The Service Tree lists all services in "branched" groups, starting with the very general and moving to the very specific. Click on the name of any group name to see the sub-groups available within it. Click on a service code to see its details and the providers who offer that service.
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Programs that are responsible for hearing appeals and resolving complaints that have been filed by people who have applied for or who are receiving services through Medicaid and believe that they have been discriminated against, that their rights have been violated or that the state or county has failed to take appropriate action with respect to their application or benefits.
County or state offices that accept applications and determine eligibility for the Medicaid program; and reinstate individuals who have lost their Medicaid benefits due to incarceration, institutionalization, noncompliance or other reasons. Also included are other programs that help people prepare and file Medicaid applications and/or are authorized to do eligibility determinations for the program.
Programs that enable people with disabilities who are working and earning more than the allowable limits for regular Medicaid to retain their health care coverage through the Medicaid program. Participants "buy into" the program, typically by paying premiums that are based on income.
Programs that provide a hotline or other mechanism that people can use to request a replacement when their Medicaid card was never received, has been lost or stolen, or when a replacement is required due to a name change or for other similar circumstance. Replacement cards can also be obtained from Medicaid applications offices.
Medicaid Estate Recovery Programs
Programs that are responsible for implementing the 1993 federal legislation that makes it mandatory for states to attempt to recover Medicaid payments for recipients from their estates after they die; and/or which provide information about the program. Since most tangible assets are spent through Medicaid spend down, estate recovery focuses on real property, personal property or business ownership that the deceased had an interest in just prior to receiving Medicaid. Recovery applies to individuals who were age 55 or older when they received Medicaid or to permanently institutionalized adults younger than age 55. Recovery can also occur from the estate of living recipients who are in a nursing home and who have been certified that they cannot reasonably be expected to be discharged and return home. The property is exempt from estate recovery if the recipient's spouse is living there, a blind or permanently disabled child lives there, or if as a result of a state lien, additional protection for siblings and adult children can be satisfied.
Medicaid Healthy Rewards Programs
Medicaid providers that seek to improve the health outcomes of beneficiaries by offering incentives for healthy behaviors such as keeping primary care appointments, participating in weight management classes or cancer screenings or achieving health goals such as lowering blood sugar to mitigate diabetes or reducing high blood pressure. Incentives may include cash awards, gift certificates, a health-related reward such as a soccer ball or yoga mat, a contribution to an HSA or access to a service such as a dental appointment. Penalties such as cost-sharing, premiums, or limits on benefits may also be imposed on people who don't get preventive care or other necessary services or use services inappropriately.
County or state offices that review requests for health care which require prior approval in order for Medicaid to be used as a payment source.
Programs that cover all or a portion of Medicare costs for low income Medicare beneficiaries with limited resources/assets. Medicare Savings Programs (MSPs) are administered by Medicaid medical assistance offices, pay all or a portion of Medicare premiums and may pay Medicare deductibles and co-insurance. Included are the Qualified Medicare Beneficiary (QMB) program that pays Medicare premiums, deductibles and co-payments for people with combined incomes that do not exceed 100 percent of the federal poverty level; the Specified Low-Income Beneficiary (SLMB) program that pays Medicare Part B premiums for people with combined incomes between 100 and 120 percent of the federal poverty level; the Qualifying Individuals (QI) program that pays Medicare Part B premiums for people with combined incomes 120 and 135 percent of the federal poverty level; and the Qualified Disabled and Working Individuals (QDWI) program that helps pay the Part A premium for individuals under age 65 who have a disability and are working, have lost their premium-free Part A when they returned to work, are not receiving medical assistance from their state and meet income and resource limits required by their state. The QI program is a limited program (block grant to states), and is available on a first come, first serve basis. Asset/resource limits for these programs are adjusted each year and may vary by state.
State Medicaid Managed Care Enrollment Programs
State programs (or private vendors under contract with the state) that enroll Medicaid recipients in a Medicaid managed care program that coordinates the provision, quality and cost of care for its enrolled members. Recipients may have a designated amount of time to choose a managed care option following eligibility determination; and once enrolled, select a primary care practitioner from the plan's network of professionals and hospitals who will be responsible for coordinating their health care and referring them to specialists or other health care providers as necessary. In some situations, where acute and primary care are not integrated into the selected option, people may work with a multidisciplinary team of professionals to support service plan development and implementation. Enrollment in a managed care plan may be voluntary or mandatory for some or all Medicaid recipients in a state. Participation requirements and associated criteria vary from state to state and in some cases, from area to area within the same state. States often make exceptions to their mandatory enrollment requirements for certain individuals and groups, e.g., people with disabilities or identified health conditions, who may be served outside the state's managed care delivery system. These individuals may enroll in a managed care program but are not required to do so. States may also identify a range of Medicaid eligibility groups who are excluded from participating in their managed care programs. Also included are other programs that help people prepare and file State Medicaid Managed Care enrollment applications.
State Medicaid Managed Care Insurance Carriers
Private insurance companies that issue managed care policies to people who qualify under Medicaid, generally on the basis of a contractual arrangement with the state. Enrollment in a managed care plan may be voluntary or mandatory for some or all Medicaid recipients in a state; and participation requirements and associated criteria vary from state to state and in some cases, from area to area within the same state. Benefits covered by Medicaid vary by jurisdiction but generally include hospitalization, physician services, emergency room visits, family planning, immunizations, laboratory and x-ray services, outpatient surgery, chiropractic care, prescriptions, eye exams, eye glasses and dental care. Other covered services may include alcohol and drug treatment, mental health services, medical equipment and supplies and rehabilitative therapy. Medical benefits are administered by the insurance companies under terms of their contract.
State Medicaid Waiver Appeals/Complaints
Programs that are responsible for hearing appeals and resolving complaints that have been filed by people who have applied for or are receiving benefits through a state Medicaid waiver program and believe that they have been discriminated against, that their rights have been violated or that the program has failed to take appropriate action with respect to their application or benefits. The program also hears appeals by providers seeking to participate in the program whose applications have been denied.
State Medicaid Waiver Programs
Medicaid programs offered by states that have been authorized by the Secretary of the U.S. Department of Health and Human Services (HHS) to waive certain Medicaid statutory requirements giving them more flexibility in Medicaid program operation. Included are home and community care based (HCBC) waiver programs operated under Section 1915(c) of the Social Security Act that allow long-term care services to be delivered in community settings; managed care/freedom of choice waiver programs operated under Section 1915(b) of the Social Security Act which allow states to implement managed care delivery systems or otherwise limit individuals' choice of provider under Medicaid; and research and demonstration project waiver programs operated under Section 1115 of the Social Security Act to projects that test policy innovations likely to further the objectives of the Medicaid program. Each of the states has developed waivers to meet their needs; and while every state's waiver programs have their own unique characteristics, there may also be common threads.