Lecture 13 done

Question 1

What is medicaid?

Answer 1

a join federal/state health insurance plan

Question 2

What is the largest single source of health coverage?

Answer 2

Medicaid. covers 70 million people(1 in 5)

Question 3

How is medicaid structured?

Answer 3

jointly funded by federal and state government. Optional program but all states participate!

Question 4

True or False: medicaid finances nearly 1/5 of healthcare spending

Answer 4

true. about 18%

Question 5

Who is eligible for medicaid?

Answer 5

1)mandated categorically needy
2)optionally categorically needy
3)medically needy

Question 6

What is mandated categorically needy?

Answer 6

required coverage in medicaid that includes SSI recipients, low income seniors, AFDC enrollees, welfare recipients

Question 7

What is optionaly categorically needy?

Answer 7

option coverge in medicaid that includes low income children, and pregnant women that don’t meet the criteria for mandated categorically needy

Question 8

What is medically needy?

Answer 8

optional coverage in medicaid that includes elderly, blind, disabled, and children with high OOP expenses

Question 9

What is the Children’s Health Insurance Program(CHIP)?

Answer 9

covers children that are ineligible for medicaid, covers a broad range of services, out of pocket cost vary

Question 10

What services could CHIP cover?

Answer 10

preventative care, immunizations, doctor visits, emergency care, perscription drugs, dental and vision

Question 11

True or false: adults with medicaid poorer but equally sick as those with private health insurance.

Answer 11

False. Both sicker and poorer

Question 12

What mandatory services are covered under medicaid?

Answer 12

Inpatient, outpatient, Lab & x-ray, nursing home and home health, fammily planning, pregnancy services, midwife, physician, nurse practitioner services

Question 13

What optional services are covered under Medicaid?

Answer 13

podiatry, optometry, perscription drugs, dental, hospice, clinical services

Question 14

What is required of medicaid?

Answer 14

same coverage throughout the state, obtain services from any participatibg provider

Question 15

How does cost sharing work within medicaid?

Answer 15

Many states require cost sharing but it cannot be a serious barrier to recieving services(low copays)

Question 16

How does medicaid control costs?

Answer 16

prior authorization, preffered drug lists, MCO(2/3 medicaid recipients enrol in MCO’s)

Question 17

How do provider’s get paid?

Answer 17

pay providers using FFS, MCO get set amount per month. provider participation optional but if the join they must accept Medicaid’s payment(no balance billing)

Question 18

What are issue faced by Medicaid?

Answer 18

budget cuts, difficult population covered, low provider reimbursment, federal/state coordination, Madiscaid expansion(Affordable Care Act)

Question 19

How does the government get involved in health care?

Answer 19

legislative, administrative regulations, reimbursment, direct care

Question 20

Describe current federal government involvment.

Answer 20

COVID testing, vaccines, mask mandates, reccomendations, legislative initiates(inflation reduction act, PBM reform

Question 21

WHich hospitals are ther government involved in?

Answer 21

Veterans affairs, TRICARE, Indian Health Service, Bureau of prisons

Question 22

Describe the VA.

Answer 22

closed ealth system that employs over 7,000 pharmacists

Question 23

What is Tricare?

Answer 23

healthcare program fo military members and their families