NURS 6202 Final Exam Questions with 100% Verified Correct Answers 2024/2025 Since its inception, Medicaid (also called Title 19 of the Social Security Act) was originally designed to finance health care services for the indigent, and therefore it has been almost entirely a tax-payer funded program. From the very beginning, Medicaid has been what we call a means-tested program.What does that mean? - Correct Answer -Eligibility depends on financial resources -Each state administers their own Medicaid program under -Federal guidelines, and Medicaid is jointly financed by both state and Federal governments -Federal government provides matching funds to each of the states based upon that state's per capita income What are the three main categories of people who are automatically eligible for Medicaid? - Correct Answer 1.Families with children receiving support under the Temporary Assistant for Needy Families (TANF) program 2.People receiving Supplement Security Income (SSI), which includes the elderly, blind, and disabled with low income 3.Children and pregnant women whose family income is at or below 133% of the Federal Poverty Level About 9 million people are called dual-eligible beneficiaries. What does that mean? - Correct Answer -They are eligible for both Medicaid and Medicare.-Dual-eligibility beneficiaries have extensive health care needs because of chronic conditions, one or more disabilities, or a need for long-term care -Example - low-income elderly and disabled young adults who are entitled to Medicare, but also become eligible for some level of assistance under Medicaid If you are in the C-suite of a large hospital system, what would you expect to happen, and what would you therefore have to plan for, if your state expanded Medicaid coverage, based upon observation and research findings? - Correct Answer -increased in the use of hospital emergency departments -increased use of Eds, even over a number of years.-In the post-affordable Care Act era, Medicaid-paid use of Eds increased by 27%.
- Look at how you are staffing your ED.
There are a couple of perplexing and ongoing problems with the Medicaid program, and it would affect just about any healthcare organization within which you might work. What are those and explain? - Correct Answer -#1 problem: comparatively poor reimbursement for providers, and the 1 / 3
result of this is that many physicians and some other providers do not serve Medicaid-covered patients **Medicare, Medicaid reimburses providers only a fraction of what Medicare pays providers for the same or similar level of services #2 churning. The constant exit and reentry of beneficiaries in the Medicaid system because their eligibility tends to change a lot based upon their wildly fluctuating income from month to month.-Data suggest that up to 30% of Medicaid beneficiaries will lose their eligibility within 6 months, and almost half lose it within 12 months.-Churning disrupts access and continuity of care What is CHIP - Correct Answer -Children's Health Insurance Program (CHIP) -Initiated in 1997 as part of the Social Security Act What does CHIP do? - Correct Answer -Intended to address the plight of uninsured children whose family income exceeded the Medicaid threshold levels, which made them ineligible for Medicaid, however for a host of other reasons did not have access to an employer-sponsored plan Federal government provides funds in the form of block grants to states to cover children and adolescents up to age 19 years.-Federal law requires that ineligibility for Medicaid be established before a family is approved for CHIP coverage benefits.-Each state is allowed to establish its own eligibility criteria for CHIP, but those criteria have to comply with Federal guidelines CHIP financing is shared between federal and state governments.Has CHIP been effective? If not, why, and if so, in what ways? - Correct Answer Yes -Impact on reducing the number of uninsured children -Improving access, continuity of care, and quality of care for children in all racial/ethnic groups and in reducing racial and ethnic disparities in access, unmet needs, and continuity of care.What is TRICARE and whom does it serve? - Correct Answer The insurance arm of the military health care system 2 / 3
-Beneficiaries are able and allowed to obtain health care through the Department of Defense medical facilities or through services purchased from civilian providers.What is the Veterans Health Administration (VHA/VA) - Correct Answer Health services branch of the US Department of Veterans Affairs.-The VA operates the largest integrated health service system in the entire US.-Operates hospitals, outpatient clinics, nursing homes and other facilities - Whom does the Veterans Health Administration (VHA/VA) serve? - Correct Answer -Provides services to about 8.7 million veterans, and its Office of Research and Development focuses on health issues that impact veterans.-Originally developed to handle war-related injuries and to rehab members w/ war-related disabilities. original mission was expanded, now includes non-service-related conditions actually accounts for the most of the care provided What are third-party payers? - Correct Answer -insurance companies -Managed Care Organizations -Blue Cross/Blue Shield -Government.+2 Other parties, Patient and Provider.What is the function of third party payers? - Correct Answer The third-party-payer function has two major functions
- Determining the methods and amounts of reimbursements
- The actual payment of the bill after services have been provided.
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Charge - Correct Answer Fee set by a provider Rate - Correct Answer a price set by any third-party payer -Also referred to as reimbursement Fee schedule - Correct Answer An index of charges listing individual fees for each type of service