Question

In: Nursing

2. What is a restricted plan under Medicaid ? 3. How is Medicaid – eligible patients...

2. What is a restricted plan under Medicaid ?

3. How is Medicaid – eligible patients identity verified

Solutions

Expert Solution

ANSWER 2:

RESTRICTED PLAN UNDER MEDICAID:

  • LIMITS THE UNWANTED AND INAPPROPRIATE USE OF MEDICAID SERVICES.
  • THE SELECTED PERSONS UNDER THIS PROGRAMME ARE PROVIDED WITH RESTRICTION PROGRAMME CARD.
  • THEY ARE ELIGIBLE ONLY FOR ONE PRIMARY CARE PROVIDER AND ONE PHARMACY.
  • THE PRIMARY CARE PROVIDERS AND THE PROVIDERS TO WHOM THEY ARE REFERRED SHOULD BE AMONG THOSE ENLISTED IN THIS PROGRAMME EXCEPT FOR EMERGENCY CASES.

ANSWER 3:

PROCESS OF IDENTITY VERIFICATION OF MEDICAID -ELIGIBLE PATIENTS:

  • ELIGIBILITY IS DETERMINED BY TWO MAIN FACTORS: FINANCIAL AND NON-FINANCIAL

1. FINANCIAL ELIGIBILITY CRITERIA:

  • INCOME ELIGIBILITY BASED ON MODIFIED ADJUSTED GROSS INCOME(MAGI)
  • RELATED TO THE TAXABLE INCOME AND TAX-FILING RELATIONSHIPS
  • ELIGIBLE FOR CHILDREN, ADULTS, PREGNANT WOMEN AND ALSO FOR BLIND AND DISABLED .
  • CHILDREN WITH ADOPTION ASSISTANCE AGREEMENT, YOUNG ADULTS WHO ARE FORMER FOSTER CARE RECIPIENT ARE ELIGIBLE.

2. NON-FINANCIAL ELIGIBILITY CRITERIA:

  • CITIZEN OF THE UNITED STATES, CERTAIN QUALIFIED PERMANENT RESIDENTS
  • CERTAIN OTHERS ARE CATEGORIZED BY AGE, PREGNANCY OR POSITION OF CERTAIN PARENTS.

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