Deck 10: Medicaid

Question 1

The federal government requires states to offer Medicaid benefits to children whose family income is under __________ percent of the poverty level.

A) 100
B) 133
C) 115
D) 150

Answer 1

133

Question 2

In a spend-down program, beneficiaries are required to

A) none of these are correct.
B) they are not required to pay for any of their expenses.
C) pay for all of their monthly expenses.
D) pay part of their monthly expenses.

Answer 2

pay part of their monthly expenses.

Question 3

The Welfare Reform Act of_________ tightened Medicaid eligibility requirements.

A) 2008
B) 2000
C) 1996
D) 1990

Answer 3

1996

Question 4

Federal guidelines mandate coverage for individuals referred to as

A) categorically needy.
B) impoverished.
C) medically needy.
D) poor.

Question 5

FMAP is the basis for federal government Medicaid allocations to

A) physicians.
B) the states.
C) hospitals.
D) individual beneficiaries.

Question 6

State Medicaid programs must provide coverage for all of the following except

A) children's vaccines.
B) vision benefits.
C) freestanding birth center services.
D) transportation to medical care.

Question 7

Most states have shifted Medicaid beneficiaries into which type of plan?

A) health savings accounts
B) fee for service
C) managed care plans
D) none of these are correct

Question 8

What does the abbreviation SSI stand for?

A) Supplemental Security Insurance
B) Supplemental Security Income
C) Social Security Insurance
D) Social Security Income

Question 9

A person eligible for Medicaid in a given state is

A) also eligible in all states that border that state.
B) is not a relevant question because Medicaid is a federal program.
C) not necessarily eligible in all other states.
D) also eligible in any of the other 50 states.

Question 10

A Medi-Medi beneficiary's claim information is usually

A) sent to both Medicare and Medicaid at the same time to see which one will pay.
B) sent by Medicare to Medicaid as the secondary payer.
C) sent to both Medicare and Medicaid as only one will pay.
D) sent by Medicaid to Medicare as the secondary payer.

Question 11

The medical insurance specialist should check patients' Medicaid eligibility

A) at the time the bill is going to be sent.
B) after an insurance payment is made.
C) when the patient leaves the office.
D) each time an appointment is made.

Question 12

About what percentage of Medicaid recipients nationally are in managed care plans?

A) 33%
B) 84%
C) 50%
D) 67%

Question 13

Which of the following is not offered under the Medicaid program?

A) benefits for people who are age 65 and over who receive Supplemental Security Income
B) comprehensive health insurance coverage offered to pregnant women whose family income is below 133 percent of the poverty level
C) benefits for people who receive foster care under Title IV-E of the Social Security Act
D) benefits for infants born to Medicaid-eligible pregnant women

Question 14

Individuals receiving financial assistance under TANF due to low incomes and few resources must be covered

A) by a spouse's insurance program.
B) by state Medicaid programs.
C) by the Medicare program.
D) by an employee insurance program.

Question 15

The __________ established the Temporary Assistance for Needy Families program.

A) TWWIIA
B) EPSDT
C) Welfare Reform Act
D) CHIP

Question 16

EPSDT is the abbreviation for

A) Early and Periodic Screening, Diagnosis, and Testing.
B) Early and Periodic Screening, Diagnosis, and Treatment.
C) Early and Preventative Screening, Diagnosis, and Treatment.
D) Early and Preventative Screening, Diagnosis, and Testing.

Question 17

The NMEH Workgroup advises which organization(s) about HIPAA compliance issues related to Medicaid?

A) CMS and OIG
B) CMS
C) OIG
D) CMS and RAC

Question 18

In a(n) __________, individuals are required to spend a portion of their income or resources on health care until they reach or drop below the income level specified by the state.

A) restricted status program
B) eligibility program
C) down-spend program
D) spend-down program

Question 19

Providers in capitated managed care plans who are paid flat monthly fees

A) are not reimbursed for Medicaid patients.
B) need not file claims with the Medicaid payer.
C) still must file claims with the Medicaid payer.
D) are not contracted to see Medicaid patients.

Question 20

FMAP is the abbreviation for

A) Federal Medicaid Assistance Program.
B) Federal Medicaid Assistance Percentage.
C) Federal Medicare Assistance Percentage.
D) Federal Medicare Assistance Program.

Question 21

Restricted status refers to a category of

A) states whose Medicaid program is in violation.
B) Medicare beneficiary.
C) states without Medicaid programs.
D) Medicaid beneficiary.

Question 22

Medicaid claims are usually submitted using the _________claim.

A) HIPAA633P
B) HCFA1500
C) HIPAA837P
D) CMS1500

Question 23

Medicaid's spenddown program is in effect

A) not in effect in the United States.
B) on a state-by-state basis.
C) in a select few states.
D) nationally.

Question 24

The Temporary Assistance for Needy Families provides which of the following?

A) free medical supplies
B) free prescriptions to beneficiaries
C) transportation to medical appointments
D) financial assistance to beneficiaries

Question 25

Medicaid beneficiaries must meet

A) either the federal or state requirements.
B) state requirements.
C) both minimum federal requirements as well as any additional state requirements.
D) minimum federal requirements.

Question 26

NMEH is the abbreviation for

A) National Medicaid Eligibility Houses.
B) National Medicaid EDI HIPAA Workgroup.
C) National Medical Enforcement Help.
D) National Medicaid Electronic HIPAA Workgroup.

Question 27

Physicians who wish to provide services for Medicaid beneficiaries enter into a contract with whom?

A) CMS
B) OIG
C) HHS
D) AMA

Question 28

Which of the following statements is true?

A) Medicaid plans will pay for a particular service if Medicare does not.
B) Medicaid and Medicare do not have any deductibles or coinsurance.
C) Medicaid and Medicare will pay the total charges.
D) Medicaid plans do not pay for a particular service if Medicare does not.

Question 29

Individuals who are eligible for both Medicaid and Medicare benefits are called

A) both dual-eligibles and Medi-Medi beneficiaries.
B) Medi-eligibles.
C) Medi-Medi beneficiaries.
D) dual-eligibles.

Question 30

Assets include all of the following except

A) certificates of deposit.
B) bonds.
C) bank accounts.
D) burial plot.

Question 31

Which program under Medicaid offers health insurance coverage for uninsured children?

A) EPSDT
B) CHIP
C) TANF
D) FMAP

Question 32

Physicians who contract with Medicaid to provide services may not

A) all of these are correct.
B) bill for services that are not medically necessary.
C) submit claims for individual procedures that are part of a global procedure.
D) bill for services not provided.

Question 33

Children under __________years old who meet TANF requirements must be offered state Medicaid benefits.

A) 18
B) 12
C) 6
D) 14

Question 34

Claims billed to Medicare which are automatically sent to Medicaid are called

A) transmission claims.
B) automatic claims.
C) urgent claims.
D) crossover claims.

Question 35

Under which program does Medicaid provide preventive services to children under age 21?

A) SCHIP
B) TANF
C) FMAP
D) EPSDT

Question 36

If people receive employment income, what is the effect on eligibility for Medicaid?

A) They cannot be eligibles.
B) They are dual eligibles.
C) They may qualify, depending on the income amount.
D) They automatically qualify.

Question 37

The Deficit Reduction Act of __________ created the Medicare Integrity Program (MIP).

A) 1998
B) 2005
C) 2008
D) 1996

Question 38

__________ is the state Medicaid program name in California.

A) MediCali
B) MediCail
C) MediCal
D) CaliMed

Question 39

A crossover claim is automatically

A) transmitted to the primary payer.
B) transmitted to the secondary payer.
C) transmitted to both payers at the same time.
D) transmitted by the primary payer to the secondary payer.

Question 40

States must cover all of the following to receive federal funding, except

A) nurse midwife services.
B) prescription drugs.
C) rural health clinic services.
D) laboratory services.

Question 41

Which of the following assets must be taken into account to determine Medicaid eligibility?

A) money in bank accounts
B) all of these things must be considered
C) cash surrender value of life insurance
D) stocks and bonds

Question 42

Most states are moving to electronic verification of Medicaid eligibility under the

A) EMEVS.
B) TANF.
C) CHIP.
D) EPSDT.

Question 43

In __________, the patient is required to see a specific physician and/or use a specific pharmacy.

A) limited status
B) specific status
C) restricted status
D) contained status

Question 44

Which of the following services may not be covered under a state's Medicaid program?

A) outpatient hospital services
B) rural health clinic services
C) inpatient hospital services
D) cosmetic procedures

Question 45

To receive federal matching funds, states must cover certain services, including

A) vaccines for children.
B) all of these things must be covered.
C) emergency services.
D) prenatal care.

Question 46

Under the Medicaid program, which of the following is true?

A) Categorically needy and medically needy do not have the same meaning.
B) Medically needy means people have low income.
C) Categorically needy refers to people with high medical expenses.
D) Categorically needy and medically needy have the same meaning.

Question 47

Under the payer-of-last-resort regulation,

A) Medicare pays last on a claim when a patient has other effective insurance coverage.
B) Medicaid will not pay when a patient has other effective insurance coverage.
C) Medicaid pays first on a claim when a patient has other effective insurance coverage.
D) Medicaid pays last on a claim when a patient has other effective insurance coverage.

Question 48

A Medi-Medi beneficiary is an individual

A) who is eligible for Medicaid from California.
B) whose spouse is also enrolled in Medicaid.
C) who is eligible for coverage from both Medicaid and Medicare.
D) whose spouse is also enrolled in Medicare.

Question 49

State Medicaid programs must provide benefits for all of the following except

A) physician services.
B) new and experimental procedures.
C) inpatient hospital services.
D) outpatient hospital services.

Question 50

Under which program does the federal government send Medicaid funding to states?

A) FMAP
B) EPSDT
C) SCHIP
D) TANF

Question 51

EMEVS stands for

A) Electronic Medical Enrollment Verification System.
B) Electronic Medicaid Eligibility Verification System.
C) Electronic Medical Eligibility Verification System.
D) Electronic Medicaid Enrollment Verification System.

Question 52

Dual eligibility refers to

A) Blue Cross and Blue Shield.
B) Medicaid and Medicare.
C) Blue Cross and Medicare.
D) Blue Cross and Medicaid.

Question 53

Categorically needy people in the Medicaid program usually have

A) high debt.
B) low incomes.
C) low debt.
D) high incomes.

Question 54

Medicaid is known as the __________, since it is always billed after another plan has been billed, if other coverage exists.

A) last payer
B) ultimate payer
C) payer of last resort
D) final beneficiary

Question 55

Which program under Medicaid offers financial assistance for people with low incomes and few resources?

A) TANF
B) EPSDT
C) SCHIP
D) FMAP

Question 56

Which of the following is considered an asset?

A) personal effects.
B) furniture.
C) cash surrender value of life insurance policies.
D) clothing.

Question 57

What organization advises CMS about HIPAA compliance issues related to Medicaid?

A) NMEH
B) MIP
C) OIG
D) HHS