| A | B |
|---|
| catagorically needy | persons with low incomes and few resources; and certain Medicare beneficiaries with low incomes |
| Children's Health Insurance Program (CHIP) | health insurance coverage for uninsured children coming from low income families whose incomes are not low enough to qualify for Medicaid |
| crossover claim | claims billed to Medicare and then submitted to Medicaid |
| Federal Medicaid Assistance Percentage(FMAP) | amount of payment by federal gov. to state based on state's ave. per capita income in relation to national income average |
| MediCal | program for California residents which provides Medicaid coverage to medically needy individuals-those with high medical expenses but low financial resources-(but not low enough to receive cash assistance) |
| medically needy | those with high medical expenses and low financial resources (but not low enough to receive cash assistance) |
| Medi-Medi beneficiary | individuals eligible for both Medicaid and Medicare benefits |
| payer of last resort | refers to Medicaid, since it is always billed after another plan has been billed, if other coverage exists |
| restricted status | patient is restricted to see a specific physician or use a specific pharmacy |
| spend down | a state-offered progran in which individuals are required to spend a portion of their income or resources to be at or below the the state's income level (resets at start of each month). Then Medicaid takes over payments |
| Temporary Assistance for Needy Families (TANF) | benefits to catagorically needy families |
| Welfare Reform Act | replaced the AFDC program with TANF. Some individuals receiving TANF payments are limited to a 5-year benefit period |
