Ross medicaid test
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| broad Federal Guide lines for each state? | -establishes it's own eligibility standards
-determines the type, amount,duration, and scope of services
-sets rates of payment for services
-administers it's own program
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| AFDC | Aid to Families with Dependent Children
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| What is title 19 of the social security act? | Federally mandated, state administered medical assistance program for individuals with incomes below the federal poverty level. MEDICAID
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| What are special groups? | Qualified Medicare Beneficiaries(QMB)
Qualified Working Disabled Individuals(QWDI)
Qualifying Individual(QI)
Specified Low-Income Medicare Beneficiaries(SLMB)
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| What are the three Specific Medical Conditions? | Women who have breast cancer or cervical cancer.
Individuals diagnosed with TB who are unisured.
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| What are Participating Providers not allowed to do? | Balance Billing.
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| FMAP | Federal Medical Assistance Percentage.
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| What determines the Federal Medical Assistance percentage? | Its based on the states average per capita income level with the national average. The federal goverment provides financial help to the 12 states that furnish the highest number of emergency services to undocumented aliens.
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| What are the Manditory services for Categorically needy Eligibility groups? | in/out patient hospital;labs/xrays;certified pediatric and family practioners;nursing facility services ages 21 and older; EPSDT-under 21; family planning services/supplies;physicians services; medical and surgical dentist; home health/aides.
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| manditory services for the Categorically needy? | Medical supplies and appliances; nurse mid-wife services
Pregnancy related services
60 days postpartum pregnancy relted services
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| EPSDT | Early and periodic Screening diagnostic and treatment services including dental, hearing screening, and vision services
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| Confirming Medicaid Eligibility | Monthly income.
Medicaid verification line-phone
POS device(like a credit card machine)
Internet
EVERY TIME
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| Preauthorization Guidlines | Elective inpatient admission
Emergency inpatient admission
more than one preoperative day
out patient procedures in an in patient setting
days exceeding state hospital stay limitations due to complications
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| SCHIP | State Childrens Health Isurance Program
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| Describe SCHIP | Low-income children with no insurance
Can cover up to three months prior if eligible- presumptive-must qualify
Up to one year(12months) of continious coverage without reevaluation
Up to age 19
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| Explain Spousal Impoverishment Protection | Medicare Catastrophic Coverage Act 1988
The spouse residing at home-the community spouse
Minimum monthly maintenance needs allowance
Protected resource amount(PRA)- Home, house hold good, one auto, burial funds
not considered a couple they are individ
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| Medicaid Eligibility Groups | Categorically Needy
Medically Needy
Special Groups
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| Categorically Needy 5 groups | Families that meet TANF requirements
Pregnant women and children under age 6 whose family income is at or below 133% of the FPL
Caretakers(relatives/legal gaurdians
SSI recipients
Individuals and couples living in medical institutions-300% of SSI inco
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| SLMB | Specified low-income medicare beneficiary
pay MC part B
100-120% FPL
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| QI | Qualifying Individuals
Pays MC part B 120-175% FPL
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| QMB | Qualified Medicare Beneficiaries
Pays MC premiums
100% FPL
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| QWDI | Qualified working Disabled individuals
Pays MC Part A
200% FPL
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| TANF | Temporary Assistance for Needy Families
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| How do you qualify as medically needy | People who may have too much income
allows individuals to "spend down" to medicaid eligibility
Families are able to establish eligibility by paying monthly premiums amount = to the difference between family income and the income eligibility standard.
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