Medicaid 301

$229.00

Get up to speed on the fundamentals of Medicaid – fast.

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Description

This course will help anyone new to the Medicaid industry get up to speed on the fundamentals quickly. Overall learning objectives of this 3-lesson course include:

  • Become familiar with Medicaid managed care, including the size of the Medicaid managed care market, how health plans are paid, the types of services they deliver, how they work with providers.
  • Understand the different types of Medicaid waiver programs and how states use them in program design.
  • Understand  how Medicaid fits into the larger safety net in the US public assistance system.

The course addresses key questions over 3 lessons.

CEU Credits: 1

Recommended pre-requisite course(s): Medicaid 101 and Medicaid 201

Course Description

Medicaid is an important public health safety net program that pays for healthcare services for millions of Americans. This course builds upon the foundation lessons covered in Medicaid 201.

The course addresses key questions over 3 lessons.

CEU Credits: 1

Recommended pre-requisite course(s): Medicaid 201

What are the learning objectives?

1- Become familiar with Medicaid managed care, including the size of the Medicaid managed care market, how health plans are paid, the types of services they deliver, how they work with providers.


2- Understand the different types of Medicaid waiver programs and how states use them in program design.


3- Understand  how Medicaid fits into the larger safety net in the US public assistance system.

What does the syllabus cover?

Lesson 1: What is Medicaid managed care?

Goal- For you to become familiar with how health plans work in the Medicaid space.

Key Questions Included

  1. What is Medicaid Managed Care? What percent of Medicaid members are enrolled in an MCO?
  2. How much money is spent on Medicaid Managed care?
  3. What are the major plans in the Medicaid Managed care space?
  4. How do MCOs provide services to members?
  5. What are the requirements for MCOs related to the provider network?
  6. What do providers think about Medicaid managed care?
  7. What is the Medical Loss Ration (MLR) and how does it apply to Medicaid Managed Care?
  8. What are HEDIS measures and External Quality Review Organizations (EQROs) and how do they apply to Medicaid?
  9. How is member satisfaction measured in Medicaid managed care?
Lesson 2: What are waiver programs?

Goal - For you to understand each type of Medicaid waiver program and how states have used them.

Key Questions Included

  1. What is a Medicaid waiver?
  2. Why is it called a waiver?
  3. What are the section 1915 waivers?
  4. How does a state apply for a waiver?
  5. How is a waiver different from a State Plan Amendment (SPA)?
  6. What is the waiver public comment period?
  7. What have been the most common types of waivers in recent years?
  8. What types of waiver features has CMS been receptive to in recent years?
  9. What types of waiver features has CMS rejected in recent years?
Lesson 3- What programs serve the same members as Medicaid?

Goal- For you to understand how Medicaid fits into the larger safety net in the US public assistance system.

Key Questions Included

  1. What is a dual-eligible?
  2. What types of healthcare needs do dual eligible members typically have?
  3. What have been the recent focus areas for meeting the needs of dual eligibles?
  4. What is TANF and how does it relate to Medicaid?
  5. What is SNAP and how does it relate to Medicaid?
  6. What is LIHEAP?
  7. What is Supplemental SSI and how does it relate to Medicaid?
  8. Who is eligible for SSI?
  9. What can be paid for under SSI benefits?

How does this course work? What is the experience like?

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