Medicaid Terms
Medicaid: A joint federal and state program that provides health coverage to low-income individuals, families, pregnant women, children, elderly adults, and people with disabilities.
Spend Down: A process used by some Medicaid programs to determine eligibility for individuals with high medical expenses. It allows applicants to "spend down" excess income on medical bills to meet Medicaid income limits.
Qualified Income Trust (QIT): Also known as a "Miller Trust," a QIT is a legal arrangement that allows individuals with income above the Medicaid limit to become eligible for Medicaid by depositing their excess income into the trust.
Excluded Assets: Assets that are not counted when determining Medicaid eligibility, such as a primary residence, personal belongings, one vehicle, and certain retirement accounts. Excluded assets do not affect an individual's eligibility for Medicaid.
Look-Back Period: A period of time during which Medicaid examines an applicant's financial transactions to ensure they have not transferred assets for less than fair market value in order to qualify for Medicaid.
Medicaid Estate Recovery: A process by which Medicaid seeks reimbursement from the estates of deceased Medicaid recipients for the costs of long-term care services provided to them during their lifetime.
Health Insurance Portability and Accountability Act (HIPAA): Federal legislation that establishes privacy and security standards for protecting individuals' medical records and personal health information.
Medicaid Waiver Program: Also known as Home and Community-Based Services (HCBS) waivers, these programs provide Medicaid-funded services to individuals who would otherwise require institutional care, allowing them to receive care in their homes or communities.
Medicaid Fraud: Any intentional deception or misrepresentation committed by healthcare providers, Medicaid recipients, or others to unlawfully obtain Medicaid benefits or payments.