Medicaid Flashcards
Medicaid
Federal program administered by states with sliding scale
Lower per capita get increased federal money
Colorado 50/50 split
Medicaid Funding
Funds directly from Federal Government General tax revenues
5th largest federal budget item
Long term care reciepient is most costly
Colorado and Nonelderly residents covered
Less than 10% are covered by Medicaid in Colorado
Medicaid Parameters
Low income families with kids
Pregnant women
Over 65 yo who meet certain income requirements
Ppl with disability who receive cash assistance through SSI program
Minimum Services
Hospital Care (IP and OP) Nursing Home care Home Health 21 and under Physician services Lab and xray services Immunization/preventive measures for kids Family planning services Nurse midwife and nurse practitioner services
Additional Services
Home and community based services (not 24 hr care)
Nursing home/custodial care (minus amt pt is able to pay)
Assisted living
Adult day care
Respite care (break for normal provider)
If these 3 requirements are met
Medical need for home care or nursing care
Income below a specified amount
Resources below a specified amount
Co-pays
Children under 18 and pregnant women are co-pay exempt
Typical co-pays for PT are around 2 bucks
How many people are dually eligible for Medicare and Medicaid?
9 million Medicare 37 million Medicaid 51 million Total Meidcare 46 million Total Medicaid 60 million
Long Term Care
2006: 7 million ppl >65 needed LTC/custodial care
Family, friends are sol caregivers for 70% elderly ppl and cared at home
People >65 face a 40% lifetime risk of entering nursing home, 10% stay more than 5 years
Women more likely to stay since they outlive men
Spend Down
Allows pt to meet the alternate income test levels typically set at 300% of SSI.
8 yr period that Medicaid looks at to make sure you didn’t hide all your money so you would get Medicaid benefits if at a SNF etc
Early Periodic Screening, Diagnosis, and Treatment (EPSDT)
Required in every state
Covers children birth-21
Physical, mental, developmental, dental, hearing, vision
Covers diagnostic tests when risks are identified
Child Health Insurance Plan (CHIP)
BBA 1997
Coverage for families who earn too much for Medicaid but cannot afford private health insurance
States are allow cap enrollments, federal financing is capped
States provide fewer services and higher cost-sharing (premiums, copay)
Eligible for CHIP in CO if parents make under 38,000
Child Health Plan Plus (CHP+)
Colorado’s program for low-cost health insurance
Covers uninsured children 18 and younger
Pregnant women 19 and younger
Prenatal Care Program
Families earn or own too much to qualify for Medicaid but cannot afford private insurance
Medicaid Waiver
Case by case decision (NOT AUTOMATIC)
Waive family’s income so children may access medical care through Medicaid (childs income is used, not parents)
Child must not have an income over 300% of SSI benefits or assets more than 2000
Long waiting lists, 3 programs in Colorado
Only for children who need a level of care that would normally be provided in hospital, nursing home, or institution qualify
