3 MEDICAID & OTHER PUBLIC PROGRAMS

Question 1

WHAT IS MEDICAID?

Answer 1

Medicaid is the joint federal and state program that helps cover healthcare costs for some people with limited income and resources.

Eligibility requirements can vary state by state but generally depend on income, family size, disability, family status, and other factors.

Question 2

The Medicaid program is structured to provide healthcare to specific populations within the United State. Among these populations are low-income adults, children, and certain people with disabilities. In terms of eligibility for Medicaid services, the following statements are true:

Answer 2

1. Some low-income adults, pregnant women, elderly adults, and people with disabilities may be eligible for Medicaid.
2. Eligibility rules vary from state to state, and each state has the power to expand its Medicaid program beyond the federal minimum standard.
3. Some states have chosen to expand their Medicaid programs to cover all adults with income below a certain level.
4. Children who ae not U.S. citizens can, indeed, be eligible for Medicaid services. While eligibility rules vary from state to state, it is a misconception that non-citizen children are universally ineligible. In fact, certain lawful resident immigrant children and pregnant women can qualify for Medicaid, even if they haven’t been in the country for five years, the usual waiting period.

Question 3

Medicaid’s financing model is a jointly funded partnership between federal and state governments, with each state administering its own Medicaid program. The following statement is true:

Answer 3

The Federal Medical Assistance Percentage (FMAP) is variable and changes based on the per capita income of each state.

Explanation:

Medicaid’s funding is a joint effort between the federal government and states. The Federal Medical Assistance Percentage (FMAP) is variable and does adjust based on a state’s per capita income. Therefore, wealthier states receive a smaller percentage in federal funds, while poorer state receive a higher percentage.

Question 4

The Patient Protection and Affordable Care Act (ACA) had significant implications for Medicaid, which included the opportunity for states to expand Medicaid coverage. The following statement are true:

Answer 4

1. The federal government initially covered 100% of the costs of Medicaid expansion.
2. As of 2020, 39 states including DC had adopted the Medicaid expansion.
3. Medicaid expansion under the ACA aims to cover more low-income adults.

Explanation:

While it’s true that the federal government initially covered 100% of the costs of Medicaid expansion, this rate has not remained constant. Starting from 2017, the federal match rate gradually decreased, reaching 90% in 2020 and staying at that level thereafter.

Question 5

Medicaid services can vary significantly from state to state. Nevertheless, certain services are mandated by federal law and must be provided by all state. What are federally mandated Medicaid services?

Answer 5

1. Inpatient hospital services
2. Nursing Facility services for individuals aged 21 or older
3. Early and Periodic Screening Diagnostic, and Treatment (EPSDT) service for individuals under the age of 21.

Explanation:

While many states do cover occupational therapy under their Medicaid programs, it is not a federally mandate service. In contrast, inpatient hospital services, nursing facility services for individuals aged 21 or older, and EPSDT services for individuals under 21 are all services that are mandated by federal law and must be provided by all states.

Question 6

Over the years, Medicaid has evolved to meet the needs of the populations it serves. Managed care is a healthcare delivery system used by Medicaid to control costs, utilization, and quality. What statement accurately describes Medicaid managed care?

Answer 6

Answer: In a managed care arrangement, Medicaid pays a capitated fee per member to a managed care organization (MCO) to deliver a set of services.

Explanation:

Managed care is an approach used by Medicaid where the program pays a capitated, or per-member per-month (PMPM), fee to Managed Care Organizations (MCOs) to deliver a range of services. This is an accurate description of how managed care works in Medicaid. Managed care arrangements can be complex, but they typically involve an arrangement where the state pays a certain amount to an MCO for each individual enrolled in the MCO’s plan, and the MCO then provides a defined set of services to those enrollees.

Question 7

Sandra, a 45-year-old woman, is applying for Medicaid. She’s a U.S. citizen, resides in a state that expanded Medicaid under the Affordable Care Act, and her income is just above 138% of the Federal Poverty Level. Although she’s unemployed, she received a severance package from her previous job six month ago. Additionally, she does not have any dependents or disabilities. Considering these factors, would Sandra be eligible for Medicaid under current guidelines?

Answer 7

Answer: No, she is not eligible because her income exceeds 138% of the Federal Poverty Level.

Explanation:

Medicaid eligibility is determined on a state-by-state basis and it varies widely. However, under the Affordable Care Act, states that expanded Medicaid are required to provide coverage to people with incomes up to 138% of the Federal Poverty Level. As Sandra’s income is just above this threshold, she would not be eligible for Medicaid in her state.

Question 8

John, a 60-year-old legal permanent resident, migrated to the United States three years ago. He is currently unemployed and his income falls below the Federal Poverty Level. Given his status and financial situation, what statement about John’s Medicaid eligibility is correct?

Answer 8

Answer: John is not eligible for Medicaid because he hasn’t been living in the United States for at least five years.

Explanation:

Generally, Medicaid coverage is available to legal permanent residents only if they have lived in the U.S. for at least five years. Since John has only been in the country for three years, he would not yet be eligible for Medicaid.

Question 9

Jessica, a pregnant woman, recently immigrated to the United States and has an income below the Federal Poverty Level. In her state of residence, Medicaid provides coverage for low-income pregnant women. Is Jessica eligible for Medicaid coverage?

Answer 9

Answer: Yes, because Medicaid provides coverage for low-income pregnant women.

Explanation:

Although Medicaid eligibility generally requires five years of residency in the United States for immigrants, there is an exception for pregnant women. In many states, Medicaid provides coverage for low-income pregnant women, regardless of their immigration status. Therefore, Jessica would be eligible for Medicaid coverage.

Question 10

Louis, a 19-year-old college student, was recently diagnosed with a disability. His income is above the Federal Poverty Level due to a part-time job, but his medical expenses are high. Considering these factors, what is the most likely outcome for Louis’s Medicaid eligibility?

Answer 10

Answer: Louis is eligible because his medical expenses could be deducted from his income, potentially bringing him below the income eligibility limit.

Explanation:

Medicaid often considers not just gross income, but also factors in certain deductions when determining eligibility. For individuals with high medical expenses, like Louis, these costs can sometimes be subtracted from income - a process known as “spend down.” This could potentially bring Louis’s counted income below the Medicaid eligibility threshold, even if his gross income is above the Federal Poverty Level.

Question 11

Cindy is a 32-year-old woman who lives in a state that didn’t expand Medicaid. Her income is at 90% of the Federal Poverty Level and she does not have any disabilities or dependents. What statement accurately describes Cindy’s Medicaid eligibility status?

Answer 11

Answer: Cindy is not eligible for Medicaid because her income is below the Federal Poverty Level.

Explanation:

For states that did not expand Medicaid under the Affordable Care Act, the eligibility requirements are often more stringent, and they do not necessarily cover all adults under the Federal Poverty Level. Since Cindy’s state did not expand Medicaid, and she doesn’t have any specific circumstances like disability or dependents that could qualify her for Medicaid, she is unlikely to be eligible.

Question 12

Marjorie, an 80-year-old woman, recently qualified for Medicaid. She has been dealing with chronic heart disease and requires frequent medical appointments, including cardiology consultations, medication, and routine lab tests. In addition, she requires non-medical home care services due to her mobility issues. Considering the usual Medicaid coverage, which services is least likely to be covered for Marjorie?

Answer 12

Answer: Non-medical home care services such as assistance with bathing, dressing, and meal preparation is least likely to be covered for Marjorie.

Explanation: Medicaid covers a wide range of services, including doctor visits, lab tests, and prescription medications. However, coverage for non-medical home care services can vary significantly from state to state. While some state’s Medicaid programs may cover these services, particularly for individuals with serious health conditions or disabilities, it’s not as consistently covered as medical services like consultations, medications, and lab tests.

Question 13

Sam, a 5-year-old boy, is enrolled in Medicaid under his state’s CHIP program. He’s due for a dental check-up and his parents are unsure if this is covered. According to federal Medicaid regulations, which statement about Sam’s dental coverage is accurate?

Answer 13

Answer: All states are required to provide comprehensive dental services for children under Medicaid.

Explanation:

Under federal Medicaid regulations, all states are required to provide comprehensive dental services for children enrolled in Medicaid. This is part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, which ensures that children under the age of 21 receive appropriate preventive, dental, mental health, developmental, and specialty services.

Question 14

Jamie, a 30-year-old woman, has recently qualified for Medicaid. She has been experiencing mental health issues and wishes to seek therapy. In considering her Medicaid benefits, which statement accurately represents the coverage of mental health services?

Answer 14

Answer: Medicaid typically covers both inpatient and outpatient mental health services.

Explanation:

Medicaid is the single largest payer for mental health services in the United States. It typically covers a broad range of mental health services, including both inpatient and outpatient services. This can include therapy, counseling, medication management, social work services, peer supports, and crisis intervention services.

Question 15

Ann, a 25-year-old woman with a disability, recently qualified for Medicaid. She requires a wheelchair for mobility. Taking into account the common benefits provided by Medicaid, which statement about coverage for her wheelchair is correct?

Answer 15

Answer: Medicaid coverage for durable medical equipment varies by state.

Explanation:

Medicaid does cover durable medical equipment, which includes wheelchairs. However, the specific coverage details can vary significantly by state. Each state’s Medicaid program may have different guidelines about what types of equipment are covered, under what circumstances, and what extent.

Question 16

Martha, a 50-year-old woman, has just enrolled in Medicaid. She has a history of smoking and wants to participate in a smoking cessation program. The following statement accurately describes Medicaid’s coverage of smoking cessation programs:

Answer 16

Medicaid coverage for smoking cessation programs varies by state and may include certain limitations.

Explanation:

Medicaid coverage for smoking cessation programs can vary by state. While many state Medicaid programs do cover these services, the extent and specific details of the coverage can differ. Some states might only cover certain types of treatment, may have limitations on the duration of coverage, or may require cost-sharing. Therefore, it’s important to verify the specific details with each state’s Medicaid program.

Question 17

Thomas, a 50-year-old man, has recently qualified for Medicaid due to his low income. He is generally healthy and only requires an annual check-up and occasional prescription medication. Considering his circumstances, what is most likely to be true about his costs under Medicaid?

Answer 17

Answer: Thomas may face some minimal out-of-pocket costs, but they will likely be limited due to his low income and the nature of his medical needs.

Explanation:

While Medicaid is designed to provide medical coverage to low-income individuals, it does not always cover 100% of all medical costs. Enrollees might be responsible for minimal out-of-pocket costs, such as small co-pays for certain services or medications. However, these costs are typically limited, particularly for individuals with very low incomes or limited medical needs.

Question 18

Rachel, a 60-year-old woman, is on Medicaid and requires regular medical services due to her chronic illness. She recently received a bill for her portion of the cost of these services. What does this charge represent?

Answer 18

Answer: The charge represents a copayment for the medical services she has received.

Explanation:

Medicaid programs often include nominal copayments for some services. Copayments are a form of cost-sharing where the beneficiary pays small fixed amount for a service. If Rachel is seeing charges after receiving medical services, it is most likely that these charges represent copayments for those services.

Question 19

Jacob, a 35-year-old man, recently lost his job and his income is now below the Federal Poverty Level. He is considering applying for Medicaid but is concerned about potential costs. What statement correctly addresses Jacob’s concern about costs associated with Medicaid?

Answer 19

Answer: Jacob may be responsible for minimal copayments for some services, but he is unlikely to face high costs due to his low income.

Explanation:

Medicaid is a program specifically designed to assist individuals with low income, and as a result, it generally minimizes out-of-pocket costs for beneficiaries. While some Medicaid programs may include nominal copayments for certain services, these are typically quite low, especially for those with very low incomes. Therefore, while Jacob might be responsible for some small costs, they are likely to be very limited.

Question 20

Hannah, a 40-year-old single mother, is enrolled in Medicaid. She frequently visits the doctor due to a chronic health condition. Which of the following is the most likely cost that Hannah would insure for her healthcare service?

Answer 20

Answer: Cost-sharing in the form of copayments.

Explanation:

While Medicaid offers comprehensive coverage for many healthcare services, beneficiaries may still be responsible for some forms of cost-sharing. This often takes the form of nominal copayments for certain services. Given Hannah’s frequent doctor visits, it’s likely that she might have to pay small copayments for her visits or related treatments.

Question 21

Peter, a 70-year-old man, is covered by both Medicare and Medicaid. He often needs to see specialists for his multiple chronic conditions. Considering the coordination of benefits between Medicare and Medicaid, what statement accurately represents Peter’s likely out-of-pocket costs?

Answer 21

Answer: Medicaid will cover Peter’s Medicare premiums, deductibles, and copayments, leaving him with minimal out-of-pocket costs.

Explanation:

For individuals who are covered by both Medicare and Medicaid, often referred to as dual eligibles, Medicaid can help cover the costs that are not fully covered by Medicare. This includes Medicare premiums, deductibles, and copayments. Therefore, it’s likely that Peter will have minimal out-of-pocket costs for his healthcare services, as Medicaid will cover most of the costs that Medicare does not.

Question 22

Sarah, a Medicaid beneficiary, recently moved from a state that uses a Fee-For-Service model to one that employs a Managed Care model. In considering this transition, which of the following changes is Sara most likely to experience?

Answer 22

Answer: Sarah will now be limited to a specific network of healthcare providers.

Explanation:

One of the key features of Medicaid Managed Care is the use of provider networks. In a Managed Care model, beneficiaries typically choose or are assigned a primary care provider from within the plan’s network and may need to get referrals to see specialists. This is different from the Fee-For-Service model where beneficiaries can generally see any provider who accepts Medicaid.

Question 23

Jack, a Medicaid beneficiary, has just been enrolled in a Managed Care plan. He is unsure of how this will affect his ability to access necessary healthcare services. How will Jack’s access to healthcare services will be managed under this plan?

Answer 23

Answer: D Jack will likely need to choose a primary care provider from within his plan’s network and may need referrals to see specialists.

Explanation:

In Medicaid Management Care plans, enrollees are generally required to select a primary care provider within the plan’s network. This provider serves as the enrollee’s main point of contact for healthcare services. They coordinate the enrollee’s care, which often includes providing referrals to see specialists. This model aims to manage care and ensure that beneficiaries receive appropriate and coordinated services.

Question 24

Alice, a 45-year-old woman, recently enrolled in a Medicaid Managed Care plan. She has been diagnosed with a rare condition that requires treatment from a specialist who is not in her plan’s network. What is the most likely course of action for Alic in this scenario?

Answer 24

Answer: Alice can seek an exception to see the specialist out-of-network due to her unique medical needs.

Explanation:

While Medicaid Managed Care plans generally require beneficiaries to use in-network providers, there are exceptions for unique circumstances. If a beneficiary has a medical need that cannot be met by in-network providers – such as a rare condition that requires a specialist not in the network – they can typically seek an exception to receive out-of-network care.

Question 25

Bob, a 55-yeaar-old man, is considering enrolling in a Medicaid Managed Care plan. However, he’s concerned about the quality of care under such plans. What best addresses Bob’s concerns?

Answer 25

Answer: Medicaid Managed Care plans must meet certain quality standards set by federal state regulations.

Explanation:

Medicaid Managed Care plans are required to adhere to quality standards set forth by federal and state regulations. These regulations aim to ensure that beneficiaries receive quality healthcare services. They cover various aspects of care, including adequacy of provider networks, accessibility of services, and quality of care measures. Therefore, Bob can be assured that the Managed Care plan he is considering must meet specific quality standards.

Question 26

Emily, a 35-year-old woman, recently switched from a Fee-For-Service Medicaid plan to a Managed Care plan. She is used to scheduling specialist appointments whenever she feels the need. Under her new Managed Care plan, which of the following is most likely to describe how Emily will access specialist care?

Answer 26

Answer: Emily will need to see her primary care provider, who can then provide a referral to a specialist if deemed necessary.

Explanation:

Under a Managed Care plan, primary care provider often act as “gatekeepers” to other services, such as specialist care. In most cases, beneficiaries need to first see their primary care provider, who can then assess the need for specialist care and provide a referral if necessary. This is a key feature of the Managed Care model, designed to ensure coordinated, appropriate care.

Question 27

The Children’s Health Insurance Program (CHIP) has been established as a federal-state partnership that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP also covers parents and pregnant women. The overarching goal of the program is to expand access to health insurance to children who would otherwise be uninsured. From the options listed below, which strategy has NOT been implemented to reach out to potential beneficiaries of CHIP?

Answer 27

Answer: Instituting automatic enrollments for all families that fall within certain income parameters, regardless of whether or not they have applied for CHIP.

Explanation:

The Children’s Health Insurance Program does not institute automatic enrollment for families that fall within a certain income bracket. Instead, the program requires eligible families to actively apply for benefits. This is because the program is not only income-based, but also depends on the specific circumstances of each family, including the number and age of children, and whether the parents have access to other forms of insurance.

Question 28

CHIP has been largely successful in reducing the number of uninsured children since its inception. While each state administers its own CHIP program, federal funding and oversight is necessary for its operation. How does the government determine the amount of CHIP funding allocated to each state?

Answer 28

Answer: The federal government considers the number of uninsured children in the state and the state’s overall economic status.

Explanation:

The federal government determines CHIP funding for each state based on the number of uninsured children and the state’s overall economic condition. While the population size and number of eligible children might factor into these considerations, they are not the sole determinants. There is also no uniform amount given to each state, meaning option B is incorrect.

Question 29

While CHIP provides substantial benefits for eligible families, it is not without its challenges and controversies. The following statements are true regarding the limitations or criticisms associated with CHIP?

Answer 29

1. Some critics argue that CHIP discourages private health insurance because it offers a more affordable alternative.
2. Critics argue that CHIP may not cover all of the health services that children require, such as specialized or experimental treatments.

Critics argue that CHIP’s funding is often unstable, leading to periods of uncertainty and potential gaps in coverage for enrolled children.

Explanation:

While CHIP has significantly reduced the number of uninsured children in the United States, it has not completely eliminated the issue. There are still children who remain uninsured for various reasons, including lack of awareness about the program, administrative barriers, or ineligibility due to income or immigration status.

Question 30

The Children’s Health Insurance Program Insurance Program (CHIP) has been established as a federal-state partnership that provides low-cost health coverage to chidden in families that earn too much money to qualify for Medicaid. In some states, CHIP also covers parents and pregnant women. The overarching goal of the program is to expand access to health insurance to children who would otherwise be uninsured. From the options listed below, which strategy has NOT been implemented to reach out to potential beneficiaries of CHIP?

Answer 30

Answer:
Instituting automatic enrollment for all families that fall within certain income parameters, regardless of whether or not they have applied for CHIP.

Explanation:

The Children’s Health Insurance Program does not institute automatic enrollment for families that fall within a certain income bracket. Instead, the program requires eligible families to actively apply for benefits. This is because the program is not only income-based, but also depends on the specific circumstances of each family, including the number and age of children, and whether the parents have access to other forms of insurance.

Question 31

CHIP has been largely successful in reducing the number of uninsured children since its inception. While each state administers its own CHIP program, federal funding and oversight is necessary for its operation. How does the federal government determine the amount of CHIP funding allocated to each state?

Answer 31

Answer:
The federal government considers the number of uninsured children in the state and the state’s overall economic status.

Explanation:

The federal government determines CHIP funding for each state based on the number of uninsured children and the state’s overall economic condition. While the population size and number of eligible children might factor into these considerations, they are not the sole determinants. These is also no uniform amount given to each state, .

Question 32

While CHIP provides substantial benefits for eligible families, it i not without its challenges and controversies. The following are true statements regarding the limitations or criticisms associated with CHIP:

Answer 32

1. Some critics argue that CHIP discourages private health insurance because it offers a more affordable alternative.
2. Critics argue that CHIP may not cover all of the health service that children require, such as specialized or experimental treatments.
3. Critics argue that CHIP’s funding is often unstable, leading to periods of uncertainty and potential gaps in coverage for enrolled children.

Explanation:

While CHIP has significantly reduced the number of uninsured children in the United States, it has not completely eliminated the issue. There are still children who remain uninsured for various reasons, including lack of awareness about the program, administrative barriers or ineligibility due to income or immigration status.

Question 33

One important aspect of CHIP is its eligibility criteria, which varies from state to state. However, some common criteria apply across all states. The following are standard eligibility criterion for a child to be enrolled in CHIP:

Answer 33

1. The child must be a U.S. citizen, U.S. national, or have qualified immigration status.
2. The child must be under the age of 19.
3. The child must live in the state where they are applying.

Explanation:

While it’s true that CHIP serves low-income families, the income eligibility threshold is actually higher than 100% of the federal poverty level The specific threshold varies by state, but it is typically to 200% or more of the federal poverty level. Hence, stating that a family’s income must be below 100% of the FPL for a child to eligible or CHIP is incorrect.

Question 34

Even though CHIP is a federal-state partnership, states have a significant amount of flexibility in how they design and implement their programs. Which of the following options correctly describes a form that a state’s CHIP program can take?

Answer 34

Answer:

A CHIP program can be an expansion of the state’s Medicaid program, a separate program, or a combination of both.

Explanation:

States have the option to implement their CHIP programs as an expansion of their Medicaid programs, as separate programs, or as a combination of both. This flexibility allows states to design their CHIP programs in ways that best meet the needs of their specific populations.

Question 35

The Veterans Health Administration (VHA) operates one of the largest health are systems in the United States, providing care at 1,293 health care facilities. These include 170 VA Medical Centers and 1,123 outpatient sites of care. Given this vast network, how does the VHA organize its healthcare system geographically to manage and deliver services effectively to veterans across the country?

Answer 35

Answer:
The VHA divides the country into Veterans Integrated Service Networks (VizSNs), with each VISN responsible for managing several facilities.

Explanation:

The VHA is divided into Veterans Integrated Service Networks (VISNs). Each VISN is responsible for managing the facilities within its geographic area. This system allows for coordinated care and resource allocation within defined regions. It’s not solely based on population density, and while VA Medical Centers do play a significant role, they do not individually manage all other facilities in a state. A unitary system with centralized control over all facilities would not allow the regional adaptation that the VISN system provides.

Question 36

The Veterans Health Administration operates numerous programs dedicated to specific groups of veterans, such as homeless veterans, veterans with disabilities, and veterans with post-traumatic stress disorder (PTSD). The following programs exist within the VHA’s portfolio:

Answer 36

1. A program focused on rehabilitation for veterans with visual impairments.
2. A program offering specialized care for veterans with traumatic brain injuries.
3. A program offering services specifically targeted at women veterans

Explanation:

The VHA does not have a dedicated program for providing care and support to veterans who are professional athletes. While the VHA offers comprehensive care to all veterans, including those who might be professional athletes, there is no specific program targeted at this group. On the other hand, the VHA does have programs focusing on veterans with visual impairments, traumatic brain injuries and specifically targeted at women veterans.

Question 37

The VHA uses a priority group system group system to manage enrollment and allocate resources. This system prioritizes access to care based on factors like service-connected disabilities, income level, and former prisoner of war (POW) status. How does the VHA utilize this priority group system to determine veterans’ eligibility for enrollment?

Answer 37

Answer:
The VHA enrolls veterans from all priority groups, but the group a veteran falls into may impact their benefits and the cost of care.

Explanation:
The VHA does enroll veterans from all priority groups, but a veteran’s priority group can affect their benefits and the cost of care. Veterans in higher priority groups may receive greater benefits or have lower costs compared to those in lower groups. While resources and disability status may affect a veteran’s priority group, they do not solely determine enrollment.

Question 38

The VHA offers many services beyond traditional medical care, recognizing the unique needs of veterans. From the following options, identify the service that the VHA offers to veterans:

Answer 38

1. Readjustment counseling services through Vet Centers across the country.
2. Support for caregivers of veterans, including education, a helpline, and a caregiver support coordinator at every VA medical center.
3. Vocational rehabilitation and employment programs to help veterans transition back into the workforce.

Explanation:

While the VHA does offer a dental are program, it’s not available to all veterans regardless of their priority group or disability status. Eligibility for VA dental care is quite specific and is based on factors such as being a former prisoner of war, having a service-connected dental disability or condition, or being homeless. In contrast, readjustment counseling, caregiver support, and vocational rehabilitation and employment programs are service provided by the VHA

Question 39

Post-traumatic stress disorder (PTSD) is a significant concern within the veteran community. The VHA has implemented various strategies to address this issue, including offering specialized PTSD programs and using evidence-based therapies. The following statements are true about the VHA’s approach to PTSD:

Answer 39

1. The VHA offers cognitive processing therapy (CPT) as an evidence-based treatment for PTSD.
2. The VHA’s PTSD programs offer group therapy as a form of treatment.
3. The VHA uses prolonged exposure (PE) therapy as part of its PTSD treatment.

Explanation:

The assertion that the VHA exclusively uses medication-based treatment for PTSD is incorrect. While medication may be a component of PTSD treatment, the VHA’s approach is much more comprehensive. It includes a variety of evidence-based therapies, such as cognitive processing therapy (CPT) and prolonged exposure (PE) therapy. The VHA also provides group therapy as part of its specialized PTSD programs, offering veterans the chance to share experiences and learn from others who are facing similar challenges.

Question 40

TRICARE is a health program that serves uniformed service members, retirees, and their families worldwide. The program is essentially managed by the Defense Health Agency under the guidance and authority of the Assistant Secretary of Defense (Health Affairs). Given TRICARE’s beneficiary population, the following statements accurately describes the population that TRICARE does cover:

Answer 40

1. TRICARE does not cover active-duty service members.
2. TRICARE does not provide coverage for the dependents of active-duty service members.
3. TRICARE does not offer coverage for retired reserve members under the age of 60.

Explanation:

TRICARE does not cover veterans who have been honorably discharged and are not retired from military service. These individuals, who served but did not retire from the military, would typically use the Veterans Health Administration (VA) for healthcare services after discharge. On the other hand, TRICARE covers active-duty service members, their dependents, and retired reserve members,.

Question 41

TRICARE provides different plans to meet the specific needs of its beneficiaries, including TRICARE Prime, TRICARE Select, and TRICARE For Life. From the following options, which accurately describes the characteristics of TRICARE Prime that differentiates it from the other TRICARE plans?

Answer 41

Answer:
TRICARE Prime operates as a managed care plan with an assigned primary care manager.

Explanation:
TRICARE Prime operates as a managed care plan, and enrollees have an assigned primary care manager (PCM) who provides most of their care. The PCM can refer patients to specialists if necessary, creating a coordinated and managed care experience. This is in contrast to TRICARE Select, which is a self-managed, preferred-provider option, and TRICARE For Life, which serves as a wraparound plan for Medicare-eligible beneficiaries.

Question 42

TRICARE covers various services, including hospitalization, outpatient care, prescriptions, and preventive services. However, TRICARE’s coverage has specific limitations. Which of the following is a service that TRICARE covers?

Answer 42

1. Mental health services, including inpatient, outpatient, and partial hospitalization.
2. Physical therapy, occupational therapy, and speech therapy.
3. Preventive screenings, such as mammograms and colonoscopies.

Explanation:

TRICARE does not cover cosmetic surgery performed solely for aesthetic reasons. However, it may cover reconstructive surgeries if they are considered medically necessary, such as after a mastectomy or for congenital anomalies. Conversely, TRICARE does cover mental health services, preventive screenings, and certain therapies like physical, occupational, and speech.

Question 43

TRICARE utilizes various types of facilities to deliver care to its beneficiaries, including Military Treatment Facilities (MTFs) and civilian providers within its network. The following statements are true regarding these facilities and providers?

Answer 43

1. MTFs are the first choice for care for TRICARE Prime beneficiaries.
2. TRICARE Select beneficiaries can visit any TRICARE-authorized provider.
3. TRICARE beneficiaries may face out-of-pocket costs when using out-of-network providers

Explanation:

TRICARE Prime beneficiaries are typically required to get a referral from their primary care manager (PCM) to see a specialist or any other TRICAR-authorized provider. If a TRICARE Prime beneficiary decides to see a specialist without a referral, it is known as “point of service” and may result in higher costs. The other options are all correct: MTFs are the first choice for care for TRICARE Prime beneficiaries, TRICARE-authorized provider, and TRICARE beneficiaries can face out-of-pocket costs when using out-of-network providers.

Question 44

Under TRICARE, certain prescriptions can be filled in various ways, including military pharmacies, TRICARE Pharmacy Home Delivery, TRICARE retail network pharmacies, and non-network pharmacies. The following statements are accurate about prescription drug coverage:

Answer 44

1. Military pharmacies offer prescriptions at no cost to TRICARE beneficiaries.
2. TRICARE retail network pharmacies provide medications at predetermined copayment amounts.
3. Using non-network pharmacies typically involve higher out-of-pocket costs compared to network pharmacies.

Explanation:

The statement that TRICARE pharmacy Home Delivery is only available to beneficiaries living overseas is incorrect. In fact, TRICAR pharmacy Home Delivery is a convenient option available to beneficiaries regardless of where they live. It allows beneficiaries to receive a 90-day supply of their maintenance medications delivered to their home. The other options are all correct: military pharmacies provide medications at no cost, TRICARE retail network pharmacies offer medications for fixed copayments, and using non-network pharmacies often involves higher out-of-pocket costs.

Question 45

The Indian Health Service (IHS) is a federal agency that provides comprehensive health service delivery to American Indians and Alaska Natives. While the IHS provides a range of servicers, some specific populations or conditions receive focused attention through dedicated programs. The following are specialized program or services offered by the IHS:

Answer 45

1. A specialized program for the management and treatment of diabetes.
2. An initiative aimed at improving maternal and child health.
3. A behavioral health program addressing mental health and substance abuse issues.

Explanation:
The IHS does not provide a nationwide program delivering dental are to non-native American residents. The IHS’s mission is to raise the health status of American Indians and Alaska Natives to the highest possible level, not to serve the general U.S. population. However, the IHS does have a specialized diabetes program, initiatives for improving maternal and child health, and a behavioral health program.

Question 46

The IHS operate on a system of care delivery that includes direct care, purchased/referred care, and tribal or urban Indian health programs. How does the Purchased/Referred Care (PRC) program function within the IHS care delivery system?

Answer 46

Answer:
The PRC program funds care for eligible patients when the required services are not available at IHS or tribal health facilities.

Explanation:

The Purchased/Referred Care (PRC) program funds care for eligible American Indians and Alaska Natives when the required services are not available at IHS or tribal health facilities. This could be due to the services exceeding the capacity or scope of the IHS or tribal health facility, or because of the geographic inaccessibility of the IHS or tribal health facility for the patient. This program does not directly provide care, support tribal health programs, or fund research.

Question 47

The IHS collaborate with numerous other federal agencies to improve the health status of American Indians and Alaska Natives. The following agencies are the IHS partners:

Answer 47

1. The Centers for Disease Control and Prevention (CDC).
2. The Food and Drug Administration (FDA).
3. The Substance Abuse and Mental Health Services Administration (SAMHSA).

Explanation:

The IHS does not partner with the Internal Revenue Service (IRS). The IRS does not have a direct role in public health or healthcare service delivery. However, the IHS does collaborate with other federal agencies that have health-related mandates, such as the CDC, FDA, and SAMHSA, to enhance its ability to provide comprehensive, culturally acceptable health services.

Question 48

In its mission to provide comprehensive health services to American Indians and Alaska Natives, the IHS offers a variety of services. The following services are provided by the IHS?

Answer 48

1. Inpatient care at IHS-operated hospitals
2. Outpatient care at IHS health centers and clinics.
3. Public health nursing and health education services

Explanation:

The IHS does not provide comprehensive dental care to all American citizens, regardless of heritage or income level. The IHS’s mandate is to provide healthcare services to American Indians care at IHS-operated hospitals, outpatient care at health centers and clinics, and public health nursing and health education services.

Question 49

Despite the efforts of the IHS, health disparities remain a significant issue among American Indians and Alaska Natives compared to the overall U.S. population. These disparities are influenced by a variety of factors. The following are considered major contributors to health disparities experienced by these populations:

Answer 49

1. Lower socioeconomic status compared to the general U.S. population.
2. Limited access to healthcare and preventive services.
3. Higher burden of chronic diseases such as diabetes and heart disease.

Explanation:

American Indians and Alaska Natives generally have lower rates of health insurance coverage compared to the general U.S. population. This lack of insurance contributes to their limited access to healthcare and preventive services. Lower socioeconomic status and a higher burden of chronic diseases such as diabetes and heart disease are also significant factors contributing to health disparities experienced by these populations.

Question 50

Medicaid and the Children’s Health Insurance Program (CHIP) serve as vital sources of health coverage for low-income adults and children. Each state has its rules and guidelines regarding who is eligible for these programs. The following statement about Medicaid and CHIP enrollment is accurate:

Answer 50

1. Both Medicaid and CHIP use the federal poverty level (FPL) as a guideline to determine eligibility.
2. States are allowed to set their income eligibility guidelines for CHIP above 300% of the FPL.
3. The Affordable Care Act expanded Medicaid eligibility to include more low-income adults.

Explanation:

The statement that Medicaid provides coverage to all low-income adults, regardless of their circumstances, is inaccurate. Although the Affordable Care Act expanded Medicaid eligibility to more low–income adults, not all states chose to expand their programs. Additionally, eligibility for Medicaid often depends on certain criteria beyond income, such as being pregnant, having a disability, or being part of a specific age group.

Question 51

The process of enrollment in Medicaid and CHIP can vary across different states. Sme sates may use facilitated enrollment or Express Lane Eligibility (ELE) to streamline the process. Which of the following best describes the Express Lane Eligibility (ELE) option?

Answer 51

1. ELE allows individuals to apply for Medicaid or CHIP at any time of the year, not just during open enrollment periods.
2. ELE allows states to automatically enroll all residents in Medicaid or CHIP, regardless of income or circumstances.
3. ELE is a fast-track process for enrolling eligible seniors into Medicaid programs.

Explanation:

Express Lane Eligibility (ELE) is a strategy that allows states to simplify and streamline their enrollment processes by using findings from other public programs to determine eligibility for Medicaid or CHIP. This option was designed to reduce the administrative burden on states and make it easier for eligible individuals to access health coverage. ELE does not involve automatic enrollment, open enrollment throughout the year, or a fast-track process specifically for seniors.

Question 52

Continuity of coverage is a crucial aspect of ensuring access to healthcare. In the context of Medicaid and CHIP, the following statement correctly describes how these programs promote continuity of coverage:

Answer 52

Answer:
Medicaid and CHIP typically require beneficiaries to renew their coverage once a year.

Explanation:

Typically, Medicaid and CHIP require beneficiaries to renew their coverage once a year. This annual renewal process allows states to verify that beneficiaries still meet the eligibility criteria for the programs. Beneficiaries are not automatically re-enrolled each year without renewal, and renewal is not required monthly or disregarded completely.

Question 53

In order to increase access to health coverage for children, some states have implemented continuous eligibility policies for children in Medicaid and CHIP. The following correctly explains this policy:

Answer 53

Answer:
Continuous eligibility allows children to remain enrolled in Medicaid or CHIP for a set period of time, regardless of changes in circumstances.

Explanation:
Continuous eligibility allows children to remain enrolled in Medicaid or CHIP for a set period of time, usually one year, regardless of changes in family income or other circumstances. This policy is designed to promote stability and continuity of coverage, ensuring that children have consistent access to needed healthcare services. It does not guarantee lifetime enrolment, automatically enroll all children at birth, or allow for simultaneous enrolment in both Medicaid and CHIP.

Question 54

Navigators and certified application counselors (CACs)play key roles in helping people apply for and enroll in Medicaid and CHIP. What is one significant difference between the roles of Navigators and CACs?

Answer 54

Answer:
Navigators can provide a broader range of assistance, including outreach and education, while CACs primarily assist with the application process.

Explanation:
The primary difference between Navigators and certified application counselors (Cacs) lies in the range of services they provide. Navigators are required to conduct public education activities to raise awareness about the Marketplace, provide information and services in a fair and impartial manner, and facilitate selection of a Qualified Health Plan. On the other hand, CACs primarily help people complete the application process. Both roles can assist with Medicaid and CHIP enrollment, and there are no specific rules about language assistance or voluntary service tied to either role.