicaid cost conservation program?
Capitation based; states pay a premium per person in exchange for comprehensive benefits.
A. Managed Long-Term Services and Supports (MLTSS)
B. Managed Care Organization (MCO)
C. Primary Care Case Management (PCCM)
D. Prepaid Health Plan (PHP)
B
The following describes which Medicaid cost conservation program?
A Medicaid-managed care program covering institutionalization, home care, and community-based long-term care.
A. Managed Long-Term Services and Supports (MLTSS)
B. Managed Care Organization (MCO)
C. Primary Care Case Management (PCCM)
D. Prepaid Health Plan (PHP)
A
The following describes which Medicaid cost conservation program?
A non-comprehensive Medicaid program that pays for certain services only; generally either outpatient (PAHP) or inpatient (PIHP)
A. Managed Long-Term Services and Supports (MLTSS)
B. Managed Care Organization (MCO)
C. Primary Care Case Management (PCCM)
D. Prepaid Health Plan (PHP)
D
The following describes which Medicaid cost conservation program?
States pay primary care physicians to help provide case management services. A small monthly case management fee and sometimes fee-for-service is paid.
A. Managed Long-Term Services and Supports (MLTSS)
B. Managed Care Organization (MCO)
C. Primary Care Case Management (PCCM)
D. Prepaid Health Plan (PHP)
C
All but which of the following are covered under Medicaid?
A. Labs
B. Transportation
C. Family planning services and supplies
D. Hospice services
D
True or false: Medicaid covers compression garments for lymphedema.
True
True or false: Medicaid does not cover durable medical equipment while Medicare does.
False
Medicaid DOES not cover durable medical equipment while Medicare does NOT.
Enrollment in Medicaid does NOT depend on:
A. Poverty rates/income
B. Age
C. Strength of the state’s economy
D. Medical price inflation
B
Medicaid Section 1115 demonstration waivers allows…
A. States to exclude mental health benefits
B. States to require fee-for-service
C. States to test new approaches in Medicaid
D. States to defund CHIP
C