MEDICAID
01.Core Concepts
• Federal/state entitlement program that pays for medical assistance for certain individuals and families with low incomes and resources. • Each state: • Establishes its own eligibility standards • Determines the type, amount, duration, and scope of services • Sets the rate of payment for services • Administers its own program • Medicaid policies for eligibility, services, and payment are complex and vary considerably, even among states of similar size or geographic proximity. 53 MEDICAID: MANDATORY BENEFITS Mandatory Benefits Inpatient and outpatient hospital services Federally qualified health-center (FQHC) services Physical services Family planning services and supplies Nursing facilities services Nurse-midwife services Home health services Pediatric and family nurse practitioner services Early and periodic screening, diagnostic, and treatment services Freestanding birth center services Laboratory and x-ray services Transportation to medical care Rural health clinic services Tobacco cessation counseling for pregnant women