HSA4109 COMPREHENSIVE EXAM QUESTIONS WITH
SOLUTIONS 2025 GRADED A+
✔✔What are ACOs? - ✔✔Accountable Care Organizations: Medicare delivery reform
model where groups of providers accept responsibility for the overall care of
beneficiaries. Providers share in financial savings with Medicare (if spending and quality
targets are met)
✔✔In addition to using ACOs, bundled payments, and restructuring Medicare benefits
and cost sharing, what are two other Medicare reform options that have been
discussed? - ✔✔Increasing premiums for higher income beneficiaries further and
raising Medicare eligibility age
✔✔Who is the payer and entity making purchasing decisions for Medicaid and the
Children's Health Insurance Program (CHIP)? - ✔✔government payers
States are making the purchases decisions for the programs
✔✔Can states require Medicaid beneficiaries and CHIP enrollees to enroll in managed
care? - ✔✔Yes
✔✔What government health insurance program pays more than half of all long-term
care services in the U.S.? - ✔✔Medicaid
✔✔What government health insurance program drives states budgets and is the largest
federal revenue source to states? - ✔✔Medicaid
✔✔What populations are eligible for Medicaid? - ✔✔Low-income families; pregnant
women; children in foster care; the aged, blind and disabled; and dual-eligibles.
✔✔Is Medicaid the primary or secondary source of insurance coverage for dual
eligibles? - ✔✔secondary
✔✔What does it mean to be a secondary source of coverage? - ✔✔coverage you can
buy separately from a medical plan. It helps cover you for care and services that your
primary medical plan may not.
✔✔What is the percentage of Medicare beneficiaries who are dually eligible? - ✔✔20%
✔✔Is Medicaid the same in all states, with eligibility varying based on residency? -
✔✔eligibility varies by state
✔✔What is the percentage of births typically covered by Medicaid? - ✔✔49%
, ✔✔To be eligible for Medicaid, do individuals/families have to meet an income
requirement? - ✔✔based on federal poverty level
✔✔What are the citizenship requirements to qualify for Medicaid? - ✔✔must be citizens,
nationals of the U.S., or qualified aliens
✔✔What is the federal poverty level (FPL) used for? - ✔✔to determine eligibility for
different programs, including Medicaid and CHIP
✔✔What is the annual income for a family of four at 100% FPL (for 2019)? - ✔✔$25,750
✔✔What do the dollar figures on the FPL table represent? - ✔✔Family income for a
family at 100% of the FPL
✔✔What is the annual income for a family of four at 200% FPL (for 2019)? -
✔✔$51,500/year
✔✔What are six characteristics of the Medicaid population? - ✔✔1. complex conditions
2. costly healthcare needs
3. children
4. long term care
5. births
6. working
✔✔Do all states cover the same benefits (yes or no)? - ✔✔no
✔✔Are states mandated to cover family planning under Medicaid? - ✔✔yes
✔✔Are states mandated to cover prescription drugs under Medicaid (yes or no)? -
✔✔no
✔✔Are states mandated to cover physical therapy under Medicaid? - ✔✔no
✔✔Are more states expanding benefits or reducing benefits? - ✔✔expanding benefits
✔✔What service category is the most common benefit expansion among state Medicaid
programs? - ✔✔mental health / substance abuse disorder
✔✔What package of services is required for Medicaid children? - ✔✔Early and Periodic
Screening, Diagnostic, and Treatment (EPSDT)
SOLUTIONS 2025 GRADED A+
✔✔What are ACOs? - ✔✔Accountable Care Organizations: Medicare delivery reform
model where groups of providers accept responsibility for the overall care of
beneficiaries. Providers share in financial savings with Medicare (if spending and quality
targets are met)
✔✔In addition to using ACOs, bundled payments, and restructuring Medicare benefits
and cost sharing, what are two other Medicare reform options that have been
discussed? - ✔✔Increasing premiums for higher income beneficiaries further and
raising Medicare eligibility age
✔✔Who is the payer and entity making purchasing decisions for Medicaid and the
Children's Health Insurance Program (CHIP)? - ✔✔government payers
States are making the purchases decisions for the programs
✔✔Can states require Medicaid beneficiaries and CHIP enrollees to enroll in managed
care? - ✔✔Yes
✔✔What government health insurance program pays more than half of all long-term
care services in the U.S.? - ✔✔Medicaid
✔✔What government health insurance program drives states budgets and is the largest
federal revenue source to states? - ✔✔Medicaid
✔✔What populations are eligible for Medicaid? - ✔✔Low-income families; pregnant
women; children in foster care; the aged, blind and disabled; and dual-eligibles.
✔✔Is Medicaid the primary or secondary source of insurance coverage for dual
eligibles? - ✔✔secondary
✔✔What does it mean to be a secondary source of coverage? - ✔✔coverage you can
buy separately from a medical plan. It helps cover you for care and services that your
primary medical plan may not.
✔✔What is the percentage of Medicare beneficiaries who are dually eligible? - ✔✔20%
✔✔Is Medicaid the same in all states, with eligibility varying based on residency? -
✔✔eligibility varies by state
✔✔What is the percentage of births typically covered by Medicaid? - ✔✔49%
, ✔✔To be eligible for Medicaid, do individuals/families have to meet an income
requirement? - ✔✔based on federal poverty level
✔✔What are the citizenship requirements to qualify for Medicaid? - ✔✔must be citizens,
nationals of the U.S., or qualified aliens
✔✔What is the federal poverty level (FPL) used for? - ✔✔to determine eligibility for
different programs, including Medicaid and CHIP
✔✔What is the annual income for a family of four at 100% FPL (for 2019)? - ✔✔$25,750
✔✔What do the dollar figures on the FPL table represent? - ✔✔Family income for a
family at 100% of the FPL
✔✔What is the annual income for a family of four at 200% FPL (for 2019)? -
✔✔$51,500/year
✔✔What are six characteristics of the Medicaid population? - ✔✔1. complex conditions
2. costly healthcare needs
3. children
4. long term care
5. births
6. working
✔✔Do all states cover the same benefits (yes or no)? - ✔✔no
✔✔Are states mandated to cover family planning under Medicaid? - ✔✔yes
✔✔Are states mandated to cover prescription drugs under Medicaid (yes or no)? -
✔✔no
✔✔Are states mandated to cover physical therapy under Medicaid? - ✔✔no
✔✔Are more states expanding benefits or reducing benefits? - ✔✔expanding benefits
✔✔What service category is the most common benefit expansion among state Medicaid
programs? - ✔✔mental health / substance abuse disorder
✔✔What package of services is required for Medicaid children? - ✔✔Early and Periodic
Screening, Diagnostic, and Treatment (EPSDT)
