Question

A.Explain the difference between "categorically needy" and medically needy" and give example of individuals who fall into each group.

B.You are a health insurance proffessional employed by Generic Family Practice. On September 7, 20xx, Emily Carson brought her 4-year-old son, Cory, to the office. Cory, who is complaining of ear pain and a sore throat, is new to the practice. Ms. Carson, a single mother, states that she and Cory are on Medicaid. After greeting Ms. Carson, what is the first thing you should do?

C. Brice Sammuels, a 9-year-old girl, come to Generic Family Practice on a monthly basic for follow-up treatment for a serve case of asthma. Gina Petter, a temp who is filling in for you during an absence, not that Brice was eligible for Medidcaid every month for the past 2 years. Assuming that Brice is eligible for Medicaid benefits on this visit, Gina neglects to verify current eligibility. 1. What, if any, possible problems could result from Gina's failure to follow proper procedures? 2. If Brice's visits have been covered by Medicaid for the past 2 years, what possible reason might there be for Medicaid to discontinue benefits?

Answer 1

Medicaid is the insurance company who offeres its benefits to the individuals who are low in their income and fall into one of the six categories : age 65, blind, disabled, family with dependent children,pregnant and incapacitated.

Categorically needy:

If an individual do not exceed the category maximum in income and resources, and fit into one of the six category then they are said to be categorically needy. Example: A teenage single mother with a dependent child.

Medically needy:

They are those individuals who is eligible for category needy but their income or resources are too high than the category maximums.Even though their resources are too high but still they are unable to pay their medical expenses. Example: An elderly adult who is residing in an old age home with recent angioplasty, though have enough income to exceed the limit of category needy but is unable to pay the huge hospital bill.

Answer B) After greeting your customer, you need to check the eligibility of Ms Caron for medicaid benefits, that if she fits into categorically needy or medically needy group.

Answer C)

• The failure to follow proper procedure by Gina will result in wrong categorizing of customer for medicaid benefit that would result in wastage of the insurance resources. The quality of service provided to her will be poor.
• Medicaid can discontinue the benefits of Brice as she may no longer fulfil the category for medicaid benefits i.e she may no longer be eligible.