AHIP Practice Exam

How does Medicaid coordinate benefits for individuals on a PFFS plan?

1. With any provider of their choice

2. Only with Medicaid participating providers

3. Separate from the existing PFFS plan

4. Based on the individual's income

The correct answer is: Only with Medicaid participating providers

In the context of Medicaid coordinating benefits for individuals enrolled in a Private Fee-for-Service (PFFS) plan, the correct answer highlights the interaction between Medicaid and participating providers. Medicaid typically coordinates benefits primarily with providers who are enrolled and accepted by Medicaid. This means that individuals on a PFFS plan must seek services from Medicaid participating providers to ensure that their Medicaid benefits can be effectively coordinated. When an individual is enrolled in a PFFS plan, they have the option to receive care from any provider who agrees to the terms and conditions set by the PFFS plan. However, Medicaid will only coordinate benefits with those providers who are recognized as participating in Medicaid. This distinct arrangement helps streamline the managed care process for beneficiaries, ensuring that they receive the coverage and support they need while navigating the complexities of both programs. The other possible options do not accurately reflect how Medicaid coordinates benefits within the structure of a PFFS plan. The option suggesting that Medicaid coordinates with any provider of their choice overlooks the requirement for Medicaid participation. The alternative implying that coordination occurs separately from the existing PFFS plan does not consider the integral connection between Medicaid and the participating provider structure. Lastly, the notion that coordination is based solely on an individual's income fails to address the necessary