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With regard to the Medicaid program in the United States, it can correctly be stated that
A. The federal government provides none of the funding for state Medicaid programs
B. Federal Medicaid law is different from Medicare law in that the federal government explicitly sets forth the methodology for payment of Medicaid-contracting plans but not Medicare-contracting plans
C. A state's payment to health plans for providing Medicaid services cannot be more than it would have cost the state to provide the services under Medicaid fee-for-service (FFS)
D. States are prohibited from carving out specific services from the capitation rate that health plans receive for providing Medicaid services
ANSWER : C
The Caribou health plan is a for-profit organization. The financial statements that Caribou
prepares include balance sheets, income statements, and cash flow statements. To
prepare its cash flow statement, Caribou begins with the net income figure as reported on
its income statement and then reconciles this amount to operating cash flows through a
series of adjustments. Changes in Caribou's cash flow occur as a result of the health plan's
operating activities, investing activities, and financing activities.
To prepare its cash flow statement, Caribou uses the direct method rather than the indirect method.
ANSWER : B
The Essential Health Plan markets a product for which it assumed total expenses to equal 92% of premiums. Actual data relating to this product indicate that expenses equal 89% of premiums. This information indicates that the expense margin for this product has:
ANSWER : A
A health plan can use cost accounting in order to
A. Determine premium rates for its products
B. Match the costs incurred during a given accounting period to the income earned in, or attributed to, that same period
ANSWER : A
The Raven Health Plan is domiciled in a state that requires the health plan to offer small employers and their employees a comprehensive healthcare benefit plan that approximates the healthcare benefits available to large employer-employee groups. This type of uniform benefit plan is known as:
ANSWER : C