MEDICAID EXAM QUESTIONS AND VERIFIED
ANSWERS
Learning about the Basis of Medicaid Eligibility
What is Medicaid - ANSWER Medicaid is a program whose purpose is
to provide payment for a range of medical services for persons with low
income and resources. It is a third-party payment system in which a
Medicaid recipient receives medical services and the bill gets sent to the
state Medicaid program for payment.
Who issues Medicaid guidelines and regulations on the Federal Level?
How do they issue guidelines? - ANSWER The Department of Health
and Human Services, publishes the State Medical Assistance Manual for
the states to administer the program.
Who issues Medicaid guidelines and regulations on the state level? How
do they issue guidelines? - ANSWER The New York State Department
of Health, through their Office of Medicaid Management. The DOH
clarifies it's regulations through Administrative Directives and
Informational Letters. (ADMs and INFs) These directives must be
followed by local agencies
What are local agencies, and what do they do? - ANSWER Local
Agencies are responsible for the day-to-day administration of the
Medicaid program.
Describe the Hierarchy of Legal Authority - ANSWER Federal statutes
have greater weight than state statutes. State statutes have more
authority the state regulations. state regulations have more authority tan
local administrative directives or informational letters.
What is MARG? - ANSWER MARG stands for Medical Assistance
Reference Guide. This is the desk reference guide used by all Medicaid
intake personnel when processing applications. MARG explains how the
worker should deal with the income and resources of the Medicaid
, applicant. It provides citations to the NYCRR, as well as the state's
ADMS
There are different categories of applicants that may be eligible for
Medicaid. What are these categories of applicants? - ANSWER 1)
Supplemental Security Income Recipients. 2) Disability Claimaints. 3)
Medically Needy Claimants. 4) Working Disabled
What are Supplemental Security Income Recipients, and how do they
become eligible for Medicaid - ANSWER Supplemental Security
Income Recipients are categorically (automatically) eligible for Medicaid
benefits. However, there are people who MAY BECOME ineligible for
SSI b/c of Social Security cost of living increases. These individuals may
still be eligible for Medicaid, even though they are no longer receiving
SSI
What are Disability Claimaints and how do they become eligible for
Medicaid? - ANSWER If the Social Security Administration has
determined that an individual is disabled, Medicaid accepts that
determination and the individual is categorically eligible for medical
coverage, regardless of their age. However if the SSA hasn't made a
determination of disability, Medicaid will have to make a determination of
one's disability.
What are Medically Needy Claimaints, and how do they come eligible for
Medicaid? - ANSWER The Medically Needy are those who would
otherwise be eligible for the SSI program except that their income and/or
resources are above income and resource limits set by the SSI program.
There are persons who are considered "SSI related": those aged 65 or
older, or those who are certified blind or disabled. These Medically
needy individuals may qualify for Medicaid if they meet the financial
income and resource limits set by NYS for the medically needy.
(Appendix 6A)
Who are they working disabled, and how do they become eligible for the
Medicaid program - ANSWER The working disabled are those who are
not eligible for traditional Medicaid because their income or resources
exceed the allowable Medicaid (SSI levels) levels, yet they meet the
ANSWERS
Learning about the Basis of Medicaid Eligibility
What is Medicaid - ANSWER Medicaid is a program whose purpose is
to provide payment for a range of medical services for persons with low
income and resources. It is a third-party payment system in which a
Medicaid recipient receives medical services and the bill gets sent to the
state Medicaid program for payment.
Who issues Medicaid guidelines and regulations on the Federal Level?
How do they issue guidelines? - ANSWER The Department of Health
and Human Services, publishes the State Medical Assistance Manual for
the states to administer the program.
Who issues Medicaid guidelines and regulations on the state level? How
do they issue guidelines? - ANSWER The New York State Department
of Health, through their Office of Medicaid Management. The DOH
clarifies it's regulations through Administrative Directives and
Informational Letters. (ADMs and INFs) These directives must be
followed by local agencies
What are local agencies, and what do they do? - ANSWER Local
Agencies are responsible for the day-to-day administration of the
Medicaid program.
Describe the Hierarchy of Legal Authority - ANSWER Federal statutes
have greater weight than state statutes. State statutes have more
authority the state regulations. state regulations have more authority tan
local administrative directives or informational letters.
What is MARG? - ANSWER MARG stands for Medical Assistance
Reference Guide. This is the desk reference guide used by all Medicaid
intake personnel when processing applications. MARG explains how the
worker should deal with the income and resources of the Medicaid
, applicant. It provides citations to the NYCRR, as well as the state's
ADMS
There are different categories of applicants that may be eligible for
Medicaid. What are these categories of applicants? - ANSWER 1)
Supplemental Security Income Recipients. 2) Disability Claimaints. 3)
Medically Needy Claimants. 4) Working Disabled
What are Supplemental Security Income Recipients, and how do they
become eligible for Medicaid - ANSWER Supplemental Security
Income Recipients are categorically (automatically) eligible for Medicaid
benefits. However, there are people who MAY BECOME ineligible for
SSI b/c of Social Security cost of living increases. These individuals may
still be eligible for Medicaid, even though they are no longer receiving
SSI
What are Disability Claimaints and how do they become eligible for
Medicaid? - ANSWER If the Social Security Administration has
determined that an individual is disabled, Medicaid accepts that
determination and the individual is categorically eligible for medical
coverage, regardless of their age. However if the SSA hasn't made a
determination of disability, Medicaid will have to make a determination of
one's disability.
What are Medically Needy Claimaints, and how do they come eligible for
Medicaid? - ANSWER The Medically Needy are those who would
otherwise be eligible for the SSI program except that their income and/or
resources are above income and resource limits set by the SSI program.
There are persons who are considered "SSI related": those aged 65 or
older, or those who are certified blind or disabled. These Medically
needy individuals may qualify for Medicaid if they meet the financial
income and resource limits set by NYS for the medically needy.
(Appendix 6A)
Who are they working disabled, and how do they become eligible for the
Medicaid program - ANSWER The working disabled are those who are
not eligible for traditional Medicaid because their income or resources
exceed the allowable Medicaid (SSI levels) levels, yet they meet the
