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
2
Q
Who does medicaid cover?
A
- low income
- elderly
- disabled
3
Q
What is Medicaid often referred as?
A
Title XIX
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)
5
Q
What are FPL values that are used often?
A
100% and 133%
6
Q
Qualifying Categories
A
- Mandated Categorically Needy
- Optional Categorically Needy
- Optional Medically Needy
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
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)
9
Q
Optional Categorically Needy
A
same as mandated but with expanded income levels
10
Q
Optional Medically Need
A
spin down; safety net for when bills exceed income
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
12
Q
Role of Federal Government
A
establish and monitor:
- funding
- eligibility standards
- quality of services
- extent of coverage
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
14
Q
Optional services of medicaid
A
- physical therapy
- dugs
- optometris and eye glasses
- intermediate care daciliy for mentally impaired
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
