A step you can take to ask Medicaid to change its mind when it
decides it will not pay for care you need.
B
Behavioral Health Services
Health care for emotional, psychological, substance use and
psychiatric problems. It is part of your health plan.
C
Care Coordination
Your primary care provider works with you and other providers to make
sure that all your providers know about your health problems.
Continuity of Care
If your primary care provider sends you to a specialist, your primary
care provider will stay involved and keep up with all your
medical/dental treatments.
Copayment
Money you have to pay out of your pocket before you can see a health provider.
D
Durable Medical Equipment
Equipment ordered by your physician that helps you at home. This
includes wheelchairs, hospital beds, canes, crutches, walkers, kidney
machines, ventilators, oxygen, monitors, pressure mattresses, lifts,
nebulizers, etc.
E
Emergency Dental Condition
A health problem that needs immediate dental attention. An example
includes a dental problem that can cause you serious harm.
Emergency Medical Condition
A health problem that needs immediate medical/dental attention. An
example includes a health problem that can cause you (or your unborn
child, if you are pregnant) serious harm.
Emergency Medical Transportation
Ambulance.
Emergency Room Care
Care for an emergency medical or dental condition that is too serious
to be treated in a clinic or urgent care center.
Emergency Services
Inpatient and outpatient medical or dental care by a healthcare
provider to screen, evaluate, and/or stabilize your emergency medical
or dental condition.
Excluded Services
Care that is not paid for by Medicaid.
G
Grievance
A report that you can make if you are not happy with the quality of
care you got or if you think a provider or someone at the clinic was
rude or denied you access to the care you needed.
H
Habilitation Services and Devices
Health care services that help you keep, learn, or improve skills and
functioning for daily living. Examples include therapy for a child who
isn’t walking or talking at the expected age. These services may
include physical and occupational therapy, speech & language
pathology, and other services for people with disabilities.
Health Insurance
A plan that helps you pay for health care visits, procedures,
hospital stays and preventive care. It will pay for the high cost
expenses and routine screenings that it says are covered.
Health Plan
A group of doctors, hospitals and other providers who work together
to help you get the health care services you need. They may provide
physical health services, like doctor, hospital and emergency room
visits; x-rays and prescriptions, and non-emergency medical transportation.
They may also provide mental health or substance use disorder
services, like psychotherapy or crisis intervention.
Health Risk Assessment
A form you fill out to tell about your health and health behavior.
Health providers use the information to figure out whether you are at
risk of getting certain diseases or medical or dental conditions.
Home Health Care
A wide range of health care given in your home to treat an illness or injury.
Examples include care for a wound, patient education, checking your
blood pressure and breathing, checking on you after you get out of the hospital.
Hospice Services
Hospice is to keep you comfortable and as free as possible from pain
and symptoms when you have a terminal illness. Hospice helps you have
a good quality of life for time remaining. Most hospice care happens
at home or it can be given in hospital or special facility.
Hospice is for patients likely to die within six months if their
disease runs its normal course.
Hospital Outpatient Care
Care given at a hospital that your doctor does not expect will need
an over night stay. In some cases you may stay overnight without being
registered as an in-patient.
Examples include same-day surgery and blood transfusions.
Hospitalization
When you are checked into a hospital for care.
M
Medically Necessary
Medical or dental care or supplies your provider says are needed to
prevent, diagnose or treat your illness, injury, or disease. To be
medically necessary, the care or supplies must be clinically
appropriate and meet accepted standards of medicine. Medicaid does NOT
pay for treatments that are experimental, non-FDA approved,
investigational, or cosmetic.
N
Network or Provider Network
The group of providers linked to your health plan who provide primary
and acute health care.
Non-participating Provider
A physician that is not part of your provider network.
P
Participating Provider
A provider who works for your health plan or is linked to your health plan.
Physician Services
Care provided by a physician.
Plan
See Health Plan.
Preauthorization
Getting permission for specific health or dental services before you
receive them so that Medicaid will pay for the care.
Premium
The amount of money you must pay for your health care plan.
Prescription Drug Coverage
The medicines your plan will pay for that your provider prescribes
that have to be filled by a pharmacy.
Prescription Drugs
These are medicines your provider prescribes that have to be filled
by a pharmacy.
Primary Care Physician
The doctor who is responsible for your health care. This doctor may
also refer you to a specialist, or admit you to a hospital.
Primary Care Provider
A physician, nurse practitioner, or physician assistant who manages
your health care needs. This includes preventive care and care when
you are sick. The primary care provider may treat you, refer you to a
specialist, or admit you to a hospital.
Primary Dental Provider
The dentist who is responsible for your dental care. This dentist may
also refer you to a specialist.
Provider
An individual, clinic, hospital or other caregiver approved by
Medicaid to provide health care.
R
Rehabilitation Services and Devices
Care and items that help restore your health and functions.
Examples include cardiac rehab (for your heart), pulmonary rehab (to
help you breathe better) and physical or speech therapy. These include
exercise, education and counseling. These are usually provided in a
hospital outpatient setting but can be offered in a skilled nursing facility.
S
Skilled Nursing Care
A high level of nursing care. Nurses help to manage, observe, and
evaluate your care.
Specialist
A health professional who is educated and trained to have in-depth
knowledge of how to care for certain medical or dental problems.
Physician specialist examples include cardiologist (heart doctor),
pulmonologist (lung doctor), nephrologist (kidney doctor) and surgeon.
U
Urgent Care
Medical care to treat an illness or injury that needs quick attention
but that is not a medical emergency. Examples include stomach pain,
dizziness that will not go away, or a suspected broken bone. Urgent
care requires face-to-face medical attention within 24 hours of
noticing the urgent problem.
