Test 2 Medicaid Flashcards

1
Q

Medicaid

A
  • Health Insurance Coverage
  • Assistance to Medicare Beneficiaries
  • Long-Term Care Assistance
  • Support for Health Care System and Safety-net
  • State Capacity for Health Coverage
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2
Q

Who does medicaid cover?

A
  • low income
  • elderly
  • disabled
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3
Q

What is Medicaid often referred as?

A

Title XIX

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4
Q

income qualifiers

A

there are two levels:

  • Federal Poverty Limit (FPL) = family of four 100%: $24,600; 133% = $32,718
  • individual state adjustments (they can go higher but not lower than FPL)
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5
Q

What are FPL values that are used often?

A

100% and 133%

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6
Q

Qualifying Categories

A
  • Mandated Categorically Needy
  • Optional Categorically Needy
  • Optional Medically Needy
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7
Q

What are the conditions to meet for income to become a main qualifier?

A
  • live in state that agreed to expand Medicaid

- household for FOF (family of four) is 133% of FPL

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8
Q

Mandated Categorically Needy

A
\+ Children and families 
- children under 6
- pregnant women 
- income level must be under 133% 
- children under 19, income must be under 100%
\+ SSI; supplemental security income 
\+ medicare release income level 100-120%
\+ ACA expansion (don't have to know this one)
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9
Q

Optional Categorically Needy

A

same as mandated but with expanded income levels

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10
Q

Optional Medically Need

A

spin down; safety net for when bills exceed income

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11
Q

ACA expansion

A
  • under 65
  • not pregnant
  • not entitled to or enrolled in Medicare part A
  • income does not exceed 133% of FPL
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12
Q

Role of Federal Government

A

establish and monitor:

  • funding
  • eligibility standards
  • quality of services
  • extent of coverage
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13
Q

Role of States

A
  • establish eligibility
  • have to make sure services are same in all geographical areas
  • set reimbursement rates
  • define administration and organizational structure
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14
Q

Optional services of medicaid

A
  • physical therapy
  • dugs
  • optometris and eye glasses
  • intermediate care daciliy for mentally impaired
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15
Q

Required services of medicaid

A
  • in- and out- patient hospital services
  • physician servies
  • home health services
  • lab and xray
  • pre-natal care
  • nursing facility for 21 and older
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