The Medicaid Glossary
This glossary is intended to be informational only and relate to terms used commonly in Medicaid programs and design. In most cases, terms are derived from publicly available sources. Terms covered in this glossary are subject to change and may have alternate definitions when used in relation to other programs or products, or by other sources or companies.
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Index of Terms
- Accountable Care Organization
- Accountable Entity (AE)
- Activities of Daily Living (ADLs)
- Advisory Board or Group
- Advocate
- Affordable Care Act (ACA)
- Aged, Blind, Disabled (ABD)
- Alternative Payment Model (APM)
- Behavioral health
- Beneficiary
- Benefit
- Block grant
- Capitation
- Care coordination
- Care integration
- Caregiver
- Categorically needy
- Centers for Medicare and Medicaid Services (CMS)
- Children’s Health Insurance Program (CHIP)
- Churn
- Collaborations
- Community-Based Organization (CBO)
- Complex care
- Continuous eligibility
- Contract requirements
- Cost-sharing
- Default enrollment
- Direct Support Professional (DSPs)
- Disability
- Disproportionate Share Hospital (DSH) payments
- Dual eligibility
- Dual Special Needs Plan (DSNP)
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services
- Electronic Health Record (EHR)
- Encounter
- Entitlement
- Equity/health equity
- Federal Financial Participation (FFP)
- Federal Fiscal Year (FFY)
- Federal Medical Assistance Percentages (FMAP)
- Federal Poverty Level (FPL)
- Federally Qualified Health Center (FQHC)
- Fee-for-Service (FFS) Delivery System
- Fee-for-Service (FFS) payment model
- Financial Management Services (FMS)
- Financially needy
- Food insecurity
- Formulary
- Foster care
- Fully Integrated Dual Eligible (FIDE)
- Fully Integrated Dual Eligible Special Needs Programs (FIDE-SNP)
- Fully Integrated Dual Special Needs Plan (FIDE-SNP)
- Health disparity
- Health Information Exchange (HIE)
- Health Information Network (HIN)
- Health Information Technology (HIT)
- Health Insurance Portability and Accountability (HIPAA)
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- Health plan
- Health Related Social Needs (HRSN)
- Health Risk Assessment (HRA)
- Highly Integrated Dual Special Needs Plans (HIDE-SNP)
- Holistic health
- Home-and Community-Based Services (HCBS)
- Hotspotting
- Housing
- Independent living
- Institutional Long-term care
- Instrumental Activities of Daily Living (IADLs)
- Intellectual and/or Developmental Disabilities (I/DD)
- Interagency collaboration
- Long-term care
- Long-Term Services and Supports (LTSS
- Long-Term Services and Supports (LTSS)
- Managed Care Organization (MCO)
- Managed Long Term Services and Supports (MLTSS)
- Managed Long-Term Services and Supports (MLTSS)
- Medicaid
- Medicaid and CHIP Payment and Access Commission (MACPAC)
- Medicaid Expansion
- Medicaid Managed Care (MMC)
- Medically needy
- Medicare
- Medicare Advantage Plans
- Medicare Payment Advisory Commission (MedPAC)
- Medication management
- Medication-Assisted Treatment (MAT)
- Natural support
- Opioid Use Disorder (OUD)
- Outcomes
- Passive enrollment
- Payer
- Poverty level groups
- Poverty Level Groups (PLG)
- Presumptive eligibility
- Primary Care Physician (PCP)
- Program design
- Program of All-Inclusive Care for the Elderly (PACE)
- Protected Health Information (PHI)
- Provider
- Risk-based contract
- Rural health clinic (RHC)
- School-Based Health Center (SBHC)
- Self-directed services
- Serious Mental Illness (SMI)
- Single-Payer Healthcare
- Social Drivers of Health (SDOH)
- Social Impact Investing
- Social Needs
- Special Needs Plans (SNPs)
- State Plan Amendment (SPA)
- Substance Use Disorder (SUD)
- Supplemental Security Income (SSI)
- System integration
- Temporary Assistance for Needy Families (TANF)
- Upper Payment Limit (UPL)
- Value-Based Care (VBC)
- Waiver
- 1115 Medicaid Waiver
- 1915(b) Medicaid Waiver
- 1915(c) Medicaid Waiver
- 1915(i) Medicaid State Plan Option
- 1915(k) Medicaid State Plan Option
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