Lecture 2: Medicaid Flashcards
Who is covered under medicaid?
All adults under age 65 & children w income at/below 138% FPL
i. Also applies to immigrants
ii. Simplified and streamlined enrollment and renewal
iii. Mandates PCP be paid at medicare rates
iiii. Federal government will finance most of ACA
What does CHIP stand for and who is eligible?
Children’s Health Insurance Program
Provides coverage for US and immigrant children up to 19 y/o of low and moderate incomes
What is Medicaid Expansion? Is it mandated in each state?
Expand medical services to people of flow-income, and under “welfare” or in need of cash assistance
Mandated but varies across states
What Durable Medical Equipment (DME) and assistive technology is covered under Medicaid?
In NYS- Basic DME such as:
tub bench
raised toilet seat
hoyer lift
hospital bed (semi-electric)
shower chair
commode
Covered for a 5 yr period unless change in functional status
DME covered under medical nessesity:
rolling commode
tilt in space commode chair
adaptive cribs
higher end electrical hospital bed
How is deriving rehav covered under medicaid?
Covers OT eval for DR: cognition, vision, and physical assessment
DOESN’T COVER:
- behind the wheel assessment
- adaptive equipment for cars (spinner knobs, hand controls, left foot accelerator)
How is home modification covered under Medicaid?
They are generally not covered by medicaid but there are exceptions – medicaid waivers
What are the home modification exceptions/waivers for medicaid?
Waivers offer variety of in-home support programs and financial support for home modifications that enable aging in place
Some will pay for:
Assistive tech
Physical mods to home
Widening of internal spaces
Resources for both technologies and modifications
*waivers formally reerred to as environment accessibility adaptors
*nursing home medicaid is an entitlement – anyone eligible will receive care (waivers are NOT an entitlement)
*programs have limited enrollments and sometimes waiting lists for services
Mandated services for traditional eligible medicaid adults?
MD, input/output hospital services
Lab & x-rays
Early and periodic screening, diagnostic and treatment (EPSDT) for people under 21
Pediatric and family nurse practitioner services
Family planning services and supplies
Transportation
Nursing facility services for individuals under 21
Home health care services for persons eligible for nursing facility services
Mandated services for newly eligible Medicaid adults
Ambulatory patient services (outpatient)
ER
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services (including beh. health treatment)
Prescription drugs
Rehabilitation and habilitation services and devices
Laboratory services
Preventative and wellness service and chronic disease management
Pediatric services, including oral and vision care (not adult oral and vision care
Medicaid waivers
Allow the federal government to waive rules that normally apply – goal is to help states accomplish goals, expand coverage and improve care
Allows those who would normally be placed in long term care to get services from home
