Program funding and eligibility

 

There are multiple ways a person can become eligible for Medicaid. And once enrolled, the program uses different funds to facilitate and support needed services. The following terms are commonly used to describe how Medicaid is funded, and eligibility standards that allow individuals to enroll in the program.

 

  • A
  • B
  • C
  • D
  • E
  • F
  • G
  • H
  • I
  • J
  • K
  • L
  • M
  • N
  • O
  • P
  • Q
  • R
  • S
  • T
  • U
  • V
  • W
  • X
  • Y
  • Z
  • 1
A
Aged, Blind, Disabled (ABD)

Aged, Blind, Disabled (ABD) is a full-coverage Medicaid eligibility classification and program for low-income adults who are either 65 and older, blind, or disabled (as determined by Social Security).

C
Categorically needy

Categorically needy is one pathway for Medicaid eligibility for people who are either financially needy with children, financially needy and pregnant, or an Aged, Blind or Disabled (ABD) individual. The base for covered services under categorically needy is much wider than for other types of Medicaid eligibility.

Continuous eligibility

Continuous eligibility refers to an approach to Medicaid enrollment that allows for an individual to continue to receive Medicaid coverage and care – even if financial changes would otherwise change that eligibility. For children under 19 the mandated continuous eligibilty period is 12 months.

Source: https://www.medicaid.gov/medicaid/enrollment-strategies/continuous-eligibility-medicaid-and-chip-coverage/index.html

D
Dual eligibility

Dual eligibility refers to an individual’s eligibility to enroll in both Medicaid and Medicare programs. Individuals who are eligible for both programs are commonly referred to as dual eligibles.

Source: https://www.cms.gov/medicare-medicaid-coordination/medicare-and-medicaid-coordination/medicare-medicaid-coordination-office

F
Federal Financial Participation (FFP)

Federal Financial Participation (FFP) refers to the matching funds the federal government provides to states to facilitate and support Medicaid. 

Source: https://www.kff.org/medicaid/state-indicator/federal-matching-rate-and-multiplier/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

Federal Fiscal Year (FFY)

The Federal Fiscal Year (FFY), which runs from October 1 to September 30, is the calendar for the U.S. government budget. Federal Medicaid and all social service funding operates within the FFY, and all grants, budgets, fees, and other financial actions are scheduled to occur within this timeframe.

Source: https://www.thebalance.com/fiscal-year-definition-federal-budget-examples-3305794

Federal Poverty Level (FPL)

The federal poverty level (FPL) is a measurement of household income utilized to determine eligibility for social services. The FPL can increase or decrease on a year-to-year basis, and varies based on household size. Additionally the non-contiguous U.S. states have their own distinct yearly FPL.

Source: https://www.healthcare.gov/glossary/federal-poverty-level-fpl/

Financially needy

Individuals can qualify for Medicaid coverage on the basis of financial need. To qualify, individuals must have a household income at or below the applicable FPL.

Source: https://www.medicaid.gov/medicaid/eligibility/index.html

M
Medically needy

Medically needy is a Medicaid eligibility pathway for individuals who have significant health needs, but may have incomes that are too high to qualify for Medicaid based on financial need. Medically needy individuals have the ability to become eligible by “spending down” the amount of income that’s above a state’s medically needy threshold, functioning similarly to a deductible.

Source: https://www.medicaid.gov/medicaid/eligibility/index.html

P
Poverty Level Groups (PLG)

Poverty level groups (PLGs) refer to federal thresholds used to determine federal program eligibility. In terms of Medicaid, the phrase “poverty level groups” is often used to define the different thresholds and groups of individuals based upon Medicaid eligibility.

Source: https://www.kff.org/wp-content/uploads/2013/05/mrbglossary.pdf

 

Download our program eligibility and funding terms sheet

 

Read the full glossary

These technology-related terms are a small selection of terms available in the UnitedHealthcare Community & State Medicaid Glossary.

 

This glossary is intended to be informational only and relates 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.

 
 

Get updates on Medicaid topics

Be the first to know about relevant news & insights by subscribing to our newsletter.