Name that Medicaid Program
This Medicaid program provides coverage to eligible children with income too high to qualify for Medicaid, but too low to afford private coverage.
CHIP
What does Part A coverage for?
Hospital Insurance
What system do we use to review a SOP?
Knowledge Central
What is HCBS?
Home and community-based services
What plan is for adults 65 and older or anyone who is disabled according to Social Security.
ABD (Aged, Blind, and Disabled)
What is Part D coverage?
Prescription Drugs Plans. (D for Drugs)
What is the system that we use to look up State Specific information. ex: phone numbers, hours of operations, and any state call outs.
Medicaid/DSNP State Specific Tool
When would you use SMERT?
When you need assistance on a live call.
This is a federally funded program. Primarily aims to support low-income families with dependent children.
TANF (Temporary Assistance for Needy Families)
What is Part B coverage?
Medical Insurance
What is the name of the system we use to help the providers?
Spire
This supports those at risk of going into a long-term care facility and keeping people home or in their community rather than a facility.
LTSS (Long term Support and Services)
What coverage is Part C?
Medicare Advantage Plan
What is APRIL?
A Path to Research, Information & Links
What does the Lock-In Program do?
Detect and prevent abuse or misuse of the pharmacy benefits.
This is apart of the Affordable Care Act (ACA). This gives states a chance to provide Medicaid coverage to people earning 138% of the federal poverty level.
Medicaid Expansion (We don't service Exchange plans)
What does HMO stand for?
Health Maintenance Organization
For Medicaid plans, where do you check to see if a code requires auth?
Intake Tool > Community & State > EPAL/SSG