Title V and Medicaid Glossary

The following list of terms related to Title V and Title XIX is not meant to be comprehensive, but to serve as an introductory quick-reference.

Beneficiary: A person who is eligible for and enrolled in a Medicaid or similar program.

Block Grant: Also known as a “formula grant,” a transfer of a capped amount of Federal funds to States and/or local governments for broad purposes such as health. A block grant usually gives States larger discretion on how the funds are to be used.

Categorical Eligibility: Medicaid’s policy of providing services to individuals in specified groups (e.g., children, senior citizens, persons with disabilities).

Categorically Needy: Specified groups of Medicaid beneficiaries who qualify for basic benefits. These groups include pregnant women and infants (1) with incomes at or below 133 percent of the FPL (who States participating in Medicaid are required to cover); and (2) with incomes between 133-185 percent of the FPL (who States participating in Medicaid have the option to cover).

Centers for Medicare and Medicaid Services (CMS): (Formerly Health Care Financing Administration (HCFA)). The agency under the Department of Health and Human Services that administers Medicare, Medicaid, and SCHIP. Online at http://www.cms.hhs.gov.

Children’s Health Insurance Program: SEE State Children’s Health Insurance Program.

Children with Special Health Care Needs (CSHCN): Individuals from birth through age 21 who have health problems requiring more than routine and basic care

Community Integrated Service Systems (CISS) Discretionary Grants: Seek to reduce infant mortality and improve the health of mothers and children – including those living in rural areas and those with special health care needs – by funding projects for the development and expansion of integrated services at the community level. Such projects include health home visiting programs; projects to increase participation of health care providers under Title V and Title XIX programs; integrated MCH service delivery systems; MCH centers providing pregnancy, preventive, and primary care services; MCH projects to serve rural populations; and outpatient and community-based services programs for CSHCN.

Discretionary Grant: An award of money or supplies by the Federal government, usually awarded through a competitive review process.

Disproportionate Share Hospital (DSH) Payments: Additional payments to hospitals that serve large populations of patients with low incomes.

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services: States must provide periodic screenings to identify physical (including vision, hearing and dental) and mental conditions, to Medicaid-eligible children under age 21. State Title V and Medicaid agencies are required to participate in coordination of EPSDT services.

Entitlement Program: A program (such as Medicaid and Medicare) that requires the Federal government to provide a specified service to identified persons. Spending is determined through the program’s eligibility criteria, not by a specific level of funding.

Federal Financial Participation (FFP): Federal matching funds paid to States to cover Medicaid services or administrative costs.

Federal Medical Assistance Percentage (FMAP): Also know as the “Federal Medicaid matching rate,” it is the share that the Federal government provides for Medicaid services or administration dependant on a State’s per capita income. While it varies from 50-83 percent, it averages to 57 percent across the States.

Federal Poverty Level (FPL): The definition of poverty used as the income standard for certain categories of beneficiaries. The current HHS Poverty Guidelines and related materials are available online at http://aspe.hhs.gov/poverty.

Federally Qualified Health-Center (FQHC) Services: FQHC Services are primary and other ambulatory care services provided by community health centers and migrant health centers receiving grants under section 330 of the Public Halth Service Act, certain tribal organizations, and FQHC Look-Alikes. States are requied to include services provided by FQHCs in their basic Medicaid benefit package as well as benchmark benefit packages.

Financial Eligibility: Medicaid’s policy of providing services to individuals with limited income. Financial eligibility varies by State and category.

Formula Grant: SEE Block Grant.

Health Insurance Portability and Accountability Act (HIPAA): Requires State Medicaid programs to use national codes for electronic transmission of information related to health claims and to have a Medicaid Management Information System (MMIS).

Health Maintenance Organization (HMO): A plan that provides health care from specific doctors and/or hospitals within a set plan.

Interagency Agreement (IAA): A binding agreement between two or more agencies (or divisions within a single agency) that specify the roles and responsibilities of the participating agencies. IAAs can serve as a major resource in coordinating activities and providing mutual support between the agencies.

Managed Care Organization (MCO): A type of Managed Care Entity (MCE) that provides certain benefits to Medicaid beneficiaries for a monthly capitation payment for each beneficiary as set forth in a State contract.

Medicaid: The Federal/State program that pays for medical assistance for certain individuals and families with low incomes. Assists States in providing medical long-term care to people who meet defined eligibility requirements.

Medical Assistance: Payment for services covered under a State’s Medicaid program.

Medically Needy: Beneficiaries who qualify for Medicaid coverage because of high medical expenses.

Performance Measure: A description of a specific health need, that when addressed will improve that health outcome in a defined place and time frame.

Population Based Services: Preventive services developed for the entire population rather than for beneficiaries in an individual basis.

Prepaid Inpatient Health Plan (PIHP): A health plan that provides less than comprehensive inpatient services on an at-risk reimbursement basis.

Presumptive Eligibility Period: The time period between when a provider determines that a beneficiary’s income does not exceed the eligibility threshold until a formal eligibility determination is made by the State Medicaid agency.

Preventive Services: Those that are aimed at reducing health problems, disease, or personal risk factors for such conditions.

Risk Factors: Scientifically established direct and indirect causes of morbidity and mortality.
Social Security Act (SSA): Full text of Title V and Title XIX of the SSA are available online at http://www.ssa.gov/OP_Home/ssact.

Special Projects of Regional and National Significance (SPRANS) Grants: Activities under SPRANS include MCH research; training grants; genetic disease testing, counseling, and information dissemination; hemophilia diagnostic and treatment centers; and other special MCH improvement projects that support a broad range of innovative strategies.

State: In this document, State refers to the 50 States, the District of Columbia, and the 9 political jurisdictions.

Supplemental Security Income (SSI): A Federal entitlement program that provides monetary assistance to specific beneficiaries. In most States (with the exception of Section 209(b) States), SSI beneficiaries are also eligible for Medicaid.

State Children’s Health Insurance Program (SCHIP): A Federal-State matching health care block grant program for uninsured low-income children. Children who are eligible for Medicaid are not eligible for SCHIP, although States can administer SCHIP through their Medicaid programs.

Temporary Assistance for Needy Families (TANF): A Federal block grant program that provided matching funds and services to States for low-income families with children.

Title V: Enacted by Congress in 1935 as part of the Social Security Act, the only legislation to promote and improve the health of all mothers and children. Title V authorized the creation of the MCH programs, providing the infrastructure to achieve this mission.

Title XIX: Enacted by Congress in 1965 as part of the Social Security Act, the legislation that authorizes the Medicaid program that pays for medical assistance for certain individuals and families with low incomes who meet defined eligibility requirements.