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MODULE 4 Flashcards

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1
Q

WHO FUNDS MEDICAID?

A

STATE & FEDERAL GOVERNMENT

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2
Q

WHO DOES MEDICAID PROVIDE COVERAGE FOR?

A

LOW INCOME CHILDREN, PARENTS / CAREGIVERS, PREGNANT WOMEN, AGED, BLIND, DISABLED

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3
Q

WHAT IS CHIP?

A

CHILDREN’S HEALTH INSURANCE PROGRAM - CREATED FOR CHILDREN WITH FAMILY INCOME TOO HIGH TO QUALIFY FOR MEDICAID

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4
Q

WHO DOES HIP COVER?

A

UNINSURED ADULTS 19-64 WITH UP TO 100% FPL

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5
Q

WHAT ARE THE PLAN FEATURES OF HIP?

A
  1. BASIC COMMERCIAL COVERAGE
  2. ANNUAL DEDUCTIBLE OF $1100 PER YEAR
  3. $500 IN PREVENTATIVE SERVICES COVERED BY INDIANA
  4. CO-PAYS FOR NON-EMERGENCY USE OF THE EMERGENCY ROOM.
  5. P.O.W.E.R. ACCOUNT - PERSONAL WELLNESS & RESPONSIBILITY ACCOUNT WHICH FUNDS THE DEDUCTIBLE USING BOTH STATE AND INDIVIDUAL CONTRIBUTIONS (2% OF INCOME)
  6. EMPLOYERS & NON-PROFITS CAN HELP WITH CONTRIBUTIONS
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6
Q

WHAT IS AN MCE?

A

MANAGED CARE ENTITY?

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7
Q

WHAT ARE THE THREE MCE’S FOR HHW & HIP?

A

MDWISE, ANTHEM AND MHS

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8
Q

HOW IS A MCE SELECTED?

A

ON THE APPLICATION, OR AUTO ASSIGNED 14 DAYS AFTER ENROLLMENT

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9
Q

HOW IS A PCP CHOSEN?

A

INDIVIDUALS CAN CHOOSE OR THEY WILL BE ASSIGNED ONE

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10
Q

WHAT IS CARE SELECT?

A

A PLAN FOR MEDICAID ENROLLEES WITH SPECIAL HEALTH NEEDS OR CHRONIC ILLNESSES

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11
Q

WHAT ARE SOME CATEGORIES OF ENROLLEES WHO WOULD HAVE CARE SELECT?

A

AGED, BLIND, DISABLED
WARD OF THE COURT
FOSTER CHILD
CHILD RECEIVING ADOPTION SERVICES

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12
Q

WHAT IS THE GOAL OF CARE SELECT?

A

TO COORDINATE CARE AND HELP TO MANAGE THE DISEASE

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13
Q

WHAT ARE SOME EXAMPLES OF QUALIFYING CONDITIONS FOR CARE SELECT?

A

ASTHMA, DIABETES, CONGESTIVE HEART FAILURE, CORONARY HEART DISEASE, COPD, HYPERTENSION, CHRONIC KIDNEY DIALYSIS, SEVERE MENTAL ILLNESS, SEVERE EMOTIONAL DISTURBANCE, DEPRESSION

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14
Q

WHAT IS A CMO?

A

CARE MANAGEMENT ORGANIZATION

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15
Q

WHO COORDINATES CARE FOR CARE SELECT?

A

CMO’S

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16
Q

WHAT POPULATIONS ARE COVERED BY TRADITIONAL MEDICAID?

A
  1. AGED, BLIND, DISABLED
  2. ADULTS RECEIVING WAIVERS OR ELIGIBLE DUE TO BREAST OR CERVICAL CANCER
  3. CHILDREN IN PSYCHIATRIC FACILITIES OR TITLE IV-E FOSTER CARE OR ADOPTION CARE CHILDREN
  4. REFUGEES WHO DON’T QUALIFY FOR ANOTHER CATEGORY.
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17
Q

WHAT IS M.E.D. WORKS ?

A

MEDICAID FOR EMPLOYEES WITH DISABILITIES

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18
Q

WHAT ARE THE CRITERIA FOR M.E.D. WORKS?

A
  1. MUST BE WORKING AND DISABLED
  2. 16-64
  3. BELOW 350% FPL
  4. BELOW ASSET LIMIT (SINGLE - $2000; COUPLE - $3000)
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19
Q

WHAT ARE THE BENEFITS OF M.E.D. WORKS?

A

RECEIVE FULL MEDICAID BENEFITS AND CAN ALSO HAVE EMPLOYER INSURANCE IF APPLICABLE.

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20
Q

WHAT IS HCBS?

A

HOME AND COMMUNITY BASED SERVICE WAIVER

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21
Q

WHAT DOES A WAIVER DO?

A

KEEPS INDIVIDUALS IN THEIR HOMES RATHER THAN NEEDING TO GO TO AN INSTITUTION BY PROVIDING HOME-BASED SERVICES.

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22
Q

WHAT ARE THE ELIGIBILITY CRITERIA FOR WAIVERS?

A
  1. INCOME LESS THAN 300 % SSI BENEFIT
  2. INCOME LESS THAN $2130/ MO AS OF 1/1/13
  3. MEETS “LEVEL OF CARE” - MEDICAL CONDITION, INTELLECTUAL DISABILITY
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23
Q

WHAT IS THE GOAL OF THE MEDICAID FAMILY PLANNING PROGRAM?

A
  1. PREGNANCY PREVENTION / DELAY
  2. PROVIDE FAMILY PLANNING SERVICES & SUPPLIES
  3. CITIZENSHIP / IMMIGRATION ELIGIBILITY REQUIREMENTS
  4. NOT PREGNANT
  5. NOT HAD A HYSTERECTOMY
  6. NOT HAD A STERILIZATION PROCEDURE
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24
Q

WHAT IS THE GOAL OF A SPEND DOWN?

A

TO ASSIST INDIVIDUALS WHO HAVE HIGH MEDICAL NEEDS BUT DO NOT MEET MEDICAID ELIGIBILITY REQUIREMENTS

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25
HOW DO YOU BECOME ELIGIBLE FOR A SPEND DOWN?
1. INCOME TOO HIGH FOR MEDICAID | 2. MEET OTHER MEDICAID CRITERIA: AGE, BLINDNESS, DISABILITY
26
WHAT IS THE GOAL OF THE BREAST & CERVICAL CANCER PROGRAM?
PROVIDE COVERAGE TO WOMEN WHO HAVE BREAST OR CERVICAL CANCER
27
HOW DOES A WOMAN BECOME ELIGIBLE FOR THE BREAST & CERVICAL CANCER PROGRAM?
DIAGNOSED THROUGH THE INDIANA DEPT OF HEALTH BREAST & CERVICAL CANCER SCREENING PROGRAM OR ``` AGE 19-64 NOT OTHERWISE ELIGIBLE FOR MEDICAID INCOME LESS THAN 200% NEED TREATMENT FOR THE CANCERS NO HEALTH INSURANCE THAT COVERS THESE TREATMENTS ```
28
WHAT ARE THE ELIGIBILITY REQUIREMENTS FOR CHILDREN IN THE HHW PROGRAM?
AGES 0-19 | INCOME UP TO 250% FPL
29
WHAT ARE THE REQUIREMENTS FOR FORMER FOSTER CHILDREN TO BE ENROLLED IN MEDICAID?
FOR AGES 18-21 - UP TO 210% FPL | FOR AGES 18-25 - NO INCOME REQUIREMENTS; ENROLLED IN MEDICAD ON 18TH BIRTHDAY
30
WHAT ARE THE REQUIREMENTS FOR PARENTS AND CARETAKERS TO BECOME ELIGIBLE FOR MEDICAID?
MUST BE CARETAKER OF DEPENDENT CHILD; UP TO 250% OF FPL
31
HOW CAN PREGNANT WOMEN BECOME ELIGIBLE FOR MEDICAID
INCOME UP TO 208% OF FPL | PREGNANT
32
HOW OLD MUST CHILDREN BE TO QUALIFY FOR MEDICAID IF THEY ARE IN A CERTIFIED PSYCHIATRIC FACILITY? ARE THERE INCOME REQUIREMENTS?
19-21 | YES. 250%
33
HOW LONG CAN CHILDREN RECEIVE MEDICAID UNDER THE ADOPTION ASSISTANCE PROGRAM?
UNDER AGE 19
34
HOW LONG CAN FOSTER CHILDREN RECEIVE MEDICAID?
UNDER 19 | CURRENT FOSTER CHILD
35
WHAT ARE THE INCOME LIMITS FOR AGED, BLIND, DISABLED?
$1066 MARRIED / MO | $710 SINGLE
36
WHAT CONSTITUTES "AGED"?
65
37
HOW DO YOU QUALIFY UNDER THE "BLIND" CATEGORY?
MEETS DEFINITION OF BLINDNESS OR RECEIVES SSI OR SSDI FOR BLINDNESS
38
WHAT ARE THE QUALIFICATIONS FOR M.E.D. WORKS?
UP TO 350% FPL 16-64 MEET DEFINITION OF DISABILITY
39
WHAT IS THE INCOME LIMIT FOR HIP?
100%
40
WHAT IS THE INCOME LIMIT FOR FAMILY PLANNING?
141%
41
WHAT IS THE INCOME LIMIT FOR MEDICARE SAVINGS PROGRAM QMB (PART A)
100%
42
WHAT IS THE INCOME LIMIT FOR MEDICARE SAVINGS PROGRAM SLMB (PART A)
120%
43
WHAT IS THE INCOME LIMIT FOR MEDICARE SAVINGS PROGRAM QI (PART A)
135%
44
WHAT IS THE INCOME LIMIT FOR MEDICARE SAVINGS PROGRAM QDW (PART A DUE TO EMPLOYMENT STATUS)
200%
45
WHAT ARE THE CITIZENSHIP REQUIREMENTS FOR MEDICAID?
US CITIZENS US NON-CITIZEN NATION LAWFUL PERMANENT RESIDENTS ELIGIBLE FOR FULL MEDICAID AFTER 5 YEARS
46
WHAT ARE SOME EXCEPTIONS TO THE CITIZENSHIP RULES?
MEDICARE ENROLLEES FOSTER CARE KIDS RECEIVING SSI OR SSDI NEWBORNS WITH A MOM ON MEDICAID
47
ALL MEDICAID APPLICANTS MUST PROVIDE A SSN UNLESS...
``` NOT ELIGIBLE TO RECEIVE A SSN DON'T HAVE A SSN RELIGIOUS REASONS ONLY ELIGIBLE FOR EMERGENCY SERVICES NEWBORN RECEIVING REFUGEE CASH ASSISTANCE ALREADY APPLIED FOR SSN. NO NUMBER YET ```
48
WHAT OTHER BENEFITS MUST BE APPLIED FOR AS A REQUIREMENT TO THE MEDICAID APPLICATION?
``` PENSIONS FROM LOCAL, STATE, FEDERAL GOV'T RETIREMENT BENEFITS DISABILITY SOCIAL SECURITY BENEFITS VA BENEFITS UNEMPLOYMENT MILITARY BENEFITS RAILROAD BENEFITS WORKER'S COMP BENEFITS HEALTH & ACCIDENT INSURANCE BENEFITS ```
49
IF AN APPLICANT HAS ANOTHER INSURANCE AND IS APPROVED FOR MEDICAID, WHICH IS BILLED FIRST?
THE OTHER INSURANCE. MEDICAID IS ALWAYS LAST EXCEPT IN THE CASE OF CSHCS.
50
WHAT IS MAGI?
STANDARDIZED INCOME COUNTING ACROSS ALL STATES
51
WHO IS EXEMPT FROM MAGI?
AGED, BLIND, DISABLED
52
HOW IS MAGI COMPUTED?
COUNT TAXABLE INCOME FOR TAX FILER, ALL TAX DEPENDENTS (MAY INCLUDE STEP-PARENTS, CHILDREN, SIBLINGS) DO NOT COUNT ASSETS, NON-TAXABLE INCOME
53
WHO IS NOT REQUIRED TO USE MAGI?
``` AGED, BLIND, DISABLED NEED LONG TERM CARE BREAST & CERVICAL CANCER PROGRAM RECIPIENTS FORMER FOSTER CHILDREN UNDER 26 MEDICARE COST-SHARING APPLICANTS NEWBORNS ```
54
WHAT INCOME WILL COUNT FOR THOSE NOT USING MAGI?
THE CURRENT INCOME COUNTING RULES | CERTAIN ASSETS
55
WHAT PROVISIONS ARE MADE FOR THE SPOUSE OF SOMEONE WHO IS IN A NURSING HOME TO HAVE RESOURCES TO LIVE ON?
COMMUNITY SPOUSE MAY KEEP ALL PERSONAL INCOME MAY KEEP 1/2 JOINTLY OWNED ASSETS IF THIS AMT IS LESS THAN $1939, MAY KEEP SOME OF INSTITUTIONALIZED SPOUSE'S INCOME
56
HOW WILL INDIANA APPLICATIONS FOR HEALTH COVERAGE BE ACCEPTED?
``` ONLINE PHONE FAX MAIL IN PERSON AT DFR ```
57
STARTING IN OCTOBER, HOW WILL PV'S BE HANDLED?
NAVIGATORS WILL BE ABLE TO VERIFY ELIGIBILITY IN MOST CASES ELECTRONICALLY AND ONLY HAVE TO ASK APPLICANTS FOR PAPER DOCUMENTS WHEN THE ELECTRONIC DATA IS INCONSISTENT WITH THE APPLICATION
58
WHAT IS PRESUMPTIVE ELIGIBILITY?
FSSA AUTHORIZES HEALTH CARE PROVIDERS TO ASK UNINSURED PATIENTS TO SCREEN POTENTIAL MEDICAID RECIPIENTS QUESTIONS TO COMPLETE A PE APPLICATION. IF THE PATIENT MEETS THE PE REQUIREMENTS FOR MEDICAID, THEY ARE CONSIDERED PRESUMPTIVELY ELIGIBLE FOR MEDICAID. THE QP IS PAID FOR SERVICES AND THE PATIENT COMPLETES THE APPLICATION FOR HEALTH CARE COVERAGE. IF ELIGIBLE, COVERAGE CONTINUES, IF NOT, COVERAGE WILL END
59
WHAT CATEGORIES OF PEOPLE WILL PE COVER?
CHILDREN UNDER 19 LOW INCOME PARENTS/CARETAKERS FAMILY PLANNING ELIGIBLE FORMER FOSTER CARE CHILDREN UP TO 26
60
WHAT ITEMS CAN BE APPEALED?
TERMINATION OF BENEFITS SUSPENSION OF BENEFITS REDUCTION OF BENEFITS
61
HOW OFTEN IS REDETERMINATION?
EVERY 12 MONTHS
62
HOW IS REDETERMINATION DONE?
STATE CHECKS ELECTRONIC DATA, IF THERE IS ENOUGH INFORMATION TO RENEW, COVERAGE IS RENEWED, IT IS, IF NOT, ENROLLEE IS CONTACTED.
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