| A | B |
|---|
| medicaid | combination of federal and state medical assistance program designed to provide healthcare for low-income families |
| safety-net providers | community health centers and public hospitals |
| Supplemental Security Income (SSI) | federally funded cash assistance to qualifying elderly and disabled poor |
| countable income | anything a person receives during a calendar month and uses to meet his or her needs for food |
| "in-kind" income | food, clothing, shelter, or something that can be used to obtain food |
| categorically needy | low income families with children with incomes less than a specified percent of federal poverty level |
| medically needy | individuals who do not qualify in the categorically needy program but need help to pay for medical expenses |
| spend down | accumulate medical expenses so that income falls below a state-established medical needy income limit |
| Medicaid contractor | commercial insurer contracted by the HHS to process and administer claims |
| SCHIP | federal programs for children whose families that ear to much to qualify for Medicaid |
| Medicaid integrity contractors (MICs) | private companies that conduct audit-related activities under contract to the Medicaid Integrity Program |
| Early Periodic Screening, Diagnosis, and Treatment (EPSDT) | developed to fit standards of pediatric care and meet special physical, emotional, and devlopmental needs of low-income children |
| Program of All-Inclusive Care for the Elderly (PACE) | comprehensive alternative care for non-institutionalized elderly people |
| Medicaid secondary claim | beneficiary has two types of healthcare coverage |
| reciprocity | one state allows Medicaid beneficiaries from another state to be treated in their state |
| third-party liability | legal obligation of third parties to pay all or part of medical expenses |
| Medicare-Medicaid crossover claims | Medicare is primary and pays its share then sends remainder to Medicaid |
| adjudicated | how the payment is determined |
