HCMG LATEST QUESTIONS AND ANSWERS UPDATE: A
MASTERING A+ MATERIAL!
How has the rise in unemployment in 2008-2009 changed health coverage?
2.8% rise in national unemployment rate increased Medicaid enrollment by 2.8 million and the
number of uninsured by 3 million
how will the new health reform law change medic aid eligibility
expand eligibility to those under 65 and with incomes below 133% of poverty. will increase
medic aid enrollment by 16 million by 2019? federal government will finance 100% from 2014-
2016 during transition and 90% after. with this match, states must provide benchmark benefits.
what 2 waivers gave states broader authority to enroll Medicaid beneficiaries in managed
care?
section 1915b and section 1115
what did the BBA 1997 due to Medicaid managed care?
states can mandate enrollment in managed care for Medicaid beneficiaries without obtaining
federal waiver. exceptions are special needs children, Medicare beneficiaries, and native
Americans.
what has been the trend in managed care usage for Medicaid
increasing use by states for cost savings. got to 71%/33.4 million people in 2008.
how many Medicaid enrollees are dual eligible?
1 in 7 Medicaid enrollees, or 6 million. includes nearly all elderly and about 1/3 of non-elderly
beneficiaries with disabilities in Medicaid.
how many Medicare enrollees are dual eligible?
18%
what do the poorest Medicare beneficiaries get from Medicaid if dual-eligible?
full assistance with Medicare premiums and cost sharing. coverage of Medicaid benefits
what do the not as poor dual-eligible Medicare beneficiaries get from Medicaid
limited assistance covering Medicare premiums and cost sharing. no Medicaid benefits.
what is known as buy-in programs?
dual-eligible Medicare enrollees who are not as poor get help with cost sharing in Medicare
from Medicaid. they do not get Medicaid benefits.
, what are some names for people who do buy-ins?
QMB (qualified Medicare beneficiaries), SLMB (specified low-income Medicare beneficiaries),
and QI (qualifying individuals)
what are some socioeconomic characteristics of dual eligible compared with Medicare
beneficiaries?
more likely to be: long term care resident, nonelderly disabled, medically needy, less than high
school education, mentally impaired, less than 10,000 annual income
how many people are enrolled in Medicaid as of 2008?
50 million people
dual-eligible spend how much of total Medicare spending?
18% of Medicaid enrollees are duals but duals spend 46% (almost half) of all Medicaid
spending.
how did the MMA affect dual eligible?
in 2006, 7 million DEs enrolled in Medicare Part D for prescription drugs. Medicare offers cost
sharing assistance to DEs and poor (no premiums, deductible, or donut hole. $1-$5 copays).
What is claw back?
while the new law shifts drug coverage for dual eligible from Medicaid to Medicare, it does not
provide full fiscal relief to states. states have to finance part of Part D for DEs through "claw
back" payments to the federal government.
what is the impact of shifting DEs to Medicare for prescription drugs?
drugs covered in part D might be less than Medicaid, out of pocket costs have increased (for
drugs not covered under part D and for higher copays). Also states cannot use Medicaid
matching funds to supplement part D coverage for DEs.
what percent of the poor are eligible for Medicaid?
40%
what is the trend in number of hospitals in US over time?
as population in US grew, number of hospitals grew. stagnate from 1950 to 1975. Fell since
1980s due to shrinking Medicare and technology reimbursement. currently we have 5000
hospitals in the US.
what is the breakdown in the type of hospitals in the US?
60% nonprofit, 20% government, 20% for-profit, 60% in network/system
MASTERING A+ MATERIAL!
How has the rise in unemployment in 2008-2009 changed health coverage?
2.8% rise in national unemployment rate increased Medicaid enrollment by 2.8 million and the
number of uninsured by 3 million
how will the new health reform law change medic aid eligibility
expand eligibility to those under 65 and with incomes below 133% of poverty. will increase
medic aid enrollment by 16 million by 2019? federal government will finance 100% from 2014-
2016 during transition and 90% after. with this match, states must provide benchmark benefits.
what 2 waivers gave states broader authority to enroll Medicaid beneficiaries in managed
care?
section 1915b and section 1115
what did the BBA 1997 due to Medicaid managed care?
states can mandate enrollment in managed care for Medicaid beneficiaries without obtaining
federal waiver. exceptions are special needs children, Medicare beneficiaries, and native
Americans.
what has been the trend in managed care usage for Medicaid
increasing use by states for cost savings. got to 71%/33.4 million people in 2008.
how many Medicaid enrollees are dual eligible?
1 in 7 Medicaid enrollees, or 6 million. includes nearly all elderly and about 1/3 of non-elderly
beneficiaries with disabilities in Medicaid.
how many Medicare enrollees are dual eligible?
18%
what do the poorest Medicare beneficiaries get from Medicaid if dual-eligible?
full assistance with Medicare premiums and cost sharing. coverage of Medicaid benefits
what do the not as poor dual-eligible Medicare beneficiaries get from Medicaid
limited assistance covering Medicare premiums and cost sharing. no Medicaid benefits.
what is known as buy-in programs?
dual-eligible Medicare enrollees who are not as poor get help with cost sharing in Medicare
from Medicaid. they do not get Medicaid benefits.
, what are some names for people who do buy-ins?
QMB (qualified Medicare beneficiaries), SLMB (specified low-income Medicare beneficiaries),
and QI (qualifying individuals)
what are some socioeconomic characteristics of dual eligible compared with Medicare
beneficiaries?
more likely to be: long term care resident, nonelderly disabled, medically needy, less than high
school education, mentally impaired, less than 10,000 annual income
how many people are enrolled in Medicaid as of 2008?
50 million people
dual-eligible spend how much of total Medicare spending?
18% of Medicaid enrollees are duals but duals spend 46% (almost half) of all Medicaid
spending.
how did the MMA affect dual eligible?
in 2006, 7 million DEs enrolled in Medicare Part D for prescription drugs. Medicare offers cost
sharing assistance to DEs and poor (no premiums, deductible, or donut hole. $1-$5 copays).
What is claw back?
while the new law shifts drug coverage for dual eligible from Medicaid to Medicare, it does not
provide full fiscal relief to states. states have to finance part of Part D for DEs through "claw
back" payments to the federal government.
what is the impact of shifting DEs to Medicare for prescription drugs?
drugs covered in part D might be less than Medicaid, out of pocket costs have increased (for
drugs not covered under part D and for higher copays). Also states cannot use Medicaid
matching funds to supplement part D coverage for DEs.
what percent of the poor are eligible for Medicaid?
40%
what is the trend in number of hospitals in US over time?
as population in US grew, number of hospitals grew. stagnate from 1950 to 1975. Fell since
1980s due to shrinking Medicare and technology reimbursement. currently we have 5000
hospitals in the US.
what is the breakdown in the type of hospitals in the US?
60% nonprofit, 20% government, 20% for-profit, 60% in network/system
