Medicaid Flashcards
In order to reduce costs and improve patients’ health, CMs must understand access, criteria and restrictions within Medicaid plans.
True or False
True
The Centers for Medicare and Medicaid Services (CMS) allows states to conduct their own reviews of state Medicaid plans to ensure conformity with federal requirements.
True or False
False
Medicaid managed care contracts require that each enrollee have an identified case manager to coordinate care across multiple settings, including community and social support services.
True or False
True
Alternative payment models, often defined as a strategy that changes the way Medicaid providers are paid, are moving away from fee-for-service payment (which rewards volume) to methods of payment that incentivize value.
True or False
True
Medicare is the largest payer of mental health services in the United States (US).
True or False
False
Medicaid is seldom the first place to seek coverage.
True or False
False
Which of the following is an accurate description of the Medicaid program?
a) Medicaid is a program funded and administered by the federal government
b) Medicaid is a program that provides health care coverage for low-income and disabled people
c) Medicaid is one of the smallest payers of healthcare services in the United States
d) Medicaid provides full coverage for healthcare services in the USA
B.
Medicaid is a program that provides health care coverage for low-income and disabled people.
Medicaid benefits, services and rules for eligibility?
a) Will be the same from state to state
b) Will vary from state to state
c) Will affect interstate transfers for care
d) Both B and C are correct
D. Both B and C are correct
The Children’s Health Insurance Program (CHIP) is?
a) A federal child welfare program
b) Health coverage for uninsured children up to age 26
c) A healthcare coverage program for children from families with incomes too high to otherwise qualify for Medicaid who cannot afford private insurance
d) A federal program to protect children from high income families who refuse to purchase healthcare coverage
C.
A healthcare coverage program for children from families with incomes too high to otherwise qualify for Medicaid who cannot afford private insurance
Over the past 15 years Medicaid enrollment has?
a) Continued to go up
b) Declined dramatically
c) Been very level
d) Gone up and down depending on the economy
D. Gone up and down depending on the economy.
What strategy has been employed by the states in response to increasing Medicaid enrollment and spending over the last decade?
a) States have predominantly applied managed care delivery systems
b) States have utilized a variety of care management strategies
c) States have curtailed spending by limiting Medicaid enrollment
d) States have recently implemented research projects to study what can be done to curtail costs
A. States have predominantly applied managed care delivery systems.
Medicaid directors are reorienting the healthcare system to deliver better care at a lower cost by?
a) Applying fee for service programs
b) Implementing value-based purchasing initiatives
c) By capping “pay per member per month” payment options
d) By going to single payment contract agreements
B. Implementing value-based purchasing initiatives.
All of the following are common types of Medicaid alternative payment models EXCEPT?
a) Supplemental payments
b) Episode-based payments
c) Population-based payments
d) Fee for Service payments
D. Fee for service payments
Medicaid eligibility is determined by?
a) Federal laws
b) Physicians
c) State defined eligibility groups
d) Case manager’s enrollment procedures
C. State defined eligibility groups
Medicaid income eligibility for most children, pregnant women, parents and adults is determined by?
a) Inflated gross domestic product (IGDP) guidelines
b) Modified Adjusted Gross Income (MAGI)
c) Poverty level income status (PLIS)
d) Take home pay (THP)
B. Modified Adjusted Gross Income (MAGI)
Which Medicaid group must “spend down” assets to become eligible?
a) Medically needy
b) Categorically needy
c) Dual eligible
d) Working disabled
A. Medically needy
What process can be used by “qualified entities” to streamline Medicaid enrollment for needy children?
a) Categorical enrollment (CE)
b) Qualified eligibility(QE)
c) Presumptive Eligibility (PE)
d) Need to be Seen Screening
C. Presumptive Eligibility (PE)
Medicaid federal law regarding provider reimbursement is?
a) Not yet established
b) So broad providers may not get paid
c) Grossly unhelpful
d) That reimbursements must assure that an adequate number of providers participate
D. That reimbursements must assure that an adequate number of providers participate
Which of the following explains why physicians refuse to accept Medicaid patients?
a) Medicaid patients are too complex for primary care
b) Medicaid is a money loser for doctors practices
c) Medicaid liability insurance premiums are too high
d) Medicaid doesn’t pay it’s bills
B. Medicaid is a money loser for doctors practices
One reason dual-eligible patients have experienced lapses in care is?
a) Lack of coordination of benefits
b) Federal failure to assign primary payer determination
c) Patient disillusionment
d) The donut hole phenomenon
A. Lack of coordination of benefits
What have some states done to address the uninsured problem?
a) Assigned a temporary PO Box (home) address
b) Established doctor-patient trust circles to facilitate enrollment in Medicaid
c) Provided temporary Medicaid for emergency care, initiating enrollment process while in the hospital
d) Assigned case managers to conduct Medicaid enrollment fairs
C. Provided temporary Medicaid for emergency care, initiating enrollment process while in the hospital.
