Medicaid

In California, Medicaid is called

Medi - Cal.

Title XIX of the Social Security Act of 1965 established

Medicaid

The program that provides comprehensive alternative care for noninstitutionalized elderly who would otherwise be in a nursing home is known as

PACE - program of all inclusive care for the elderly.

Medicare beneficiaries who qualify for certain Medicaid benefits if they have incomes below the FPL and resources at or below twice the standard allowed under the SSI program are known as

QMB's - Qualified Medicare Beneficiaries.

Under the federal Medicaid guidelines, federal and state governments, must contribute what specified amount of total healthcare expenditures ?

The federal contribution is approximately 50 % the states pay the remaining costs.

Balance Billing is

billing the recipient for any amount not paid by Medicaid and is not allowed.

Medicaid's two major groups are

categorically needy, and medically needy.

Aged and /or disabled persons who are very poor are covered under both the Medicaid and Medicare programs, commonly referred to as

dual eligibles, and Medi - Medi .

Medicaid does not, as a rule process claims, individual states contract with an organization specializing in administering government healthcare programs, they are called

fiscal intermediaries "FIs" or fiscal agents.

The Deficit Reduction Act "DRA" of 2005 (introduced and clarified in the Tax Relief and Health Care Act of 2006)

gave states new flexibilities in their Medicaid programs, allowing them to impose cost sharing charges and premiums on certain categories of Medicaid recipients.

TANF - Temporary assistance for needy families

is the Medicaid federal / state cash assistance program for poor families , typically headed by a single parent.

In all cases Medicaid is the payer of

last resort, meaning that all other available third party resources must meet their legal obligation to pay claims before the Medicaid program.

Categorically needy individuals typically include

low income families with children, individuals receiving SSI, pregnant women, infants, and children with incomes less than a specified percent of the "FPL" federal poverty level.

Medicaid is a combination federal and state medical assistance program designed to provide medical care for

low income individuals and families, specifically children, pregnant women, the elderly, the disabled, and parents with dependent children.

People who have been denied Medicaid because of income level might qualify as

medically needy.

Medicaid coverage should be verified

no less than once a month.

When one state allows Medicaid beneficiaries from other states to be treated in its medical facilities, this exchange of privileges is referred to as

reciprocity.

The term used for the process of depleting private or family finances to the point that the individual / family becomes eligible for Medicaid assistance is called

spend down.

There are federally approved optional services for which federal funding is available,

states may provide as many or as few as they choose.

Medicaid is administered by

the Centers for Medicare and Medicaid Services "CMS" under the general direction of the Department of Health and Human Services "HHS".

SSI is a cash benefit program controlled by

the Social Security Administration.

During the late 1980's and early 1990's , Congress expanded Medicaid eligibility to include more categories of people,

the poor elderly, individuals with disabilities, children and certain categories of pregnant women.

Time limit for filing claims vary from state to state but are typically

two months to one year.

In 1972 federal law established the supplemental security income "SSI" program

which provides federally funded cash assistance to qualifying elderly and disabled poor.