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Ross medicaid test

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
AFDC Aid to Families with Dependent Children
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
What are special groups? Qualified Medicare Beneficiaries(QMB) Qualified Working Disabled Individuals(QWDI) Qualifying Individual(QI) Specified Low-Income Medicare Beneficiaries(SLMB)
What are the three Specific Medical Conditions? Women who have breast cancer or cervical cancer. Individuals diagnosed with TB who are unisured.
What are Participating Providers not allowed to do? Balance Billing.
FMAP Federal Medical Assistance Percentage.
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.
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.
manditory services for the Categorically needy? Medical supplies and appliances; nurse mid-wife services Pregnancy related services 60 days postpartum pregnancy relted services
EPSDT Early and periodic Screening diagnostic and treatment services including dental, hearing screening, and vision services
Confirming Medicaid Eligibility Monthly income. Medicaid verification line-phone POS device(like a credit card machine) Internet EVERY TIME
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
SCHIP State Childrens Health Isurance Program
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
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
Medicaid Eligibility Groups Categorically Needy Medically Needy Special Groups
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
SLMB Specified low-income medicare beneficiary pay MC part B 100-120% FPL
QI Qualifying Individuals Pays MC part B 120-175% FPL
QMB Qualified Medicare Beneficiaries Pays MC premiums 100% FPL
QWDI Qualified working Disabled individuals Pays MC Part A 200% FPL
TANF Temporary Assistance for Needy Families
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.
Created by: 1324061123
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