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MED112 CODE/BILL
MED112 KEY TERMS CH 10
| Term | Definition |
|---|---|
| MED112 CH 10 KEY TERMS | |
| categorically needy | A person who receives assistance from government programs such as Temporary Assistance for Needy Families (TANF). |
| Children’s Health Insurance Program (CHIP) | Program offering health insurance coverage for uninsured children under Medicaid. |
| crossover claim | Claim for a Medicare or Medicaid beneficiary; Medicare is the primary payer and automatically transmits claim information to Medicaid as the secondary payer. |
| dual-eligible | A Medicare-Medicaid beneficiary. |
| Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) | Medicaid’s prevention, early detection, and treatment program for eligible children under the age of twenty-one. |
| Federal Medicaid Assistance Percentage (FMAP) | Basis for federal government Medicaid allocations to individual states. |
| Medicaid Integrity Program (MIP) | Program created by the Deficit Reduction Act of 2005 to prevent and reduce fraud, waste, and abuse in Medicaid. |
| MediCal | California’s Medicaid program. |
| medically needy | Medicaid classification for people with high medical expenses and low financial resources, although not sufficiently low to receive cash assistance. |
| Medi-Medi beneficiary | Person who is eligible for both Medicare and Medicaid benefits. |
| payer of last resort | Regulation that Medicaid pays last on a claim when a patient has other insurance coverage. |
| restricted status | A category of Medicaid beneficiary. |
| spenddown | State-based Medicaid program requiring beneficiaries to pay part of their monthly medical expenses. |
| Temporary Assistance for Needy Families (TANF) | Government program that provides cash assistance for low-income families. |
| Welfare Reform Act | Law that established the Temporary Assistance for Needy Families program in place of the Aid to Families with Dependent Children program and that tightened Medicaid eligibility requirements. |
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