Upgrade to remove ads
SPH 273 PART V
Terms in this set (19)
Medicaid covers a broad range of the U.S. population, i.e., 76 million enrollees in 2016 -- 20% of all Medicare beneficiaries; 40% of non-elderly adults with substance use disorders; and 25% of California residents.
Medicaid "Categorical Eligibility" include Children, Pregnant women, Parents with dependent children, Aged, Blind, Disabled, and Others. Income eligibility are different for each category.
Children's Health Insurance Program [CHIP]" was launched in 1997 to expand children's health coverage for incomes above prior Medicaid limits, based on federal-state partnership.
Eligibility: varies by state, generally incomes up to 200% federal poverty level [FPL]. Federal Medical Assistance Percentage [FMAP; federal financial responsibility] of CHIP is higher than that of Medicaid.
CHIP+Medicaid cover nearly half of all children in US, achieving that 95% of children in US have coverage. Around 75% of remaining uninsured are eligible for Medicaid/CHIP .
Under the ACA, around half of the uninsured are eligible for financial assistance in 2017.
Healthcare Safety Net" includes multiple providers such as Charity care/Uncompensated care, Emergency Departments [EMTALA], Public and non-profit safety net hospitals, Community Health Centers, Rural Health Clinics, Free clinics, Walk-in/Pharmacy clinics, and Alternative/Complementary providers.
Safety net providers are critical for both uninsured and Medicaid populations
"Safety Net Hospitals" have a general mission of serving low-income, uninsured and other vulnerable populations. Their funding source is primarily federal, followed by state and local governments.
"Community Health Centers [CHC]" must be public or private non-profit, receiving federal support such as grants and "Enhanced Medicaid reimbursement."
Requirements for CHC are: Accept all comers; Community governance; Primary care services; Relationship with a hospital; and Health Professions Shortage Area/Medically Underserved Area/Population.
ACA substantially increased revenue sources for "Community Health Centers [CHCs]" and expanded number of CHC sites. Consequently, a large proportion of CHCs provide clinical services such as vision, dental, and mental health and substance use disorder.
Among all CHC patients in 2016, around 50% were Medicaid enrollees and around 25% were uninsured.
The basic foundations of Medicaid are related to the entitlement and the federal-state partnership. Federal sets core requirements on eligibility and benefits.
States have flexibility to administer the program within federal gridlines. Eligible individuals are entitled to a defined set of benefits. States are entitled to federal matching funds.
Medicaid benefits vary across states. Children have comprehensive coverage. "Long-term Services and Supports" include nursing facilities, and Home and Community-based Services.
Adults have acute care coverage. Adults optional benefits [varying across states] include prescriptions, vision, dental, and therapies. There are restrictions on premiums and cost-sharing.
Medi-Cal [Medicaid in California State] had a full expansion in 2014 to cover 13 million enrollees in total with $80+ billion state expenditures, ranked 48/50 in reimbursement [measured by the ratio to Medicare reimbursement].
About one sixth of enrollees are "elderly and disabled" who use 60% of the total expenditure.
YOU MIGHT ALSO LIKE...
HCS Ch 13,18,21
OTHER SETS BY THIS CREATOR
SPH 273 PART VII
SPH 273 PART VI
SPH 273 PART IV
SPH 273 PART III