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Medicaid Terms A-L

By

Definition:

Capitation
A method of payment for health services in which a provider is paid a fixed amount to cover a specific period of time for each person served, regardless of the actual number of services.

Care Coordination
Coordination of health care services for all members of a Medicaid managed care plan.

Case Management
Process by which patients with specific diagnosis or requiring high-cost or extensive services are managed by a physician or nurse or designated health professional.

Categorical Eligibility
Medicaid eligibility is based on defined indicators of financial need by families with children and pregnant women, and to persons who are aged, blind, or disabled. Persons not falling into these categories cannot qualify.

Disease Management
A strategy to deliver health care services using interdisciplinary clinical teams, continuous analysis of data, and cost-effective technology to improve health outcomes.

Dual Eligible
Refers to people who are enrolled in both Medicaid and Medicare.

Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT)
Designed to improve primary health benefits for Medicaid children with emphasis on preventive care.

Enhanced Federal (FMAP) Reimbursement
The "Enhanced Federal Medical Assistance Percentages" are for use in the State Children's Health Insurance Programs.

Federal Block Grant
States are responsible for implementing more than 300 separate programs. These programs are administered by different agencies at the federal level. Block grants offer states an opportunity to develop policies based on local needs.

Federal Medical Assistance Percentages (FMAP)
Medicaid is a federal-state partnership. The FMAPs are used in determining the amount of federal matching funds for state expenditures.

Federal Waivers
The Social Security Act authorizes states flexibility in operating Medicaid programs.

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