Medicaid Only definition

Medicaid Only means an individual who is eligible for Medicaid either categorically or through optional coverage groups such as medically needy or special income levels for institutionalized or home and community-based waivers, but who does not meet the federal income or resource criteria for QMB or SLMB. For purposes of this Agreement, Medicaid Only does not include individuals required to recertify eligibility monthly. Medicare Advantage Dual Eligible Special Needs Plan or MA Dual SNP means a Medicare Advantage coordinated care plan that is filed and approved as a dual eligible special needs plan by CMS. The plan must be designed for and offered to individuals who are eligible for Medicare under Title XVIII of the Social Security Act (“SSA”) and entitled to medical assistance under the Texas State Plan, in accordance with Title XIX of the SSA.
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Medicaid Only means an individual who is eligible for Medicaid either categorically or through optional coverage groups such as medically needy or special income levels for institutionalized or home and community-based waivers, but who does not meet the federal income or resource criteria for QMB or SLMB. Medicare Advantage Dual Eligible Special Needs Plan or MA Dual SNP means a Medicare Advantage coordinated care plan that is filed and approved as a dual eligible special needs plan by CMS. The plan must be designed for and offered to individuals who are eligible for Medicare under Title XVIII of the Social Security Act (“SSA”) and entitled to medical assistance under the Texas State Plan, in accordance with Title XIX of the SSA.
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Medicaid Only. "Medicaid-only" means a category of public assistance whereby a family receives Medicaid but is not eligible for or receiving AFDC TANF.
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Examples of Medicaid Only in a sentence

  • The categories of eligible recipients authorized to be enrolled in the plan are: Low Income Families and Children; Sixth Omnibus Budget Reconciliation Act (SOBRA) Children; Supplemental Security Income (SSI) Medicaid Only, Refugees, and the Meds AD population.

  • Behavioral Health Capitation Rates are represented by the following Rate Cohorts: TANF/AFDC, all ages CISC, all ages SSI, 0-14 years SSI, 15-20 years SSI, 21+ years LTSS Medicaid Only LTSS Dual Eligible OAG BH 19-64 The CONTRACTOR shall ensure that all of the funding, through the Capitation Payments, is made available for Behavioral Health services.

  • HCA may include risk corridor arrangements as deemed appropriate or include an add-on PMPM to the Medicaid only SDCB (Rate Cohort Medicaid Only - Self Direction) for Covered Services.

  • Rate Cohorts Dual Eligible - NF LOC (Region 1,3,4), Dual Eligible - NF LOC (Region 2), and Dual Eligible - NF LOC (Region 5) represent the blended Rate Cohorts for Dual Eligible Members and Rate Cohorts Medicaid Only - NF LOC (Region 1,3,4), Medicaid Only - NF LOC (Region 2), and Medicaid Only - NF LOC (Region 5) represent the blended Rate Cohorts for Medicaid only Members.

  • SDCB Capitation Rates are represented by Rate Cohorts Dual Eligible - Self Direction and Medicaid Only - Self Direction.

  • Provider Appeal (Medicaid Only) - An appeal to DMAS filed by a service provider that has already provided a Medicaid-based service and has received a denial, in whole or part, regarding payment or authorization for the Medicaid-based service.

  • These specific population groups are as follows: TANF; SSI No Medicare, non- LTC eligible; SSI with Medicare, non-LTC eligible; Dual Eligible, LTC eligible; Medicaid Only, LTC eligible; HIV/AIDS Specialty Population, with Medicare; HIV/AIDS Specialty Population, No Medicare; and Child Welfare Specialty Population.

  • These specific population groups are as follows: TANF; SSI No Medicare, non-LTC eligible; SSI with Medicare, non-LTC eligible; Dual Eligible, LTC eligible; Medicaid Only, LTC eligible; HIV/AIDS Specialty Population, with Medicare; HIV/AIDS Specialty Population, No Medicare; and Child Welfare Specialty Population.

  • TABLE 9-1: QUEST INTEGRATION – HIGH COST DRUG CORRIDOR PMPMS POPULATION PMPM ABD - Medicaid Only $61.40 Family and Children $3.98 Expansion $7.10 Timing  For the gain/loss calculation, the net gain or loss percentage will be computed for each MCO separately.

  • Applies to the following  Populations o All Family and Children and Expansion newborns (defined as being in an ‘Ages < 1’ rate code) o Medicaid Only ABD newborns (defined as being in an ‘Ages < 1’ rate code)  MCOs o All MCOs Exclusions  Membership o Retroactive enrollment for Family and Children and Expansion newborns o Dual eligible enrollment for all newborns  Health Care Expenses o Claims not meeting the eligibility criteria described below.


More Definitions of Medicaid Only

Medicaid Only means a category of public assistance whereby a family receives Medicaid but is not eligible for or receiving TANF.
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Medicaid Only means that the member has one managed care plan for their Medicaid benefits and a different managed care plan or Medicare fee-for-service for their Medicare benefits. “Dual Benefits” means that the same managed care plan manages the member’s Medicaid and Medicare benefits.
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Related to Medicaid Only

  • Medicaid means the medical assistance programs administered by state agencies and approved by CMS pursuant to the terms of Title XIX of the Social Security Act, codified at 42 U.S.C. 1396 et seq.

  • Medicaid program means the Kansas program of medical

  • Medicaid Regulations means, collectively, (i) all federal statutes (whether set forth in Title XIX of the Social Security Act or elsewhere) affecting the medical assistance program established by Title XIX of the Social Security Act and any statutes succeeding thereto; (ii) all applicable provisions of all federal rules, regulations, manuals and orders of all Governmental Authorities promulgated pursuant to or in connection with the statutes described in clause (i) above and all federal administrative, reimbursement and other guidelines of all Governmental Authorities having the force of law promulgated pursuant to or in connection with the statutes described in clause (i) above; (iii) all state statutes and plans for medical assistance enacted in connection with the statutes and provisions described in clauses (i) and (ii) above; and (iv) all applicable provisions of all rules, regulations, manuals and orders of all Governmental Authorities promulgated pursuant to or in connection with the statutes described in clause (iii) above and all state administrative, reimbursement and other guidelines of all Governmental Authorities having the force of law promulgated pursuant to or in connection with the statutes described in clause (ii) above, in each case as may be amended, supplemented or otherwise modified from time to time.

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

  • TRICARE means, collectively, a program of medical benefits covering former and active members of the uniformed services and certain of their dependents, financed and administered by the United States Departments of Defense, Health and Human Services and Transportation, and all laws applicable to such programs.

  • Health care facility or "facility" means hospices licensed

  • Medicare Regulations means, collectively, all federal statutes (whether set forth in Title XVIII of the Social Security Act or elsewhere) affecting the health insurance program for the aged and disabled established by Title XVIII of the Social Security Act and any statutes succeeding thereto; together with all applicable provisions of all rules, regulations, manuals and orders and administrative, reimbursement and other guidelines having the force of law of all Governmental Authorities (including without limitation, Health and Human Services ("HHS"), HCFA, the Office of the Inspector General for HHS, or any Person succeeding to the functions of any of the foregoing) promulgated pursuant to or in connection with any of the foregoing having the force of law, as each may be amended, supplemented or otherwise modified from time to time.

  • HIPAA means the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder.