Welcome to the Medicaid
Download
1 / 31

Welcome to the Medicaid Policy Panel - PowerPoint PPT Presentation


  • 122 Views
  • Updated On :

Welcome to the Medicaid Policy Panel. Welcome to the Medicaid Policy Panel Adult Medicaid Quiz (or…What you hoped you would never need to know about Adult Medicaid).

Related searches for Welcome to the Medicaid Policy Panel

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Welcome to the Medicaid Policy Panel' - forster


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Slide2 l.jpg

Welcome to the Medicaid Policy Panel

Adult Medicaid Quiz

(or…What you hoped you would never need to know about Adult Medicaid)


Slide3 l.jpg

As you know, the recently completed Medicaid case review revealed several areas where we could improve. During the course of this meeting, we will be addressing these areas, but first, we want to find out what we may (or may not) know about policy in these areas.


Slide4 l.jpg

The following questions are taken from our Adult Medicaid Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.


Slide5 l.jpg

Don’t sweat this test! Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

It’s designed to give you some points to ponder and to give us some talking points. It will also challenge what you may believe regarding this policy and review findings.


Slide6 l.jpg

Let others take the test as well! Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

When you get back home, you can access the PowerPoint version of this test. You can use it as a training tool for your staff. The test is located under the Learning Sessions area of the Adult Medicaid web site located at

http://www.training.eku.edu/adultmedicaid/learningsessions.htm


Slide7 l.jpg

Question #1 Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Place in order (from most error-prone to least), the following causes of errors during the recent Medicaid review

  • Income Eligibility

  • Pass-Through Eligibility

  • Resources (Burial issues)

  • On-going ineligibles


Slide8 l.jpg

And the Answer Is Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Place in order (from most error-prone to least), the following causes of errors during the recent Medicaid review

  • Resources (Burial issues)

  • On-going ineligibles

  • Pass-Through Eligibility

  • Income Eligibility


Slide9 l.jpg

Question #2 Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Which of the following are technical eligibility factors that must be met in order to meet requirements for Long Term Care? Check all that apply:

A. Resides in a nursing facility listed on KAMES Inquiry

B. Aged, Blind or Disabled

C. Enrolled in Part B of Medicare

D. A resident of Kentucky

E. Sign the MA 36

F. A US citizen or qualified Alien

G. Verification of shelter expenses

H. Enumeration

I. Third Party Liability

J. Knows someone in high places


Slide10 l.jpg

And, the Answer Is Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Which of the following are technical eligibility factors that must be met in order to meet requirements for Long Term Care? Check all that apply:

B. Aged, Blind or Disabled

D. A resident of Kentucky

F. A US citizen or qualified Alien

H. Enumeration

I. Third Party Liability


Slide11 l.jpg

Question #3 Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Which of the following are “Excluded Resources” for AMA?Check all that apply:

A. Term and burial Insurance

B. Homestead property during the first six months of continuous institutionalization

C. Homestead property after the first six months of continuous institutionalization, when the spouse resides at the property

D. Nursing home savings account

E. One vehicle, if used for employment, to obtain medical treatment, or is equipped for the disabled

F. Two vehicles, one used for medical transportation, and one used for employment

G. All resources of an SSI individual

H. Gravesites, crypts, caskets, and headstones

I. $1,500 burial exclusion for each member of the assistance group


Slide12 l.jpg

And, the Answer Is Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Which of the following are “Excluded Resources” for AMA?Check all that apply:

A. Term and burial Insurance

B. Homestead property during the first six months of continuous institutionalization

C. Homestead property after the first six months of continuous institutionalization, when the spouse resides at the property

E. One vehicle, if used for employment, to obtain medical treatment, or is equipped for the disabled

G. All resources of an SSI individual

H. Gravesites, crypts, caskets, and headstones

I. $1,500 burial exclusion for each member of the assistance group


Slide13 l.jpg

Question #4 Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Wendy Frost has made application for HCBS. She has a fully funded irrevocable funeral contract in the amount of $5,500. The itemized contract shows that $4,700 of the $5,500 contract is for excludable burial items. She also has two life insurance policies. Policy A has a FV of $5,000 and CSV of $1,235. Policy B has a FV of $4,000 and a CSV of $921. A signed MA-36 is in the case record. What is the amount that should be added to her other resources to be compared to the Resource Scale?

A. $2,156 C. $2956

B. $0 D. $2,056


Slide14 l.jpg

And the Answer is Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Since Wendy already had a fully funded funeral contract, she is not allowed to designate her life insurance policies as burial reserves. Therefore, the CSV of all the policies has to be considered as a regular resource.

A. $2,156


Slide15 l.jpg

Question #5 Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Which of the following are technically eligible for the Pass Through Category?

A. Individual lost SSI, but received at least one SSI check and one RSDI check in the same month correctly

B. Individual received SSI due to disability as a child and lost SSI due to entitlement to or increase in RSDI DAC receipt

C. Individuals who were disabled as a child and later recovered

D. Individuals, ages 60-64, who lost SSI or SSP as a result of entitlement to RSDI early widow's or widower's benefits, and who are not yet entitled to Medi­care Part A

E. Individuals who received SSI and a private pension in the same month

F. Individuals who received SSI or SSP and who lost SSI or SSP as a result of entitlement to RSDI disabled widow's or widower's or disabled surviving divorced spouse's benefits, and are not yet entitled to Medicare Part A.


Slide16 l.jpg

And the Answer Is Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Which of the following are technically eligible for the Pass Through Category?

A. Individual lost SSI, but received at least one SSI check and one RSDI check in the same month correctly

B. Individual received SSI due to disability as a child and lost SSI due to entitlement to or increase in RSDI DAC receipt

D. Individuals, ages 60-64, who lost SSI or SSP as a result of entitlement to RSDI early widow's or widower's benefits, and who are not yet entitled to Medi­care Part A

F. Individuals who received SSI or SSP and who lost SSI or SSP as a result of entitlement to RSDI disabled widow's or widower's or disabled surviving divorced spouse's benefits, and are not yet entitled to Medicare Part A.


Slide17 l.jpg

Question #6 Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Which type of case would best suit the following?

  • Lost their SSI due to a COLA increase in their RSDI

  • Has Medicare A & B with countable income of $700 and no medical bills

  • Has Medicare A & B, lives alone in home, countable income of $1345, has medical bill from prior month of $3000

  • Has Medicare A & B, lives alone in home, gross income of $600, pays a neighbor to cook meals and sort medicines daily


Slide18 l.jpg

And the Answer Is Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Which type of case would best suit the following?

A. Lost their SSI due to a COLA increase in their RSDI

Pass-through (F,G,H)

B. Has Medicare A & B with countable income of $700 and no medical bills

QMB (Z Case)

C. Has Medicare A & B, lives alone in home, countable income of $1345, has medical bill from prior month of $3000

Spend Down (J,K,M)

D. Has Medicare A & B, lives alone in home, gross income of $600, pays a neighbor to cook meals and sort medicines daily

SSP (FP, GP, HP)


Slide19 l.jpg

Question #7 Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

State Supplementation

Samantha is single and lives in a Family Care Home. Her only income is $632 monthly from RSDI based upon her disability. If eligible for State Supp. What would the amount of her grant be?

  • $149

  • $179

  • $163

  • $159


Slide20 l.jpg

And, the Answer Is Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

State Supplementation

Samantha is single and lives in a Family Care Home. Her only income is $632 monthly from RSDI based upon her disability. If eligible for State Supp. What would the amount of her grant be?

$795 Family Care home (includes $40 PNA)

-632 monthly income

$163 Monthly SSP Grant

C. $163


Slide21 l.jpg

Question #8 Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Determine the amount of excess burial reserves:

Mary Jones is a resident of an approved nursing facility. She has 3 life insurance policies and no funeral contract for burial. She has signed a MA-36 to designate all three policies for burial.

Policy A – FV = $2500 CSV = $900

Policy B – FV = $1500 CSV = $236

Policy C – FV = $1500 CSV = $726

What is the amount of the excess burial reserve?

  • $362 B. $4000

  • C. $0 D. $1500


Slide22 l.jpg

And the Answer Is Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Determine the amount of excess burial reserves:

Mary Jones is a resident of an approved nursing facility. She has 3 life insurance policies and no funeral contract for burial. She has signed a MA-36 to designate all three policies for burial.

Policy A – FV = $2500 CSV = $900

Policy B – FV = $1500 CSV = $236

Policy C – FV = $1500 CSV = $726

What is the amount of the excess burial reserve?

Policy A – FV = $2500 CSV = $900

Policy B – FV = $1500 CSV = $236

Policy C – FV = $1500 CSV = $726

Total $1862

- 1500

Excess 362

  • $362


Slide23 l.jpg

Question #9 Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Determine the total amount of resources:

Susan Jones has been admitted to a Medicaid approved nursing facility. Her representative has provided verification of the following for Ms. Jones:

Checking Account of $429 Savings Account of $682;

Nursing Facility Account of $110

Prearranged funeral contract of $6,000 that is funded by a life insurance policy of $6,000 that has an irrevocable assignment of ownership to the funeral home. Excludable burial space items included in the funeral contract total $4,000.

  • $7221 B. $1221

  • C. $0 D. $3221


Slide24 l.jpg

And the Answer Is Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Determine the total amount of resources:

Susan Jones has been admitted to a Medicaid approved nursing facility. Her representative has provided verification of the following for Ms. Jones:

Checking Account of $429 Savings Account of $682;

Nursing Facility Account of $110

Prearranged funeral contract of $6,000 that is funded by a life insurance policy of $6,000 that has an irrevocable assignment of ownership to the funeral home. Excludable burial space items included in the funeral contract total $4,000.

Since there is an irrevocable assignment of Ownership (rather than the Funeral Home being the “Beneficiary”) of the life insurance policy that funds the prearranged funeral contract, none of that insurance policy will be considered as a resource. The total of the other assets:

$429 + $682 + $110 = $1,221

B. $1221


Slide25 l.jpg

Question #10 Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Determine Patient Liability:

Bob Mac is 70 years old, lives alone and has been certified eligible for HCBS level of care. He has the following income: $728 from RSDI; $428 from a private pension; and $43 in monthly interest. He pays $93.50 for SMI premiums and $86.30 per month for health insurance. How much will he have to pay toward his own care (Patient Liability)?

  • $992 B. $794

  • C. $333 D. $952


Slide26 l.jpg

And the Answer Is Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Determine Patient Liability:

Bob Mac is 70 years old, lives alone and has been certified eligible for HCBS level of care. He has the following income: $728 from RSDI; $428 from a private pension; and $43 in monthly interest. He pays $78.20 for SMI premiums and $86.30 per month for health insurance. How much will he have to pay toward his own care (Patient Liability)?

Mr. Mac’s gross income:

$728 (RSDI) + $428 (pension) = $1,156. (Interest income is excluded.) His deductions are: $93.50 (SMI) + $86.30 (health insurance) + $643 (Personal Needs Allowance) = $822.80. $1,156 - $822.80 = $333.20, which rounds up to $333.

C. $333


Slide27 l.jpg

Question #11 Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Pass Through:

If a Pass Through applicant lost his/her SSI eligibility for any reason other than a COLA, what must happen in order to meet the Pass Through technical eligibility requirement?

A. He/she must reapply for SSI

B. He/she must go through two COLA’s

C. He/she must verify the reason the SSI was discontinued

D. He/she must go through at least one COLA

E. He/she cannot be eligible for the Pass Through Program


Slide28 l.jpg

And the Answer Is Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Pass Through:

If a Pass Through applicant lost his/her SSI eligibility for any reason other than a COLA, what must happen in order to meet the Pass Through technical eligibility requirement?

D. He/she must go through at least one COLA


Slide29 l.jpg

Question #12 Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Estate Recovery:

Estate Recovery applies to individuals over 55 who receive MA for: (Check all that apply)

A. Nursing Facility, excluding institutionalized Hospice

B. Spenddown

C. ICF/MR/DD

D. Supports for Community Living

E. Non-Institutionalized Hospice

F. Home and Community Based Services


Slide30 l.jpg

And the Answer Is Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

Estate Recovery:

Estate Recovery applies to individuals over 55 who receive MA for: (Check all that apply)

A. Nursing Facility, excluding institutionalized Hospice

C. ICF/MR/DD

D. Supports for Community Living

F. Home and Community Based Services


Slide31 l.jpg

Test Scoring Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.

All 12 Correct – Too Much Time on Your Hands

8-11 Correct – Above Average (Please stay!!!)

4-7 Correct – About average Good job!

0-3 Correct – Don’t feel too bad… THIS STUFF IS HARD!!!!!!


ad