Medicaid and CHIP Programs Flashcards
7 cards from real CES practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Medicaid and CHIP Programs flashcards as text
Which program allows states to use eligibility findings from other programs (like SNAP or TANF) to fast-track Medicaid/CHIP enrollment?
Answer: Express Lane Eligibility (ELE)
Express Lane Eligibility lets states use findings from other benefit programs to streamline and accelerate Medicaid and CHIP enrollment determinations.
When a child who would otherwise qualify for CHIP has access to employer-sponsored insurance, what is the name of the option that allows CHIP to pay the employee's share of premiums?
Answer: CHIP Premium Assistance
CHIP Premium Assistance (also called 'wrap-around' coverage) allows CHIP to pay employer-sponsored insurance premiums when that coverage is cost-effective for the state.
Under Medicaid managed care, states contract with health plans to deliver services. What is the most common type of Medicaid managed care arrangement?
Answer: Comprehensive Risk-Based Managed Care (Capitated MCO)
Capitated MCOs (Managed Care Organizations) are the dominant form of Medicaid managed care, where states pay a fixed per-member-per-month rate for comprehensive services.
What is the CHIP Reauthorization Act of 2009 (CHIPRA) most known for?
Answer: Expanding CHIP coverage, improving quality, and increasing outreach to eligible children
CHIPRA reauthorized and expanded CHIP, adding funds, improving quality measures, extending coverage to lawfully residing immigrant children, and boosting outreach efforts.
Which of the following individuals is EXEMPT from the ACA's MAGI-based Medicaid income rules?
Answer: An elderly individual applying for long-term care Medicaid
Elderly and disabled individuals applying for long-term services and certain Medicare Savings Programs still use the older SSI-based income and asset rules, not MAGI.
A Medicaid Section 1915(c) Home and Community-Based Services (HCBS) waiver is primarily designed to serve which population?
Answer: Individuals who would otherwise require nursing facility or institutional care
HCBS waivers allow states to provide long-term services in home and community settings to individuals who meet the clinical criteria for institutional care.
What document must states submit to CMS to make changes to their Medicaid program that do not require a waiver?
Answer: State Plan Amendment (SPA)
A State Plan Amendment (SPA) is the formal mechanism states use to notify CMS of changes to their Medicaid programs within existing federal authority, without needing a waiver.