Glossary
Tags
- ACA
- ACA Marketplace
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- CMS
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Assisted Living Facility
A residential facility providing support and care for individuals who need assistance with daily activities, such as dressing, bathing, and managing medications. Coverage of assisted living varies by Medicaid program and state.
A residential facility providing support and care for individuals who need assistance with daily activities, such as dressing, bathing, and managing medications. Coverage of assisted living varies by Medicaid program and state.
Behavioral Health Services
Healthcare services that focus on treating mental health conditions, emotional disorders, and substance use issues. These services are covered under programs like Medicaid, CHIP, and Medicare.
Healthcare services that focus on treating mental health conditions, emotional disorders, and substance use issues. These services are covered under programs like Medicaid, CHIP, and Medicare.
Community Health Center
A nonprofit clinic that provides primary care and preventive services to low-income individuals, often funded by federal programs such as Medicaid and CHIP. These centers serve uninsured, underinsured, and Medicaid-eligible populations.
A nonprofit clinic that provides primary care and preventive services to low-income individuals, often funded by federal programs such as Medicaid and CHIP. These centers serve uninsured, underinsured, and Medicaid-eligible populations.
Durable Medical Equipment (DME)
Equipment prescribed by a healthcare provider that can be used at home to help with medical conditions, such as wheelchairs, crutches, oxygen tanks, and hospital beds. Medicare, Medicaid, and CHIP cover DME when deemed medically necessary.
Equipment prescribed by a healthcare provider that can be used at home to help with medical conditions, such as wheelchairs, crutches, oxygen tanks, and hospital beds. Medicare, Medicaid, and CHIP cover DME when deemed medically necessary.
Dependent Care
Care provided for children or dependent adults who require assistance with daily living. Medicaid may cover home or community-based services for dependent care under certain circumstances.
Care provided for children or dependent adults who require assistance with daily living. Medicaid may cover home or community-based services for dependent care under certain circumstances.
Emergency Services
Immediate medical care provided for acute, life-threatening conditions. Medicare, Medicaid, CHIP, and ACA-compliant plans all cover emergency services, often without requiring prior authorization.
Immediate medical care provided for acute, life-threatening conditions. Medicare, Medicaid, CHIP, and ACA-compliant plans all cover emergency services, often without requiring prior authorization.
Federally Qualified Health Center (FQHC)
A community-based health clinic that provides comprehensive primary and preventive care services, including dental, mental health, and substance use services. Medicaid, Medicare, and CHIP typically cover services received at FQHCs, which serve low-income, uninsured, and underserved populations.
A community-based health clinic that provides comprehensive primary and preventive care services, including dental, mental health, and substance use services. Medicaid, Medicare, and CHIP typically cover services received at FQHCs, which serve low-income, uninsured, and underserved populations.
Geriatric Care
Specialized healthcare services for older adults, focusing on age-related conditions such as mobility issues, chronic diseases, and dementia. Medicare and Medicaid provide coverage for many geriatric care services, including nursing home care and home healthcare.
Specialized healthcare services for older adults, focusing on age-related conditions such as mobility issues, chronic diseases, and dementia. Medicare and Medicaid provide coverage for many geriatric care services, including nursing home care and home healthcare.
Home Health Care
Medical and personal care services provided to individuals in their own homes, often after hospitalization or surgery. Medicare, Medicaid, and CHIP cover home health care services, including nursing care, physical therapy, and assistance with daily activities.
Medical and personal care services provided to individuals in their own homes, often after hospitalization or surgery. Medicare, Medicaid, and CHIP cover home health care services, including nursing care, physical therapy, and assistance with daily activities.
Hospice Care
End-of-life care provided to individuals with terminal illnesses, focusing on comfort and quality of life rather than curative treatment. Medicare and Medicaid cover hospice care, including medical services, emotional support, and pain management.
End-of-life care provided to individuals with terminal illnesses, focusing on comfort and quality of life rather than curative treatment. Medicare and Medicaid cover hospice care, including medical services, emotional support, and pain management.
Home and Community-Based Services (HCBS)
Services that allow individuals, particularly those with disabilities or chronic illnesses, to receive care in their homes or communities rather than in institutional settings. Medicaid provides coverage for HCBS, including personal care, nursing, and therapy.
Services that allow individuals, particularly those with disabilities or chronic illnesses, to receive care in their homes or communities rather than in institutional settings. Medicaid provides coverage for HCBS, including personal care, nursing, and therapy.
Hospice Respite Care
Short-term inpatient care provided to hospice patients to give their primary caregivers temporary relief. Medicare and Medicaid cover respite care as part of hospice services for individuals receiving end-of-life care.
Short-term inpatient care provided to hospice patients to give their primary caregivers temporary relief. Medicare and Medicaid cover respite care as part of hospice services for individuals receiving end-of-life care.
Inpatient Care
Medical treatment provided to a patient who is admitted to a hospital or facility for at least one overnight stay. Medicare Part A, Medicaid, and CHIP cover inpatient care, which includes hospital stays, surgery, and rehabilitation services.
Medical treatment provided to a patient who is admitted to a hospital or facility for at least one overnight stay. Medicare Part A, Medicaid, and CHIP cover inpatient care, which includes hospital stays, surgery, and rehabilitation services.
Integrated Care
A coordinated approach to healthcare that involves integrating physical, behavioral, and mental health services to provide holistic care. Integrated care models are often used in Medicare, Medicaid, and CHIP programs to improve outcomes.
A coordinated approach to healthcare that involves integrating physical, behavioral, and mental health services to provide holistic care. Integrated care models are often used in Medicare, Medicaid, and CHIP programs to improve outcomes.
Kidney Transplant
A surgical procedure to replace a failing kidney with a healthy one from a donor. Individuals with End-Stage Renal Disease (ESRD) are eligible for Medicare, regardless of age, and Medicare covers kidney transplants, dialysis, and related services.
A surgical procedure to replace a failing kidney with a healthy one from a donor. Individuals with End-Stage Renal Disease (ESRD) are eligible for Medicare, regardless of age, and Medicare covers kidney transplants, dialysis, and related services.
Long-Term Care (LTC)
A range of services that provide medical and personal care to individuals with chronic illnesses or disabilities who cannot manage their daily activities independently. Medicaid is the primary payer for long-term care services, covering nursing homes, assisted living, and home care.
A range of services that provide medical and personal care to individuals with chronic illnesses or disabilities who cannot manage their daily activities independently. Medicaid is the primary payer for long-term care services, covering nursing homes, assisted living, and home care.
Level of Care (LOC)
A term used in Medicaid to determine the intensity of care required by an individual. LOC assessments are used to establish eligibility for long-term care services, such as nursing home care or home and community-based services.
A term used in Medicaid to determine the intensity of care required by an individual. LOC assessments are used to establish eligibility for long-term care services, such as nursing home care or home and community-based services.
Mental Health Services
Services that focus on the diagnosis, treatment, and management of mental health conditions, such as therapy, counseling, and psychiatric care. Medicaid, Medicare, and CHIP provide coverage for a range of mental health services.
Services that focus on the diagnosis, treatment, and management of mental health conditions, such as therapy, counseling, and psychiatric care. Medicaid, Medicare, and CHIP provide coverage for a range of mental health services.
Non-Emergency Medical Transportation (NEMT)
Transportation services provided to individuals who need assistance getting to and from medical appointments but do not require emergency care. Medicaid often covers NEMT for eligible beneficiaries, especially those with disabilities or mobility issues.
Transportation services provided to individuals who need assistance getting to and from medical appointments but do not require emergency care. Medicaid often covers NEMT for eligible beneficiaries, especially those with disabilities or mobility issues.
Nursing Home Care
Long-term care services provided in a nursing facility for individuals who need assistance with daily activities or medical care. Medicaid is the largest payer of nursing home care, though Medicare provides limited coverage for skilled nursing facility care.
Long-term care services provided in a nursing facility for individuals who need assistance with daily activities or medical care. Medicaid is the largest payer of nursing home care, though Medicare provides limited coverage for skilled nursing facility care.