UHI Medicaid
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| TANF | Temporary Assistance for Needy Families
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| TANF was formally known as | AFDC (aid to families & dependent children)
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| EPSDT | Early & Periodic Screening Diagnostic & Treatment
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| SCHIP | State Children's Health Insurance Program
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| OMB | Qualified Medicare Beneficiaries
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| SSI | Supplemental Security Income
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| FMAP | Federal Medical Assistance Percentage
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| What is the differecne between Medicaid and TNAF? | TNAF is food and cash assistance, Medicaid is Medical insurance
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| When do Medicaid patients pay out of pocket? | Non covered monthly insurance premiums, out of pocket expenses, deductiable & copays
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| What is a Community Spouse? | the spouse of a nursing home patient left at home
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| What is Medi-Medi | duel elibible, patient has both Medicare and Medicaid.
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| How is eligibility determined for Medicaid at the provider's office? | MEV (Medicaid eligibility Verification)
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| What are the 3 types of MEV? | point of sale, computer software, automated voice response
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| When do you verify the patient's Medicaid eligibility? | Each time they receive services
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| When must hospitalizations be preauthorized? | when they are non emergency
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| Who receives the payment the patient or provider? | provider
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| Medicaid what implemented in what year | 1965
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| Medicaid is jointly funded by whom? | federal & the state
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| What are the three groups covered under Medicaid? | Categorically needy, Medically needy & Special groups
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| Categorically needy medicaid eligibility groups are not nescessarily entitled to | nursing facility services for inividuals under the age of 21
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| medicaid operates as an what type of payment system? | Vendor & fee for service
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| What types of services are exempt from copayments from Medicaid recipients? | Emercency & Family planning
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| The portion of Medicaid program paid by the federal government is known as the | Federal Medical Assistance Percentage
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| Medicaid is always either the what payer? | secondary payer or payer of the last resort
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| Any provider who accepts a Medicaid patient must accept the Medicaid-determined payment as | payment in full
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| How do providers received reimbursement form Medicaid? | Lump sum, several claims at once, Medicaid Remittance Advice
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| Medically needy | spend down on Medicaid eligibility
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| Safeguards agains inappropriae use of Medicaid services | Surveillance and utilization review system
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| PACE | Alternative care for persons aged 55 or older who require nursing facility level care
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| MCCA | prevents married couples from being required to spend down
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| Deduction from lump-sum payment made to provider | voided claim
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| adjustment in the lump-sum payment made to provider due to elegilibity of the patient | adjusted claim
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| Services provided to a baby under mother's ID number | Mother/baby claim
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| who is eligable | families with incomes at or below the federal poverty level, until they reach 19 years old
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| who do you contact for Medicaid laws and or questions (Fiscal Agent)? | local county government
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| Persumptive Eligilibity | benifit that allows individuals to be enrolled in Medicaid for a limited time before the application is filed and processed
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| Who mandated Medicare and who administeres it | Federally mandated, state administered
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| Within federal guidelines each state does what? | establishes eligibility standards, determines the type amount duration and scope of services, sets rates of payment for services and administers its own program
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| are each states programs the same | no, each state determines their own programs
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| Categorically Needy Groups | TANF, pregnant women and children under 6, caregivers, SSI recipients, Individuals and couples living in medical institutions
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| Medically Needy Program | Spend down (per month deductable), pregnant women through 60 days postpartum, children under 18, newborns for 1 year, blind persons
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| Qualified Medicare beneficiary (QMB) | state pays Medicare premiums, deductable and coinsurance amounts for those under the poverty level
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| Qualified working disabled individuals (QWDI) | state pays Medicare Part A premimums for individuals under the federal poverty level
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| Specified low-income Medicare beneficiary (SLMB) | state pays Medicare Part B premiums
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| State Children's Health Insurance Program (SCHIP) | state creat or expand existing insurance progrsm providing more federal funds to states to include a greater bnumber of uninsured children
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| Special Groups | QMB, QWDI, SLMB
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| Medicare Catastrophic Coverage Act of 1988 (MCCA) | implemented spousal impovershment protection to prevent married couples form beign required to spend down income and other liquid assets (cash & property) before one of the partners could be declaired eligible for Medicaid coverage for nurshing home care
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| To receive federaly matching funds the state must offer what service? | Family planning services & supplies
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| Who is a participating provider? | any provider who accepts a medicaid patiens must accept the Medicaid determined paymetn as payment in full
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| Monthly Survey letter | random survey requesting verification of services paid the parevious month
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| What would cause a patient to be eligible one month and not the next? | change in income
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| What must be attached to the Medicaid claim when there is a primary insurance? | Remittance advice from the primary coverage
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| How long is an infant of a Medicaid mother automatically eligible for Medicaid? | the first year of life
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| When claims are submitted under mother's id number coverage is limited to how long. | first 10 days of life
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| how many claim forms must be submitted for a birth? | two, one for mother and one form infant using mother's id #
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