Medicaid/CHIP Exam Study Questions

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Medicaid/CHIP Exam Study Questions State Children's Health Insurance Program (CHIP) - ✔✔a means-tested, block grant program established in 1997 designed to provide health insurance to low income ... children whose family is income is above the eligibility for Medicaid in their state Medicaid - ✔✔Federal-state entitlement program for the indigent (very poor) Block grant - ✔✔a defined sum of money that is allocated for a particular program (often but not always from the federal government to the states) over a certain amount of time. i.e. CHIP Is CHIP and entitlement or a block grant program? - ✔✔a block grant program Who does Medicaid cover?* - ✔✔low income pregnant women, children, adults with dependent children, the disabled, and the elderly Means Testing* - ✔✔You must meet certain income requirements in order to participate based around the federal poverty line Federal Poverty Line* - ✔✔A numeric amount that if a person makes below it you are considered to be in poverty based on household size and income; Originally calculated based on the cost of food Who does CHIP cover? - ✔✔low income children who are under age 19 with no health insurance, and who would not have been eligible for Medicaid under the federal and state rules in effect when CHIP was first initiated in 1997 (whose family is income is above the eligibility for Medicaid in their state); AND pregnant women How is CHIP financed? - ✔✔Federal (from general/non-earmarked taxes) appropriations divided among all states (2 year allotment) based on the number of low income children and the cost of care per state (FMAP+) - match funds range from 88% to 100% for the poorest states; AND state funds How is Medicaid financed?* - ✔✔through a matching payment system that divides the amount paid by the federal and state governments - the matching rate (Federal Medical Assistance Percentage) is determined by each state's per capital income; AND some beneficiary copayments, co-insurance, and premiums Who runs the Medicaid program? (Macroorganization) - ✔✔jointly operated by state and Federal - Centers for Medicare and Medicaid Services (CMS) and state Medicaid agency; state participation is optional; managed care federal medical assistance percentage (FMAP) - ✔✔formula used to determine how much states get reimbursed for medicaid program spending - based on the state's income (range 50-73%) Who is eligible for Medicaid? - ✔✔1. Categorical: pregnant, children, adults with dependent children, disabled, elderly 2. Income: limit based on federal poverty line 3. Resources: limits on non-wage assets (car) 4. Residency: US resident, resident of state giving benefit 5: Immigration: at least 5 years residency 6: Medically Needy: high medical expenses; based on spend down (only some states) What does Medicaid cover (very generally)?* - ✔✔Set by federal and state, varies greatly fromstate to state; a combination of mandatory benefits and optional benefits - must be at least as generous as the essential health benefit package offered in the state exchanges Medicaid benefits - ✔✔Acute care, physician services, lab and x-ray services, inpatient hospital, outpatient hospital, screening, diagnostics, treatment, family planing, midwife, pediatrics, long tern care, tobacco cessation What does CHIP cover (very generally)?* - ✔✔benefits are undefined; must use a benchmark package - limited basic services are required. ACA Medicaid expansion* - ✔✔** eligibility expanded to include individuals and families with incomes up to 133% of the federal poverty level, including adults without disabilities and without dependent children; also provides for a 5% "income disregard", making the effective income eligibility limit for Medicaid 138% of the poverty level. Deficit Reduction Act of 2005 (DRA) - ✔✔gives the state options for significant changes to Medicaid benefit and cost-sharing rules; benchmark packages, reduced state requirements; state option to impose and enforce higher cost sharing Medicaid Waiver - ✔✔provides additional flexibility for states vi application to waive certain requirments Children's Health Insurance Program Reauthorization Act (CHIPRA) - ✔✔Passed by congress in 2009 to extend the CHIP program and is funding through 2013 [Show More]

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