Government Health Insurance Programs

Vignette

A short, descriptive story presenting Governor Jadyn's dilemma over the burden of Medicaid expansion, health insurance exchange establishment, and state resources allocation.

federal poverty level (FPL)

Annual income threshold based on family size, used to determine Medicaid eligibility.

CHIP

Children's Health Insurance Program providing coverage for uninsured children in families with moderate incomes, with states having flexibility in program design.

EPSDT

Early and Periodic Screening, Diagnostic, and Treatment package of benefits for Medicaid beneficiaries younger than 21 years, providing preventive care and early treatment.

Medicare

Federal health insurance program for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.

Indian Health Service

Federal health services provider for American Indians and Alaska Natives.

entitlement programs

Government programs where all eligible individuals have a legal right to receive benefits without a cap on spending, posing open-ended budget obligations.

Medicaid

Jointly operated federal-state public health insurance program for low-income individuals and families, with unique eligibility rules and benefits for each state.

Patient Protection and Affordable Care Act (ACA)

Legislation altering Medicaid, CHIP, and Medicare, including significant Medicaid eligibility expansion and new Medicare benefits.

medically needy category

Medicaid option covering individuals with high medical expenses who earn too much to qualify otherwise, with a 'spend down' process for eligibility.

DRA Benchmark Plans

Options for states to set Medicaid benefits based on benchmark plans, including federal employee health benefits, state employee health plan, and largest commercial non-Medicaid HMO in the state.

employer-sponsored health insurance

Private health insurance provided by employers, offering flexibility in coverage design and selection, but lacking incentives to cover high-risk populations.

Ryan White Care Act

Program providing HIV/AIDS services to infected individuals and their families.

block grant programs

Programs with a defined sum of money allocated over a certain period, allowing additional funds if costs exceed, otherwise requiring program changes or termination.

immigration status

Requirement for immigrants to meet certain criteria, including having been in the country for at least 5 years, to be eligible for Medicaid.

categorical eligibility

Requirement for individuals to fit within a covered category, such as pregnant women, for Medicaid eligibility.

two-tier Medicaid program

Result of the ACA expansion, creating different eligibility, financing, and benefit rules for newly eligible individuals compared to traditional Medicaid beneficiaries.