CES Medicaid and CHIP Programs 2 — Questions and Answers
Question 1: What is the Federal Medical Assistance Percentage (FMAP) used to determine?
- The share of Medicaid costs the federal government reimburses to each state (Correct answer)
- The maximum income limit for Medicaid in each state
- The percentage of beneficiaries enrolled in managed care
- The share of CHIP costs paid by beneficiaries as premiums
Correct answer: The share of Medicaid costs the federal government reimburses to each state
FMAP is the formula-driven percentage of state Medicaid expenditures that the federal government matches, varying by state based on per capita income.
Question 2: Which of the following is a mandatory Medicaid service that all states must cover?
- Inpatient hospital services (Correct answer)
- Dental care for adults
- Vision care for adults
- Chiropractic services
Correct answer: Inpatient hospital services
Inpatient hospital services are a mandatory Medicaid benefit all states must provide, while adult dental, vision, and chiropractic services are optional.
Question 3: What is 'presumptive eligibility' in the context of Medicaid and CHIP?
- A qualified entity temporarily enrolls an applicant who appears eligible while the formal application is processed (Correct answer)
- Automatic enrollment in Medicaid at birth for all newborns
- A determination made by an employer about an employee's Medicaid status
- A waiver that allows states to bypass standard eligibility criteria
Correct answer: A qualified entity temporarily enrolls an applicant who appears eligible while the formal application is processed
Presumptive eligibility allows trained qualified entities to provide temporary Medicaid/CHIP coverage while the state agency completes the full eligibility determination.
Question 4: What is the Medicaid Estate Recovery Program (MERP) designed to do?
- Recover Medicaid costs from the estates of deceased beneficiaries who were 55 or older (Correct answer)
- Recover premium payments from beneficiaries who had employer coverage
- Seize assets of Medicaid applicants at the time of enrollment
- Collect unpaid CHIP premiums from families after coverage ends
Correct answer: Recover Medicaid costs from the estates of deceased beneficiaries who were 55 or older
MERP requires states to seek repayment of Medicaid costs from the estates of deceased beneficiaries who were age 55 or older when they received services.
Question 5: Under Medicaid rules, retroactive coverage can go back up to how many months prior to the month of application?
- 3 months (Correct answer)
- 6 months
- 12 months
- 1 month
Correct answer: 3 months
Medicaid may cover eligible medical expenses incurred up to 3 months before the month an individual applies, provided they were eligible during those months.
Question 6: Most lawfully present immigrants must wait how long before becoming eligible for federally funded Medicaid benefits?
- 5 years (Correct answer)
- 2 years
- 1 year
- No waiting period applies
Correct answer: 5 years
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 imposed a 5-year bar on most lawfully present immigrants for federally funded Medicaid.
Question 7: Which Medicaid waiver authority allows states to test innovative service delivery and financing models that deviate from standard Medicaid rules?
- Section 1115 Demonstration Waiver (Correct answer)
- Section 1902 State Plan Amendment
- Section 1915(b) Managed Care Waiver
- Section 1905 Mandatory Services Waiver
Correct answer: Section 1115 Demonstration Waiver
Section 1115 Research and Demonstration Waivers give states broad flexibility to pilot approaches that deviate from standard Medicaid requirements, subject to HHS approval.
CES Medicaid and CHIP Programs 2
What is the Federal Medical Assistance Percentage (FMAP) used to determine?