It helps pay for medical services for low- income and disabled people. For those eligible for full Medicaid services, Medicaid pays healthcare providers. Providers are doctors, hospitals and pharmacies who are enrolled with DC Medicaid. A Medicaid recipient can be any age, race or sex. You may call (2. 02) 7. Qualifying for CHIP/Children's Medicaid; Questions about CHIP coverage; Questions about Children's Medicaid coverage; Address Change; Other; More Info.IMA Service Center. You may apply for benefits at the IMA Service Centers listed below. Service Center. Address. Phone. Fax. 2. 10. Martin Luther King Avenue, SE. Congress Heights. South Capitol Street, SW. Alabama Avenue, SE. H Street, NE. (2. Taylor Street. 1. Medicaid is a joint federal and state government program that helps people with low income and assets pay for some or all of their health care bills. Taylor Street, NW. What are some Medicaid programs? The doctor or clinic must be willing to accept Medicaid's Payment. Other Health Insurance (Third Party Liability / TPL): You must report to the Department of Health Care Finance (DHCF) any health insurance you may have. If you have health insurance and Medicaid, you must give your insurance information to your doctor when you get services. Medical payments from any source (insurance, liability coverage, Worker's Comp, employer liability, CHAMPUS, lawsuits, accidents or other) that you get for services covered by Medicaid must be reported to Medicaid. In order to be eligible for Medicaid, you must assign your rights to medical payments from any source to DHCF. Things You Must Do to Get Health Care Services: Always remember to take your Medicaid ID card every time you go to get health services. Remember that not all doctors, dentists and other providers accept Medicaid. You should always ask the provider if he accepts DC Medicaid before you get services. Civil Rights: Participating providers of services in the Medicaid program must comply with the requirements of Title VI of the Civil Rights Act of 1. Questions and answers that may be helpful for families applying for low- cost or no-cost health. State of New Jersey > Department of Human Services > Division of Medical Assistance and Health Services > Consumers & Clients - Individuals & Families > NJ Medicaid. Medicaid Eligibility and Benefits. This summary is intended to give you basic information about the State of Maryland’s Medicaid Program. Medicaid provides medical coverage to low-income individuals and families. The state and federal government share the cost of the Medicaid program. Section 5. 04 of the Rehabilitation Act of 1. Under the terms of those laws, a participating provider or vendor of services under any program using federal funds is prohibited from making a distinction in the provision of services to recipients on the grounds of race, age, gender, color, national origin or disability. This includes distinction made on the basis of race or disability with respect to (a) waiting room, (b) hours for appointments or (c) order of seeing patients. Fair Hearings: The Social Security Administration (SSA) holds fair hearings for Medicaid eligibility decisions that are part of a Supplemental Security Income (SSI) decision for low income, aged and blind and disabled individuals.
You may call the SSA at 1- 8. Fraud: Please contact the Department of Health Care Finance at 1- 8. GAO - High Risk: Medicaid Program. GAO designated Medicaid as a high- risk program in 2. This federal- state program covered an estimated 6. Patient Protection and Affordable Care Act (PPACA). A significant pressure on federal and state budgets, estimated Medicaid outlays for fiscal year 2. Populations covered include children in low- income families, and low- income individuals who are elderly, disabled, or are experiencing high medical needs. Within these broad parameters, however, states administer their own programs, including making decisions regarding any health services or populations to cover beyond what are mandated by law, setting provider reimbursement rates, and operating state- specific data systems to enroll eligible beneficiaries and providers and to process and pay claims. This variability complicates oversight and has contributed to challenges in overseeing payments, financing, and access to quality care. For example, under Section 1. Social Security Act, the Secretary of Health and Human Services can approve waivers of traditional Medicaid requirements, and provide states with new spending authorities, for purposes of implementing Medicaid demonstration projects. The demonstrations under the law are for purposes of testing new ways to operate state programs and deliver services, and agency policy requires that the programs not increase federal costs. In the past, this authority was used by states to test, for example, whether efficiencies from managed care could help provide savings to cover otherwise ineligible populations. In recent years, many states have sought demonstrations for other purposes, such as providing long term services and supports in a managed care delivery system. While states have the first- line responsibility for preventing improper payments, the Centers for Medicare & Medicaid Services (CMS) in the Department of Health and Human Services (HHS) has an important role in overseeing and supporting state efforts to reduce and recover improper payments. Highlights of Significant Legislation and Key Reform Efforts. Medicaid enrollment and spending are growing under PPACA. The most significant change to Medicaid under PPACA is the option for states to expand Medicaid eligibility to non- Medicare eligible individuals under age 6. As of June 2. 01. Medicaid eligibility under PPACA. FPL refers to federal poverty guidelines issued by the Department of Health and Human Services each year in the Federal Register. Although CMS has taken positive steps, reducing Medicaid improper payments remain high- risk as the rate of improper payments has increased in recent years and federal program spending is expected to increase on average 7 percent per year between 2. Medicaid Program. The effects of unprecedented changes recently made to the Medicaid program will continue to emerge in the coming years and are likely to exacerbate the challenges and shortcomings that already exist in federal oversight and management of the program. A key challenge to federal oversight is the lack of accurate, reliable, and timely data at the federal level needed to oversee the diverse and complex state Medicaid programs. Our work to date illustrates the challenges and the need for improved federal oversight of Medicaid in six areas. Medicaid beneficiaries, children in particular, have showed increases in the use of dental services but still visited the dentist less often than privately insured children. These visits are essential to preventing future high cost dental services. Medicaid children may also not be receiving appropriate mental health treatment and services. Access to providers of mental health services is not solely a problem for Medicaid children; however, children on Medicaid have additional issues regarding receipt of appropriate mental health services. For example, national survey data indicate concerns that children on Medicaid may be inappropriately prescribed psychotropic drugs and are not receiving needed mental health services, such as counseling and therapy. Access to preventive health services. Preventive health services can serve as a mechanism to promote better health and avoid high cost medical treatments in the future. The higher prevalence of some health conditions among Medicaid beneficiaries nationally that can be identified and managed by preventive services suggests that more can and should be done to ensure Medicaid beneficiaries receive these services. However, national data suggest that receipt of these services is below established goals, states have not properly reported the extent to which these services are provided as required, and data are lacking on whether treatments, to address conditions identified through screenings and checkups, are actually provided. For adults in Medicaid, PPACA provides incentives for states to cover recommended preventive services. The federal government shares in the costs of state Medicaid payments using a Federal Medical Assistance Percentage (FMAP), a statutory formula based in part on each state’s per capita income. States with lower per capita incomes receive higher matching rates. States are responsible for financing the non- federal share of their programs, and can use state general funds as well as other sources, such as taxes on health care providers and transfers of funds from local governments. Financing Structure. During economic downturns, states typically experienced increased Medicaid enrollment while their own revenues declined. In response to a mandate by Congress, we developed a prototype formula, which offers an automatic timely and targeted option for providing states with temporary assistance during national economic downturns. States have increasingly relied on funds from sources other than state general funds to finance the non- federal share of their programs, such as health care provider taxes and funds transferred from local governments and local government health care providers. Although such sources are allowed under certain circumstances, the increased reliance on these sources has implications for federal spending and beneficiary access. Such sources can create incentives for states to overpay providers that contribute funds to the state for the non- federal share in order to reduce state obligations, and can result in cost shifts to the federal government. Also, it is unclear whether increased federal funding improves beneficiary access. CMS does not collect accurate and complete data on state sources of funds to finance the Medicaid program, which makes it difficult for CMS and federal policymakers to oversee the program and assess the need for and make changes. The federal government shares in the cost of state payments. CMS is responsible for ensuring that state Medicaid payments are consistent with federal requirements, including requirements that Medicaid payments be economical and efficient. To oversee the program, CMS needs information on state spending as well as on payments states make to individual providers. Spending transparency. We identified inconsistent CMS guidance and state practices that resulted in differences between these two data sets that could not be quantified. We have also identified gaps in the data, for example, the lack of reporting of large supplemental payments that states often make. With timely, complete, and accurate data sets, CMS oversight would be enhanced, allowing for monitoring aggregate spending trends, per beneficiary spending growth, comparison of differences in provider payment levels, and cross- state comparisons of spending. States’ supplemental payments that result in total Medicaid payments well in excess of a provider’s costs raise questions about whether payments are consistent with the statutory requirement that payments be economical and efficient, and are actually for covered Medicaid services. Concerns have also been raised about higher regular, claims- based payments made to government facilities. Total payments in fiscal year 2. The federal government provides federal funding for state payments made to MCOs for Medicaid beneficiaries enrolled. The MCOs bear some or all of the risk for the costs of providing or paying for contractually agreed- upon health care services for enrollees. Federal law requires that states collect encounter data—information on the services and treatments provided to enrollees—from MCOs and submit these data to CMS. States are also required to submit information on the methodology for determining actuarial soundness of MCO payment rates, including a description of the data used. CMS cannot ensure the quality of the data used to set MCO payment rates or whether states’ rates are appropriate, and this lack of assurance places billions of federal and state dollars at risk for misspending. The demonstrations provide a way for states to test and evaluate new approaches for delivering Medicaid services. In fiscal year 2. By policy, demonstrations should be budget neutral to the federal government; they must not increase federal costs. However, HHS has approved demonstration spending limits that were significantly higher than what was supported in the approval documentation. Budget Neutrality of Medicaid Demonstrations. Federal spending on Medicaid demonstrations could be reduced by billions of dollars if HHS were required to improve the process for reviewing, approving, and making transparent the basis for spending limits approved for Medicaid demonstrations. However, HHS continues to approve demonstrations that are not budget neutral. HHS approved a spending limit for the demonstration that was based, in part, on hypothetical costs—significantly higher payment amounts the state assumed it would have to make to providers if it expanded coverage under the traditional Medicaid program. We estimated that, by including these costs, the 3- year, nearly $4 billion spending limit that HHS approved for the state’s demonstration was approximately $7. Medicaid program.
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