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Medicaid provides medical and health realated services to individuals and families with low incomes.
States are not required to provide Medicaid coverage for individuals who receive federally assisted incomeaintenance payments.
States are required to extend Medicaid eligiability to all children born after September 30, 1983 until they reach age 19
The BBA allows states to provide 12 months of continuous Medicaid coverage (without reevaluation) for eligible children under the age of 19
Retroactive eligibility is never granted to paients who had hight medical expenses prior to filing for Medicaid.
States must provide home health services to beneficiaries who are entitled to receive nursing facility services.
There is no limit on the amount that a noncontract provider, physician, or other entity cab charge a PACE participant
States may not require nominal deductibles, coinsurance, or copayments for certain services performed.
Services covered by both Medicaid and Medicare are first paid by Medicaid and the difference is paid by Medicare
The Medicaid eligibilty verifaction system allows providers to electronically access the state's eligibility file
Medicaid - covered services must be recognized as the prevailing standard and consistent with generally accepted professional medical standards of the provider's peer group
Medically necessary services are furnished primarily for the convenience of the recipient or the provider.
Medicaid is jointly funded by the ______ and _____governments to assist states in providing adequate medical care to qualified individuals
Federal and State
The following would be covered under Medicaid
1. Categorically needy
2. Medically needy
3. Special Groups
Categorically needy Medicaid eligibility groups ARE NOT necessarily entitled to
nursing facility services for individuals under the age of 21
What type (s) of services are exempt form copayments from Medicaid recipients
Emergency and Family planning
The portion of the Medicaid program paid by the federal government is known as the
Federal Medical Assistance Percentage
The federal government reimburses states _____ of the cost of services provided through facilities of the Indian Health Service
Dual eligibles refers to
Individual entitled to Medicare and eligible for some type of Medicaid services
Any provider who accepts a Medicaid patient must accept the Medicaid determined payment as
Payment in Full
Surveillance and utilization review system
Safeguards against inappropriate use of Medicaid services
Part B Covers
Providers , Labs, Outpatient services, (DME) Durable Medical Equipment (Walkers) , therapy, Occupational, Physical , and Speech
Eligibiligy Wrecks 65D
Worked Eligible if they or spouse worked 10 years
ESRD - End Stage Renal Disease (Dialysis)
Civil service retirement a Medicare covered government employment
Kidney donor (during donation)
SS- Social Security
65 yrs, &US Citizens or perm resident
Disabled and on SSDI for 2 years
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