PUBH 6012 EXAM 2 QUESTIONS
AND ANSWERS
What is the goal of CHIP - Answer-reduce the number of uninsured children
Is CHIP an entitlement program - Answer-no it is a block grant that is reauthorized every
ten years (states have more flexibility to use the funds)
Who is eligible for CHIP - Answer-children not otherwise eligible for Medicaid, up to 300
percent of FPL, i.e. covers children above federal poverty level set by Medicaid
Based on state choice, allows coverage for pregnant women, immigrant pregnant
women and children, and children of state employees
What benefits does CHIP include - Answer-EPSDT benefits relevant to children,
CHIPRA (reauthorization) also imposed dental coverage and mental health parity
are there premiums and cost sharing in CHIP - Answer-yes, state can set these on a
sliding scale within set federal limits (i.e. you need to be above certain percentages of
the FPL before you will be required to pay premiums)
How is CHIP financed? - Answer-also shared fed-state funding; govt provides
allotments based on spending and population growth, they have capped amounts for
each state because it's not an entitlement program
What makes CHIP unique compared to medicare and medicaid - Answer-it is not an
entitlement program and it has evaluations stipulated within it
what can section 11-15 waivers function to do - Answer-modify state's medicaid
programs through things like work requirements (make medicaid more of a transitional
insurance program), or by imposing cost sharing to expand who can qualify (i.e. raise
the % FPL eligibility but then impose a premium or cost sharing)
t/f most nursing home residents pay for their long term nursing care through Medicaid -
Answer-true
, t/f medicaid covers almost half of all births in the us - Answer-true -- it's an important
safety net for pregnant women
what are the impacts of medicaid on the overall health care system - Answer-lowers the
out of pocket expenditures for families in the program; states that expanded medicaid
saw slightly greater decreases in poverty
prescription drug doughnut hole - Answer-gap in prescription drug coverage between a
limit for coverage and catastrophic coverage
What group accounts for the most medicaid spending - Answer-disabled (despite
making up smallest portion of beneficiaries)
What eligible group accounts for least medicaid spending - Answer-children (despite
making up almost 40 percent of beneficiaries)
Who is primarily responsible for administering medicaid - Answer-the states. they set
policies for eligibility requirements, cost sharing, provider payment structure, optional
additional coverage, waivers
T/F Medicare Advantage offers less choice in provider than traditional medicare -
Answer-true because medicare advantage is similar to managed care-- there is a
preferred or required network of providers where you can receive care, traditional
medicare is fee-for-service from any medicare provider
prospective payment - Answer-A method of reimbursement based on payment rates
that are established in advance and reflect an average of what a service should cost.
used by medicare
who might be more likely to stay on traditional medicare - Answer-someone who wants
to keep their dr, someone who has more expensive care
before ACA who qualified for medicaid - Answer-low-income AND another eligibility
category (disabled, pregnant, a child)
how is medicaid financed - Answer-jointly financed by state and fed, fed chips in 50-
76% depending on the state, money is attached with conditions for different populations
covered and services provided
11 15 waiver - Answer-allows states to add populations covered by their medicaid
program, need to apply and have it be approved, would lead to more federal funding for
adding that population
t/f the majority of children is covered under medicaid/ CHIP - Answer-true
AND ANSWERS
What is the goal of CHIP - Answer-reduce the number of uninsured children
Is CHIP an entitlement program - Answer-no it is a block grant that is reauthorized every
ten years (states have more flexibility to use the funds)
Who is eligible for CHIP - Answer-children not otherwise eligible for Medicaid, up to 300
percent of FPL, i.e. covers children above federal poverty level set by Medicaid
Based on state choice, allows coverage for pregnant women, immigrant pregnant
women and children, and children of state employees
What benefits does CHIP include - Answer-EPSDT benefits relevant to children,
CHIPRA (reauthorization) also imposed dental coverage and mental health parity
are there premiums and cost sharing in CHIP - Answer-yes, state can set these on a
sliding scale within set federal limits (i.e. you need to be above certain percentages of
the FPL before you will be required to pay premiums)
How is CHIP financed? - Answer-also shared fed-state funding; govt provides
allotments based on spending and population growth, they have capped amounts for
each state because it's not an entitlement program
What makes CHIP unique compared to medicare and medicaid - Answer-it is not an
entitlement program and it has evaluations stipulated within it
what can section 11-15 waivers function to do - Answer-modify state's medicaid
programs through things like work requirements (make medicaid more of a transitional
insurance program), or by imposing cost sharing to expand who can qualify (i.e. raise
the % FPL eligibility but then impose a premium or cost sharing)
t/f most nursing home residents pay for their long term nursing care through Medicaid -
Answer-true
, t/f medicaid covers almost half of all births in the us - Answer-true -- it's an important
safety net for pregnant women
what are the impacts of medicaid on the overall health care system - Answer-lowers the
out of pocket expenditures for families in the program; states that expanded medicaid
saw slightly greater decreases in poverty
prescription drug doughnut hole - Answer-gap in prescription drug coverage between a
limit for coverage and catastrophic coverage
What group accounts for the most medicaid spending - Answer-disabled (despite
making up smallest portion of beneficiaries)
What eligible group accounts for least medicaid spending - Answer-children (despite
making up almost 40 percent of beneficiaries)
Who is primarily responsible for administering medicaid - Answer-the states. they set
policies for eligibility requirements, cost sharing, provider payment structure, optional
additional coverage, waivers
T/F Medicare Advantage offers less choice in provider than traditional medicare -
Answer-true because medicare advantage is similar to managed care-- there is a
preferred or required network of providers where you can receive care, traditional
medicare is fee-for-service from any medicare provider
prospective payment - Answer-A method of reimbursement based on payment rates
that are established in advance and reflect an average of what a service should cost.
used by medicare
who might be more likely to stay on traditional medicare - Answer-someone who wants
to keep their dr, someone who has more expensive care
before ACA who qualified for medicaid - Answer-low-income AND another eligibility
category (disabled, pregnant, a child)
how is medicaid financed - Answer-jointly financed by state and fed, fed chips in 50-
76% depending on the state, money is attached with conditions for different populations
covered and services provided
11 15 waiver - Answer-allows states to add populations covered by their medicaid
program, need to apply and have it be approved, would lead to more federal funding for
adding that population
t/f the majority of children is covered under medicaid/ CHIP - Answer-true
