Question 1

Medicaid eligibility is limited to people who fall into three coverage groups

Accepted Answer

1) Medically needy
2) Categorically needy 
3) Special groups

Question 2

Medicaid provides

Accepted Answer

medical and health-related services to individuals and families with low incomes ( indigent)

Question 3

Spousal Impoverishment Protection Legislation of 1989

Accepted Answer

prevents married couples from being required to spend down income and other liquid assets before one of partners could be declared eligible for nursing care coverage

Question 4

Medically necessary services

Accepted Answer

are not provided for the sake of anyone's convenience, regardless of whether it is the doctor or patient

Question 5

TANF

Accepted Answer

Temporary Assistance to Needy Families

Question 6

States are required to

Accepted Answer

extend Medicaid eligibility to all children born after 9/30/83 until they are 19 years old

Question 7

TANF makes cash assistance available, for

Accepted Answer

a limited time, for children deprived of support due to parent's absence, death, incapacity or unemployment

Question 8

TANF was previously known as

Accepted Answer

AFDC (Aid to families with Dependent Children )

Question 9

SCHIP

Accepted Answer

State Children's Health Insurance Plan

Question 10

SCHIP allows states to

Accepted Answer

create or expand existing insurance programs and provides more federal funds to states for the purpose of expanding Medicaid eligibility to include a greater number of children who are currently uninsured

Question 11

Medi-Cal

Accepted Answer

is California's equivalent to the Medicaid program

Question 12

Medicaid began in

Accepted Answer

1965

Question 13

Surveillance Utilization Review System

Accepted Answer

Safeguards against unnecessary or inappropriate use of Medicaid services or excess payments and assesses the quality of those services

Question 14

States are required to

Accepted Answer

provide Medicaid coverage for people who receive federally assisted income-maintenance payments

Question 15

Preauthorization guidelines

Accepted Answer

include elective inpatient admission

Question 16

States may require

Accepted Answer

small deductibles, coinsurance or copayments for certain services performed

Question 17

Services covered by both Medicaid and Medicare?

Accepted Answer

Medicare pays first and Medicaid pays the difference. Medicaid is ALWAYS the payer of last resort

Question 18

In many cases, Medicaid eligibility will depend on

Accepted Answer

the patient's monthly income

Question 19

Medicaid is

Accepted Answer

jointly funded by the state and federal governments

Question 20

Each state administers it's own Medicaid program and the

Accepted Answer

CMS (Centers for Medicare and Medicaid Services) monitors the programs

Question 21

Categorically needy Medicaid eligibility groups are not

Accepted Answer

necessarily entitled to nursing facility services for individuals under age 21

Question 22

The BBA allows

Accepted Answer

states to provide 12 months of continuous Medicaid coverage (without reevaluation) for eligible children under the age of 19 years old

Question 23

Medicaid operates as

Accepted Answer

a vendors and fee for service payment system

Question 24

Medicaid-covered services must be recognized as

Accepted Answer

the prevailing standard and consistent with generally accepted professional medical standards of the provider's peer group

Question 25

Providers receive reimbursement from

Accepted Answer

Medicaid on a lump sum basis- several claims are paid at on time

Question 26

Retroactive eligibility

Accepted Answer

is sometimes granted to patients who had high medical expenses before filling for Medicaid

Question 27

Emergency and Family Planning services are

Accepted Answer

exempt from copayments

Question 28

There is a limit on

Accepted Answer

the amount that a non-contract provider, physician, or other entity can charge a PACE participant

Question 29

Medicaid PARs ( participating providers)

Accepted Answer

have to accept the Medicaid payment as payments in full

Question 30

The Medicaid Eligibility Verification System

Accepted Answer

allows providers to electronically access the state eligibility file

Question 31

States must provide

Accepted Answer

home health services to beneficiaries who are entitled to receive nursing facility services

Question 32

Federal Medical Assistance Percentage

Accepted Answer

the portion of the Medicaid program paid by the federal government

Question 33

Dual eligible

Accepted Answer

refers to individuals entitled to Medicare and eligible for some type of Medicaid services

Question 34

The federal government reimburses states

Accepted Answer

100% of the cost of services provided through facilities of the Indian Health Service

Question 35

Spend down to Medicaid eligibility is

Accepted Answer

used for the medically needy

Question 36

EPSDT

Accepted Answer

routine pediatric checkups for all children enrolled in Medicaid

Question 37

Mother/baby claim refers to

Accepted Answer

services provided to a baby under the mother's ID number

Question 38

PACE

Accepted Answer

alternative care for people 55 or older who require nursing facility level care

Question 39

Community Spouse

Accepted Answer

spouse who is not in nursing home

Question 40

Voided claim

Accepted Answer

a deduction is taken from the lumps-sum payment made to provider

Question 41

Medicaid Remittance Advice

Accepted Answer

Shows the current status of all claims

Question 42

MCCA

Accepted Answer

prevents married couples from being required to spend down

Question	Answer
Medicaid eligibility is limited to people who fall into three coverage groups	1) Medically needy 2) Categorically needy 3) Special groups
Medicaid provides	medical and health-related services to individuals and families with low incomes ( indigent)
Spousal Impoverishment Protection Legislation of 1989	prevents married couples from being required to spend down income and other liquid assets before one of partners could be declared eligible for nursing care coverage
Medically necessary services	are not provided for the sake of anyone's convenience, regardless of whether it is the doctor or patient
TANF	Temporary Assistance to Needy Families
States are required to	extend Medicaid eligibility to all children born after 9/30/83 until they are 19 years old
TANF makes cash assistance available, for	a limited time, for children deprived of support due to parent's absence, death, incapacity or unemployment
TANF was previously known as	AFDC (Aid to families with Dependent Children )
SCHIP	State Children's Health Insurance Plan
SCHIP allows states to	create or expand existing insurance programs and provides more federal funds to states for the purpose of expanding Medicaid eligibility to include a greater number of children who are currently uninsured
Medi-Cal	is California's equivalent to the Medicaid program
Medicaid began in	1965
Surveillance Utilization Review System	Safeguards against unnecessary or inappropriate use of Medicaid services or excess payments and assesses the quality of those services
States are required to	provide Medicaid coverage for people who receive federally assisted income-maintenance payments
Preauthorization guidelines	include elective inpatient admission
States may require	small deductibles, coinsurance or copayments for certain services performed
Services covered by both Medicaid and Medicare?	Medicare pays first and Medicaid pays the difference. Medicaid is ALWAYS the payer of last resort
In many cases, Medicaid eligibility will depend on	the patient's monthly income
Medicaid is	jointly funded by the state and federal governments
Each state administers it's own Medicaid program and the	CMS (Centers for Medicare and Medicaid Services) monitors the programs
Categorically needy Medicaid eligibility groups are not	necessarily entitled to nursing facility services for individuals under age 21
The BBA allows	states to provide 12 months of continuous Medicaid coverage (without reevaluation) for eligible children under the age of 19 years old
Medicaid operates as	a vendors and fee for service payment system
Medicaid-covered services must be recognized as	the prevailing standard and consistent with generally accepted professional medical standards of the provider's peer group
Providers receive reimbursement from	Medicaid on a lump sum basis- several claims are paid at on time
Retroactive eligibility	is sometimes granted to patients who had high medical expenses before filling for Medicaid
Emergency and Family Planning services are	exempt from copayments
There is a limit on	the amount that a non-contract provider, physician, or other entity can charge a PACE participant
Medicaid PARs ( participating providers)	have to accept the Medicaid payment as payments in full
The Medicaid Eligibility Verification System	allows providers to electronically access the state eligibility file
States must provide	home health services to beneficiaries who are entitled to receive nursing facility services
Federal Medical Assistance Percentage	the portion of the Medicaid program paid by the federal government
Dual eligible	refers to individuals entitled to Medicare and eligible for some type of Medicaid services
The federal government reimburses states	100% of the cost of services provided through facilities of the Indian Health Service
Spend down to Medicaid eligibility is	used for the medically needy
EPSDT	routine pediatric checkups for all children enrolled in Medicaid
Mother/baby claim refers to	services provided to a baby under the mother's ID number
PACE	alternative care for people 55 or older who require nursing facility level care
Community Spouse	spouse who is not in nursing home
Voided claim	a deduction is taken from the lumps-sum payment made to provider
Medicaid Remittance Advice	Shows the current status of all claims
MCCA	prevents married couples from being required to spend down

"Know" box contains:
Time elapsed:
Retries:

Chapter 15