Spouses, children, in-laws and other relatives and friends who volunteer to help with personal care, medication management and a range of household and financial matters. Sometimes referred to as “informal caregiver.”
Health care plans offered to federal civilian employees who can annually choose among a number of approved, community-rated private health insurance plans. The federal government pays a major portion of the cost of the coverage.
Percentage used to determine the amount of federal matching funds for state Medicaid expenditures. Before the recession of 2007-2009, the FMAP was not less than 50 percent or more than 80 percent. Congress increased the federal matching as part of the American Recovery and Reinvestment Act of 2009 to help states during the recession, and later extended increased FMAP payments through June 2011.
The federal government’s working definition of poverty that is used as the reference point to determine eligibility for certain public programs, including Medicaid and the Children’s Health Insurance Program. Sometimes called federal poverty level/line (FPL). (The poverty guidelines are different from the U.S. Census Bureau’s “poverty thresholds,” which are used for Census statistical purposes.)
A facility that has been approved by the government for a program to provide low-cost health care. FQHCs include community health centers, tribal health clinics, migrant health centers, rural health centers and health centers for the homeless.
A complete listing of fees used by health plans to pay doctors or other providers.
A method of paying health care providers a fee for each medical service rendered, rather than paying them salaries or capitated payments.
A three year, multi-state demonstration that began in January 2013 and tests new service delivery and payment models for people dually eligible for Medicare and Medicaid. These demonstrations enroll full dual eligibles in managed fee-for-service or capitated managed care plans that seek to integrate benefits and align financial incentives between the two programs.
Benefits that are covered without the insurance company first requiring payment of a deductible.
A private contractor that pays hospital bills on behalf of Medicare.
The 12-month period used for calculating annual fiscal spending. The U.S. government fiscal year runs from October 1 of the previous year to September 30 of the calendar year for which the fiscal year is numbered. States’ fiscal years do not always correspond to the federal fiscal year.
An employee benefit program that enables the employee to set aside pre-tax money to be used for certain health care and dependent care expenses.
A list of selected pharmaceuticals and their appropriate dosages created by health insurance plans and state Medicaid programs, and are usually intended to include a broad array of prescription drugs that are also cost-effective for patient care. Physicians are often required or urged to prescribe from the formulary developed by the insurance plans, pharmacy benefit managers or health maintenance organizations with which they are affiliated.