Medicaid is a joint program administered and funded by the federal government and state governments under a variety of name welfare. Title 19, Medi-Cal (in California), Medical Assistance, and others. The federal government shares the cost of Medicaid by contributing .1 portion ot the cost.
To qualify foi Medicaid, applicants must meet the following (wo requirements:
1.???? Have an annual income level near the national poverty guidelines (set each year bv Congress)
2.??? Not have resources, such as bank accounts or stocks and bonds, worth more than $4,000 for an individual or $6,000 for a couple
Coverage under the Medicaid program is limited to payment for only medically necessary procedures; that is, those services that are reasonably calculated to prevent, diagnose, correct, cure, alleviate, or prevent the worsening of conditions that endanger life, cause pain or suffering, or result in illness or infirmity where there is no other equally effective
or substantially less costly course of treatment available.
The U.S Department of Health and Human Services requires clinical evidence (labora-tory findings, X-rays, medical reports) to determine the medical necessity of treatment. A request tor medical services may be denied if such evidence is not provided.
PRIOR APPROVAL PROCEDURE
In 1986, a ruling known as Prior Approval Procedure went into effect. Under the ruling. the Department of Health and Human Services (DHHS) pays claims only when the attending physician calls the Regional Medical Unit prior to a person's admittance to a facility for inpatient hospital ization.