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Categorically needy
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A person who receives assistance from government programs such as Temporary Assistance for Needy Families (TANF)
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Crossover claim
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Claim for a Medicare or Medicaid beneficiary; Medicare is the primary payer and automatically transmits claim information to Medicaid as the secondary payer.
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Dual-eligible
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A Medicare-Medicaid beneficiary.
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Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
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Medicaid's prevention, early detection, and treatment program for eligible children under the age of twenty-one.
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Federal Medicaid Assistance Percentage (FMAP)
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Basis for federal government Medicaid allocations to individual states.
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MediCal
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California's Medicaid program
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Medically needy
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Medicaid classification for people with high medical expenses and low financial resources, although not sufficiently low to receive cash assistance.
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Medi-Medi beneficiary
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Person who is eligible for both Medicare and Medicaid.
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Payer of last resort
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Regulation that Medicaid pays last on a claim when a patient has other insurance coverage.
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Restricted status
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A category of Medicaid beneficiary.
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Spend-down
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State-based Medicaid program requiring beneficiaries to pay part of their monthly medical expenses.
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State Children's Health Insurance Program (SCHIP)
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Program offering health insurance coverage for uninsured children under Medicaid.
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Temporary Assistance for Needy Families (TANF)
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Government program that provides cash assistance for low-income families.
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Welfare Reform Act
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Law that established the Temporary Assistance for Needy Families program in place of the Aid to Families with Dependent Children program and that tightened Medicaid eligibility requirements.
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Medicaid
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A federal and state assistance program that pays for health care services for people who can afford them.
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