The Advocate's Guide to
the Medicaid Program

 

The Advocate's Guide to Medicaid

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About the Guide

 

 

 

For nearly 40 years, advocates, policy makers, and others have relied on the Advocate's Guide to the Medicaid Program to assure that the Medicaid program is implemented as the law intends, and that eligible low-income people can access the services that the program provides.

The revised Guide will once again be available in hard copy, as well as by online membership, for the first time featuring brand new interactive web features, such as live updates and user forums.

Order now!

This widely anticipated update incorporates provisions from the Patient Protection and Affordable Care Act (2010), the Children's Health Insurance Program Reauthorization Act (2009), and the Deficit Reduction Act (2005).  The Guide covers Medicaid administration, eligibility, and services, drawing extensively from numerous sources:  the United States Constitution, the Medicaid Act, the Medicaid regulations, federal guidance documents, and federal and state court case law. Support for this guide was provided by a grant from the Robert Wood Johnson Foundation.

 

Contents

Acknowledgements
I. Introduction
II. Administration
A. Centers for Medicare & Medicaid Services
B. Single State Medicaid Agency
C. Federal Financial Participation
D. State Medicaid Plans
E. Statewideness
F. Federal Medicaid Waivers
G. Demonstration Programs and Grants
H. Managed Care Programs
I. Enrollment of Beneficiaries in Group Health Plans
J. Premium Assistance for Children
K. Long Term Care Partnership Programs
L. Oversight of Providers
M. Medicaid Advisory Committees
N. Applying for Medicaid
O. Eligibility Determinations
P. Eligibility Redeterminations
Q. Presumptive Eligibility
R. Liens and Recoveries
S. Third Party Liability, Assignment, and Cooperation
T. Notice and Hearings
U. Judicial Enforcement
III. Eligibility
A. Mandatory Categorically Needy
B. Optional Categorically Needy
C. Medically Needy
D. Financial Eligibility
E. Post-eligibility Disregards of Income and Resources
F. Spousal Impoverishment Protections
G. Retroactive Eligibility
H. Residency
I. Citizenship/Immigration Status
IV. Services
A. Mandatory Services for the Categorically Needy
B. Optional Services for the Categorically Needy
C. Services for the Medically Needy
D. Early and Periodic Screening, Diagnostic and Treatment Services
E. Benchmark Coverage
F. Medicaid and the Individuals with Disabilities Education Act
G. Transportation
H. Drug Coverage
I. Organ Transplants
J. Health Homes
K. Abortion Coverage
L. Amount, Duration, and Scope of Services and Reasonable Promptness
M. Comparability of Services
N. Utilization Controls
O. Quality of Care
P. Nursing Facility Preadmission Screening
Q. Premiums and Cost Sharing
R. Freedom of Choice
S. Medicaid as Payment in Full
T. Payments to Providers
U. Direct Payments to Beneficiaries
Appendices
APPENDIX A: Social Security Act/42 U.S.C. Conversion Chart
APPENDIX B: CMS Regional Offices

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A Template for States to Use

Interested in creating a Guide for your state from our template? Click here for more info.


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