The Advocate's Guide to
the Medicaid Program

 

The Advocate's Guide to Medicaid

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National Health Law Program, Washington 20005

Copyright © 1991, 1993, 2001, 2011 by National Health Law Program

First edition published 1991. Second edition 1993. Third edition 2001. Fourth edition 2011

Print Edition ISBN: 978-0-9834720-0-1

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The Advocate’s Guide to the Medicaid Program – Fourth Edition / Jane Perkins

Published by National Health Law Program

1444 I Street NW, Suite 1105, Washington, DC 20005 USA

Order online or contact: 202-289-7724; nhelp@healthlaw.org

Website: www.healthlaw.org

 

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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