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Medicaid Unit
Vocabulary assigned for Medicaid Unit
| Term | Definition |
|---|---|
| EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) services | congressional law mandating that states provide routine pediatric check-ups to all children enrolled in Medicaid and provide treatment for any problems identified during these check-ups |
| categorically needy | medicaid eligibility factor that is determined by income level |
| medically needy | medicaid eligibility factor that includes persons who are above the set income level but fall into one or more of the following categories: pregnant, aged, disabled, blind |
| SCHIP (State Children's Health Insurance Program) | due to an amendment of the social security act that allows states to create health insurance programs for children of low-income working families |
| PACE (Programs of All-inclusive Care for the Elderly) | State by state optional programs that provides skilled nursing home coverage for persons 55 or older |
| Medicaid | cost-sharing program between the federal and state governments to provide healthcare services to low-income Americans |
| Medicaid eligibility verification system (MEVS) Recipient eligibility system (REVS) | system used by providers to electronically access the state's eligibility file through computer, point of service device, or automated voice response system; used to verify patient coverage and eligibility |
| Medicaid Remittance Advice | report sent to provider to explain the current status of claims; paid, denied, pended, adjusted, or voided |
| dual eligible | term used to describe persons eligible for both Medicare and Medicaid |
| Federal Medical Assistance Program (FMAP) | federal portion of Medicaid program that determines amount of federal funding that will be provided to each state |
| payer of last resort | the insurance carrier that will always be billed last. |
| Qualified Medicare Beneficiary Program (QMB) | program that pays the premiums, deductibles, and patient co-payments for Medicare-eligible persons with incomes below federal poverty guidelines |
Created by:
tina.reynolds
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