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An
Advocate's Guide to the Medicaid
Program
Table of Contents
Foreword
I. Introduction
II. Administration
- Centers for Medicare and Medicaid Services
- Single State Medicaid Agency
- Federal Financial Participation
- State Medicaid Plans
- Statewideness
- Federal Medicaid Waivers
- Managed Care Programs
- Enrollment of Beneficiaries in Group Health Plans
- Oversight of Providers
- Medical Care Advisory Committee
- Applying for Medicaid
- Eligibility Determinations
- Eligibility Redeterminations
- Presumptive Eligibility
- Liens and Recoveries
- Third Party Liability, Assignment, and Cooperation
- Notice and Hearings
- Judicial Enforcement
III. Eligibility
- Mandatory Categorically Needy
- Optional Categorically Needy
- Medically Needy
- Financial Eligibility
- Post-eligibility disregards of income and resources
- Spousal impoverishment protections
- Retroactive Eligibility
- Residency
- Citizenship/Immigration Status
IV. Services
- Mandatory Services for the Categorically Needy
- Optional Services for the Categorically Needy
- Services for the Medically Needy
- Early and Periodic Screening, Diagnosis and Treatment
- Medicaid and the Individuals with Disabilities Education Act
- Transportation
- Drug Coverage
- Organ Transplants
- Abortion Coverage
- Amount, Duration, and Scope of Services
- Comparability of Services and Reasonable Promptness
- Utilization Controls
- Nursing Facility Preadmission Screening
- Cost Sharing
- Freedom of Choice
- Medicaid as Payment in Full
- Payments to Providers
- Direct Payments to Beneficiaries
Appendix A
Appendix B
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