Deck 13: Medicaid and Other State Programs

Question 1

DEFRA and CHAP were responsible for

A) reducing Medicaid-covered services.
B) decreasing the number of people covered by Medicaid.
C) expanding Medicaid eligibility requirements.
D) changing the way the Medicaid program is administered.

Answer 1

expanding Medicaid eligibility requirements.

Question 2

The Medicaid program was a direct result of

A) funds provided by the Federal Emergency Relief Administration.
B) a law passed by the U.S. Congress in 1950.
C) the Social Security Act of 1935.
D) Title XIX of the Social Security Act.

Answer 2

a law passed by the U.S. Congress in 1950.

Question 3

The Omnibus Budget Reconciliation Act

A) helped set up a Medicaid fund for each state.
B) provided assistance for the blind who are below the poverty level and who are covered under the Medicare program.
C) provided assistance for the aged and disabled who are receiving Medicare and whose incomes are below the poverty level.
D) set up counseling centers for those on Medicaid and Medicare.

Answer 3

provided assistance for the aged and disabled who are receiving Medicare and whose incomes are below the poverty level.

Question 4

The Federal Emergency Relief Administration made funds available to pay for

A) food and living expenses of the needy unemployed.
B) food and living expenses of the needy employed.
C) medical expenses of the needy unemployed.
D) medical expenses of the needy employed.

Question 5

If a physician accepts Medicaid patients, the physician must accept

A) the Medicaid-allowed amount.
B) the Medicare-allowed amount.
C) an amount equal to his or her regular fee schedule.
D) the Medicaid-allowed amount plus 20%, which may be collected from the patient.

Question 6

The Medicaid service for prevention, early detection, and treatment for welfare children is known as

A) CHPS.
B) EPSDT.
C) EPDT.
D) CHAP.

Question 7

Medicaid was legally established by Title ____________________ of the Social Security Act.

Question 8

The medically needy aged

A) require help in meeting costs of medical care.
B) qualify for cash assistance.
C) are classified as those with extremely low income.
D) qualify for housing assistance.

Question 9

The abbreviation for the Deficit Reduction Act of 1984 is ____________________.

Question 10

To control escalating health care costs by curbing unnecessary emergency department visits and emphasizing preventive care, Medicaid reform has involved

A) increased state funding.
B) increased federal funding.
C) managed care programs.
D) fee-for-service programs.

Question 11

Basic Maternal and Child Health Program (MCHP) provisions offered in all states include

A) children with handicap needs who require orthopedic treatment or plastic surgery.
B) children with hearing problems.
C) children with mental retardation.
D) children with paralyzed muscles.

Question 12

The time limit to appeal a claim varies from state to state, but it is usually

A) 30-60 days.
B) 90-120 days.
C) 6 months.
D) 1 year.

Question 13

Medicaid eligibility must always be checked for the

A) month of service.
B) type of service.
C) year of service.
D) both a and b

Question 14

State Children's Health Insurance Programs (SCHIPs)

A) operate with state funds.
B) operate with federal grant support under Title V of the Social Security Act.
C) operate through private donations solicited by volunteers.
D) are operational in only 25 states owing to lack of funds.

Question 15

Medicaid managed care patient claims should be sent to the

A) Medicaid fiscal agent or carrier.
B) state government office.
C) local Medicaid office.
D) managed care organization and not the Medicaid fiscal agent.

Question 16

Medicaid is administered by the

A) federal government.
B) federal government with partial state funding.
C) state government with partial federal funding.
D) state government.

Question 17

In the Medicaid program, Congress authorized vendor payments for medical care, which are payments from the

A) federal government directly to welfare recipients.
B) welfare agency directly to the physician.
C) welfare agency directly to welfare recipients.
D) state agency directly to welfare recipients.

Question 18

The Social Security Act of 1935

A) set up the public assistance programs.
B) made a special provision for medical assistance.
C) made a special provision for dental coverage.
D) set up the state medical programs.

Question 19

Medicaid is available to the needy and low-income people such as

A) the blind.
B) the disabled.
C) the aged (65 years or older).
D) all of the above.

Question 20

The federal aspects of Medicaid are the responsibility of the

A) AMA.
B) AHA.
C) HIAA.
D) CMS.

Question 21

Time limits for Medicaid claim submission can vary from ____________________ months to 1 year from the date of service depending on the state in which service was provided.

Question 22

The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act are federal legislation passed in _________________.

Question 23

Medicaid is not so much an insurance program as an assistance program.

Question 24

The federal government determines the payment for medical services in the Medicaid program.

Question 25

The ____________________ form accompanies all Medicaid payment checks.

Question 26

Most states have ____________________ for Medicaid payments if a patient requires medical care while out of state.

Question 27

Emergency care and pregnancy services are exempt by law from copayment requirements.

Question 28

Medicaid identification cards are usually issued every ____________________.

Question 29

TEFRA stands for Tax Equity and Financial Reimbursement Act.

Question 30

The Medicaid patient may be responsible for a copayment.

Question 31

It is possible for a Medicaid patient to be on Medicaid one month and off Medicaid the following month.

Question 32

Medicaid is an established program of medical assistance in 46 states.

Question 33

The group of Medicaid recipients referred to as ____________________ includes all cash recipients of the Aid to Families with Dependent Children, certain other AFDC-related groups, most cash recipients of the Supplemental Security Income program, and other SSI-related groups.

Question 34

The federal government financially supports the minimum assistance level of the medically needy aged, and the states must wholly support any part of the program that goes beyond the federal minimum.

Question 35

Some Medicaid recipients in the medically needy category must pay a coinsurance payment and/or deductible, also known as a/an ____________________, within the eligibility month before state benefits may be received.

Question 36

The Medicaid medical assistance program in California is called ____________________.

Question 37

The federal government designs the Medicaid program for each state on the basis of the needs of the state.

Question 38

The two Medicaid eligibility classifications are the ____________________ needy group and the ____________________ needy class.

Question 39

The _______________________________________ Law prevents the community spouse from being impoverished by his or her spouse's institutionalization in a nursing facility.

Question 40

Medicaid is administered by federal funding only.

Question 41

A physician may accept or refuse Medicaid patients on the basis of the individual patient and his or her circumstances.

Question 42

Medicaid patients in managed care plans must go to hospitals participating in their assigned plan.

Question 43

Family planning is a Medicaid basic benefit.

Question 44

When Medicaid and a third-party payer cover the patient, Medicaid is always the payer of last resort.

Question 45

The patient's Medicaid card must be checked each time the patient visits the physician's office to verify eligibility for month of service.

Question 46

In some cases the welfare office may grant retroactive eligibility to a patient.

Question 47

All states processing medical claims must bill using the CMS-1500 claim form.

Question 48

All state Medicaid programs operate with a fee-for-service reimbursement system.

Question 49

Home health care is never covered under Medicaid.

Question 50

Prior approval or authorization is never required in the Medicaid program.

Question 51

It is not possible for a person to be eligible for Medicaid benefits and also have additional group health insurance coverage.

Question 52

It is not possible for an immigrant to have Medicaid coverage.

Question 53

Managed care Medicaid programs usually save money in health care delivery.

Question 54

The gatekeeper in a Medicaid managed care program is the specialist to whom the patient is referred.

Question 55

If a service is totally disallowed by Medicaid, a physician is within legal rights to bill the patient.