Medicaid, Military and Indian Health Services Chapter 9 Flashcards
What is Means-Tested Program?
Beneficiaries must qualify by demonstrating a level of need usually based on low income and personal assets or excessive medical expenses.
Who Received Medicaid?
Population served include those with severe intellectual disabilities, physical disabilities, and elderly who are poor
Medicaid is the largest purchaser of long term care in the US funding the “safety net” for the health care system.
Who is Eligible for Medicaid?
Income assessed as a percentage of the federal poverty level (FPL)
Set annually, assets include personal investments or saving and must be very low to qualify for Medicaid.
Income between 100% and 400% FPL
Income below 138% FPL
Income below 100% FPL
How ca income medicate beneficiaries qualify for medicaid?
Muse meet both income and assets limits.
Qualify but have to “spend down” assets to meet criteria.
Spousal impoverishments Protection
A portion of the jointly held assets is protected for the community dwelling spouse.
Medicaid Services
3 tier packages of benefits
Basic package for states that offer Medicaid benefits to categorically eligible populations
Package for states that offer medically needy programs
States that include several optional benefits at their discretion.
Mandatory benefits:
Medically necessary OT and PT are optional, but all states must cover therapy services to children in early and periodic screening, diagnosis, and treatment program and to categorically eligible people over 21 who reside in SNF.
Home and community based waiver Program
Alternative to expensive SNF care.
Comprehensive state plan to provide package to those with disabilities living in the community.
Many provide therapy services to keep individuals functional in the community
Personal care services are an optional benefit.
Primary Care Case Management
Free for service program that contracts with physicians who provide routine care and coordinate referral and utilization of specialty care.
Capitation
Forms contracts with managed care organizations to provide all the services needed by the beneficiary at a predetermined monthly rate
Veteran Affairs Health System
Eligibility Criteria
Minimum of two years of service honorable discharge from the military
Veterans with service related injury or disability are given highest enrollment priority
Impoverished veterans also receive priority enrollment in the VA
Non-service connected veterans have to meet income asset requirements or pay deductibles and co-pays
Benefits package vary for each Veteran
Established co-pays for prescription drugs, inpatient – outpatient hospital services is, a nursing home care.
Tricare
For active military personnel
Tricare 3 insurance options
Tricare Prime
Use his military hospitals and clinics as a primary provider care
Active members are required to enroll
Retired military may access for annual enrollment fee and pay out-of-pocket
Uses a health maintenance organization HMO model
- Tricare Extra
- Tricare Standard
Available to non-active during military
Utilize fee-for-service insurance model
Preferred provider organization model with contracted civilian providers
Indian Health Services (HIS)
Agency of the federal government to provide healthcare to 2.56 million American Indian an Alaskan natives
- From one of the 573 recognized tribes
Provided through one or two mechanisms
- Direct delivery by the Indian health service.
- Healthcare developed and administrated by the tribes (Tribal self determination
Both use a global budgeting system
- Resource come from direct appropriations by Congress
- Per person expenditure 2020 = $9,726
OT and PT provided since the 1960s as a civilian or as a commissioned member of the public health service
