The Service Tree lists all services in "branched" groups, starting with the very general and moving to the very specific. Click on the name of any group name to see the sub-groups available within it. Click on a service code to see its details and the providers who offer that service.
Medicaid
County or state offices that accept applications and determine eligibility for the Medicaid program; and reinstate individuals who have lost their Medicaid benefits due to incarceration, institutionalization, noncompliance or other reasons. Also included are other programs that help people prepare and file Medicaid applications and/or are authorized to do eligibility determinations for the program.
Programs that cover all or a portion of Medicare costs for low income Medicare beneficiaries with limited resources/assets. Medicare Savings Programs (MSPs) are administered by Medicaid medical assistance offices, pay all or a portion of Medicare premiums and may pay Medicare deductibles and co-insurance. Included are the Qualified Medicare Beneficiary (QMB) program that pays Medicare premiums, deductibles and co-payments for people with combined incomes that do not exceed 100 percent of the federal poverty level; the Specified Low-Income Beneficiary (SLMB) program that pays Medicare Part B premiums for people with combined incomes between 100 and 120 percent of the federal poverty level; the Qualifying Individuals (QI) program that pays Medicare Part B premiums for people with combined incomes 120 and 135 percent of the federal poverty level; and the Qualified Disabled and Working Individuals (QDWI) program that helps pay the Part A premium for individuals under age 65 who have a disability and are working, have lost their premium-free Part A when they returned to work, are not receiving medical assistance from their state and meet income and resource limits required by their state. The QI program is a limited program (block grant to states), and is available on a first come, first serve basis. Asset/resource limits for these programs are adjusted each year and may vary by state.
State Medicaid Managed Care Enrollment Programs
State programs (or private vendors under contract with the state) that enroll Medicaid recipients in a Medicaid managed care program that coordinates the provision, quality and cost of care for its enrolled members. Recipients may have a designated amount of time to choose a managed care option following eligibility determination; and once enrolled, select a primary care practitioner from the plan's network of professionals and hospitals who will be responsible for coordinating their health care and referring them to specialists or other health care providers as necessary. In some situations, where acute and primary care are not integrated into the selected option, people may work with a multidisciplinary team of professionals to support service plan development and implementation. Enrollment in a managed care plan may be voluntary or mandatory for some or all Medicaid recipients in a state. Participation requirements and associated criteria vary from state to state and in some cases, from area to area within the same state. States often make exceptions to their mandatory enrollment requirements for certain individuals and groups, e.g., people with disabilities or identified health conditions, who may be served outside the state's managed care delivery system. These individuals may enroll in a managed care program but are not required to do so. States may also identify a range of Medicaid eligibility groups who are excluded from participating in their managed care programs. Also included are other programs that help people prepare and file State Medicaid Managed Care enrollment applications.
State Medicaid Managed Care Insurance Carriers
Private insurance companies that issue managed care policies to people who qualify under Medicaid, generally on the basis of a contractual arrangement with the state. Enrollment in a managed care plan may be voluntary or mandatory for some or all Medicaid recipients in a state; and participation requirements and associated criteria vary from state to state and in some cases, from area to area within the same state. Benefits covered by Medicaid vary by jurisdiction but generally include hospitalization, physician services, emergency room visits, family planning, immunizations, laboratory and x-ray services, outpatient surgery, chiropractic care, prescriptions, eye exams, eye glasses and dental care. Other covered services may include alcohol and drug treatment, mental health services, medical equipment and supplies and rehabilitative therapy. Medical benefits are administered by the insurance companies under terms of their contract.
State Medicaid Waiver Programs
Medicaid programs offered by states that have been authorized by the Secretary of the U.S. Department of Health and Human Services (HHS) to waive certain Medicaid statutory requirements giving them more flexibility in Medicaid program operation. Included are home and community care based (HCBC) waiver programs operated under Section 1915(c) of the Social Security Act that allow long-term care services to be delivered in community settings; managed care/freedom of choice waiver programs operated under Section 1915(b) of the Social Security Act which allow states to implement managed care delivery systems or otherwise limit individuals' choice of provider under Medicaid; and research and demonstration project waiver programs operated under Section 1115 of the Social Security Act to projects that test policy innovations likely to further the objectives of the Medicaid program. Each of the states has developed waivers to meet their needs; and while every state's waiver programs have their own unique characteristics, there may also be common threads.