Medicaid Flashcards
Who is covered under Medicaid
- Infants and Children
- Individuals with Physical/Mental disability
- Poor Elderly
- Poor adults and dependents
- Disabled Medicare Benefits
- Pregnant Women
What is CHIP
Children’s Health Insurance Program
Why was CHIP created
Because 10 Million children had no health insurance
What did CHIP do?
Provided coverage for US and Immigrants children up to 19 not eligible for Medicaid
- For those with low to moderate income levels (starts at 200% of poverty line and now 300%)
Federal Funding of Medicaid
How much federal government pays is different in each state
- Government matches 50-78% depending on state per capita income relative to national average
- Created Minnimun Medicaid eligibility –> Mandatory group and income based on federal poverty level
State Funding of Medicaid
Every state has program
- Must have single agency to administer Medicaid - Overseen by CMS
- Participation is voluntary and they can design and administer own programs
- They control cost/spending beyond core requirements –> eligibility, benefits, provider payment, delivery systems
What is Medicaid expansion
Patient Protection and Affordable Care Acts (2010) and Health Care and Education Reconciliation Act (2010)
- Expansion was mandatory until Supreme Court made it optional
- Increased eligibility to adults up to 138% of poverty level
- Decreased penalty for not buying insurance
- Increase Medicaid reimbursement to PCPs to match Medicare
- Increased Tax Credits to buy insurance
- More subsidies for lower income groups
- Penalties for companies of more than 50 employees for not sponsoring health insurance coverage
DME Covered under Medicaid
Basics: Tub bench, raised toilet seat, hoyer lift, hospital bed (semi-electronic), shower chair, commode
- Must last 5 years unless functional status changes
- Medical necessity must be demonstrated for : rolling commode, tilt in space commode chair, adaptive cribs, higher end electronic hospital beds
What Assistive Tech is covered under Medicaid
Devices/Equipment/Systems that enhance, increase, or maintain physical or mental capabilities of those with disabilities
- Communication devices are covered but requires speech eval and must pay to unlock
Wheelchair Coverage under Medicaid
Standard wheelchair is covered
Medical necessity letter needed for custom manual wheelchairs and power mobility devices
Driving Rehab coverage under Medicaid
Covers OT evaluation for driving rehabilitation (cognitive, vision, physical assessment)
- NO coverage for behind wheel assessment and adaptive equipment
Home modification coverage under Medicaid
Not covered
Why there are waiver programs
- you can submit claim but no promises you will be reimbursed
Medicaid Waivers
To allow disabled and elderly to continue living at home (it is cheaper and preferable to client to remain there)
- Offers in-home support programs, financial support and home modification
- some offer assistive tech
Mandated Services under Medicaid
- MD in-patient/out-patient hospital services
- Lab and X-Rays
- Early and periodic screenings, diagnostic treatments for individuals under 21
- Pediatric and Family NP services
- Family planning services and supplies
- Transportation
- Nursing facilities services for 21+
- Home health care services
- Compression garments (for lymphedema patients)
