Government Financing: Medicaid And Other Resources (CHIP, WIC, Public Health Department) Flashcards
What is the purpose of Medicaid ?
- Provides health coverage to low income people
*single largest source of health coverage in the US
What is Medicaid
- Federal program administered by states
- Funded jointly by states and federal government
What are the federal regulations of Medicaid?
- Requires that certain categories of low-income people be enrolled in state Medicaid programs
- Requires certain mandatory benefits
*inpatient and outpatient hospital services
*physician services
*laboratory and X-ray services
*home health services
What are the state regulations of Medicaid
- Establish and administer their own Medicaid programs
*determine type, amount, duration, and scope of services within broad federal guidelines - Allows choice of optional benefits
*prescription drugs
*case management
*PT and OT
What do the states have the option of doing with Medicaid and the regulations
- Have the option to charge premiums and establish out-of pocket spending or cost sharing
- Out of pocket costs are limited, but states may impose higher charges for targeted group with higher income
- Children and pregnant women are exempt
What are the five Medicaid care plans in ohio
- Buckeye health plan
- Care source
- Molina healthcare
- Paramount advantage
- Untied health care
What are the federal eligibility regulations for Medicaid
- Eligible low income adults
- Children’s under age 6
- School aged children 6-18 whose family is at or below federal poverty level
- Pregnant women whose family income is at or below federal poverty level
*<138% of the federal poverty line
When does coverage begin for Medicaid
- Effective either on date of application or first day on the month
- Benefits may be covered retroactively up to three months prior to application
- Coverage stops at the end of the month if no longer meets requirements
What is CHIP
Children’s Health Insurance Program
1. Provides coverage to reliable children in families with income too high to qualify for Medicaid, but cant afford private coverage
*companion program to Medicaid
What are the regulations of CHIP
- Covers uninsured children up to age 19
- Most states place income eligible up to or above 200% of federal poverty level
- Must provide well baby, WCC, dental coverage, behavioral health care, and vaccines
What is WIC
Women, infants, children
1. Supplemental nutrition program that provides federal grants to states
*includes supplemental foods, health care referrals, nutrition education
*automatically eligible if already in other income based program
What are the regulations of WIC
- Must be income eligible and state resident
*between 100% and no more than 185% of FPL - Must be found to be at nutrition risk to qualify
*HCP or trained health official must determine
What are the medically based risks (WIC)
- Anemia
- Underweight
- Hisotry of pregnancy complications
- Poor pregnancy outcome
What are the Dietary risks (WIC)
- Inappropriate nutrition/feeding practice or failure to meet current dietary guidelines for Americans
What populations use WIC
- Pregnant women
*up to 6 weeks after birth or after pregnancy ends - Breastfeeding women up t infants 1st birthday
- Non breastfeeding up to 6 months after brith of infant
- Infants up to 1st birthday
- Children up to 5th birthday
