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Medicaid Unit

Vocabulary assigned for Medicaid Unit

TermDefinition
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