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Who is Medicaid administered by?

the state government with partial federal funding

Who is eligible for Medicaid?

certain needy and low-income people such as elderly, blind, disabled,& families with children. Only available to U.S. citizens. Patients can be eligible one month and not the next.

What is categorically needy?

care provided to families, pregnant women, aged, disabled, and persons receiving institutional or long term care.

What is medically needy?

general assistance for medically indigent and low income people losing employer health coverage

What is the EPSDT program designed to do?

program of prevention, early detection, and treatment of welfare children who are under the age of 21

Know about the blocks on the claim form?

Medicaid has the least number of mandatory blocks to be completed on the CMS claim form

Know about Medicaid fraud?

each state has a fraud control unit that is federally funded. Investigates and prosecutes cases of fraud and other violations

When would you bill Medicaid if the patient has private insurance?

secondary, after primary has paid. Medicaid is always the payer of last resort

Are you able to bill a patient when a waiver of liability has been signed?

yes, as long as the patient has been informed and signed the waiver of liability

What are 3 programs Medicaid offers patients over 65?


What are the categorically needy groups?

families, pregnant women, aged, disabled, and persons receiving institutional or long-term care

What are the two copayment types?

fixed copay and share of cost (spend-down)

What are some conditions for a MCHP to qualify?

cerebral palsy, clubfoot, cleft lip, cleft palate, and chronic conditions affecting bones or joints

Who is responsible for the guidelines of Medicaid?

CMS (Centers for Medicare and Medicaid Services)

What is reciprocity?

applies when the patient obtains services while out of the state where he/she receives benefits. Contact Medicaid Intermediary in patient's own state.

What year did Medicaid begin?


Can a physician refuse to treat a Medicaid patient?

yes, they may accept or refuse patients, but the decision has to be based on the Medicaid program and not the patient's situation

What is capitated?

moneys paid on monthly basis

What is fee-for-service?

money is reimbursed for every service performed

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