MCQ Quiz-Medicaid

MCQ Quiz: Medicaid

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Medicaid serves as a cornerstone of the U.S. healthcare safety net, providing essential health coverage to millions of low-income Americans. As a joint federal and state program, its structure and benefits can vary significantly, creating a complex landscape for both patients and providers. For PharmD students, a strong understanding of Medicaid prescription drug programs, formularies, and federal requirements is critical to effectively serving this large and often vulnerable patient population.

1. How is the Medicaid program primarily funded?

  • Exclusively by the federal government
  • Exclusively by individual state governments
  • Through a partnership between federal and state governments
  • Through patient premiums only

Answer: Through a partnership between federal and state governments

2. Which population is the primary focus of the Medicaid program?

  • Individuals aged 65 and older, regardless of income
  • All federal government employees
  • Low-income individuals and families
  • Uniformed service members and their families

Answer: Low-income individuals and families

3. The Omnibus Budget Reconciliation Act of 1990 (OBRA ’90) established which key requirements for state Medicaid programs regarding pharmacy services?

  • Mandated manufacturer rebates and drug use review (DUR) programs
  • The elimination of all patient copayments
  • Coverage of over-the-counter medications only
  • The creation of Medicare Part D

Answer: Mandated manufacturer rebates and drug use review (DUR) programs

4. A state’s list of medications that are covered by its Medicaid program is known as the:

  • National Drug Code Directory
  • Preferred Drug List (PDL) or formulary
  • Orange Book
  • P&T Committee roster

Answer: Preferred Drug List (PDL) or formulary

5. A key difference between Medicare and Medicaid is that:

  • Medicare is primarily for low-income individuals, while Medicaid is for the elderly
  • Medicaid is administered solely by the federal government
  • Medicaid eligibility and benefits can vary significantly from state to state
  • Medicare does not cover any prescription drugs

Answer: Medicaid eligibility and benefits can vary significantly from state to state

6. Under OBRA ’90, pharmacists are required to ________ for Medicaid beneficiaries.

  • offer to counsel patients on their prescriptions
  • provide free delivery for all medications
  • charge a higher price than for cash-paying patients
  • refuse to dispense generic medications

Answer: offer to counsel patients on their prescriptions

7. A “dual-eligible” individual is a person who is eligible for:

  • Two different private health insurance plans
  • Both Medicare and Medicaid
  • A health savings account and a flexible spending account
  • A pharmacy discount card and a manufacturer coupon

Answer: Both Medicare and Medicaid

8. State Medicaid programs often use utilization management tools to control costs. An example of such a tool is:

  • Prior Authorization
  • Direct-to-consumer advertising
  • Waiving all copayments
  • A medication synchronization program

Answer: Prior Authorization

9. The Medicaid Drug Rebate Program requires drug manufacturers to pay a rebate to states in order to have their drugs covered by:

  • State Medicaid programs
  • All private insurance companies
  • Employer-sponsored health plans
  • Medicare Part B

Answer: State Medicaid programs

10. A state Medicaid program may implement a “lock-in” program for a beneficiary who is found to be:

  • Overusing physician or pharmacy services
  • Highly adherent to their medications
  • Enrolled in a research study
  • Eligible for Medicare


Answer: Overusing physician or pharmacy services

11. The Affordable Care Act (ACA) gave states the option to do what with their Medicaid programs?

  • Eliminate them entirely
  • Expand eligibility to cover more low-income adults
  • Sell them to private corporations
  • Merge them with the Medicare program

Answer: Expand eligibility to cover more low-income adults

12. A prospective drug use review (DUR) for a Medicaid prescription occurs:

  • After the patient has finished the medication
  • At the point of sale, before the prescription is dispensed
  • Once a year for all of a patient’s medications
  • Only if the patient is hospitalized

Answer: At the point of sale, before the prescription is dispensed

13. A state’s Medicaid Preferred Drug List (PDL) is typically developed by a:

  • Group of patients
  • State legislature
  • Pharmacy and Therapeutics (P&T) Committee
  • Pharmaceutical manufacturer’s marketing team

Answer: Pharmacy and Therapeutics (P&T) Committee

14. When a pharmacist receives a rejection for a Medicaid prescription, a common reason is:

  • The drug is not on the state’s Preferred Drug List and requires prior authorization
  • The patient has too many medications
  • The pharmacy’s computer system is down
  • The patient’s income is too high for that day


Answer: The drug is not on the state’s Preferred Drug List and requires prior authorization

15. Unlike Medicare Part D, traditional Medicaid pharmacy benefits have:

  • A standardized four-phase benefit structure in every state
  • No federal requirements for coverage
  • Minimal or no monthly premiums and low cost-sharing
  • A focus on covering only brand-name drugs

Answer: Minimal or no monthly premiums and low cost-sharing

16. The federal government’s share of Medicaid funding (FMAP – Federal Medical Assistance Percentage) is highest for:

  • States with higher per capita incomes
  • States with lower per capita incomes
  • All states receive the same percentage
  • Only states that did not expand Medicaid


Answer: States with lower per capita incomes

17. What is the role of a Medicaid Managed Care Organization (MCO)?

  • To act as the state’s P&T committee
  • To contract with the state to manage the delivery of healthcare services to Medicaid beneficiaries
  • To set the federal guidelines for Medicaid eligibility
  • To manufacture generic drugs for the Medicaid program

Answer: To contract with the state to manage the delivery of healthcare services to Medicaid beneficiaries

18. OBRA ’90’s requirement for pharmacists to offer counseling was a landmark event that recognized pharmacists as:

  • Dispensers of products only
  • Professionals responsible for improving patient outcomes
  • Salespeople for drug companies
  • Administrative staff

Answer: Professionals responsible for improving patient outcomes

19. A state Medicaid program may require step therapy, meaning a patient must:

  • Try a generic drug before a brand-name drug is covered
  • Try a preferred drug before a non-preferred drug is covered
  • Participate in physical therapy
  • Climb a step before entering the pharmacy

Answer: Try a preferred drug before a non-preferred drug is covered

20. For a dual-eligible beneficiary, which program is generally the primary payer for prescription drugs?

  • Medicaid
  • Medicare Part D
  • The state’s workers’ compensation program
  • A private charity


Answer: Medicare Part D

21. A pharmacist’s role in caring for the Medicaid population is crucial because these patients often:

  • Have fewer chronic health conditions
  • Have complex health needs and face significant social determinants of health challenges
  • Prefer to pay cash for their medications
  • Rarely use the healthcare system


Answer: Have complex health needs and face significant social determinants of health challenges

22. Which entity is responsible for the day-to-day administration of a state’s Medicaid program?

  • The U.S. Congress
  • A designated state agency
  • The Centers for Medicare & Medicaid Services (CMS)
  • The Food and Drug Administration (FDA)

Answer: A designated state agency

23. The requirement for a tamper-resistant prescription pad is a security measure that applies to:

  • All written Medicaid prescriptions
  • Electronically prescribed medications only
  • Prescriptions for non-controlled substances only
  • Prescriptions filled at hospital pharmacies

Answer: All written Medicaid prescriptions

24. A state Medicaid program can receive larger rebates from manufacturers for which type of drugs?

  • Generic drugs
  • Brand-name drugs with a generic available
  • Brand-name drugs that are designated as “innovator” products
  • Over-the-counter drugs


Answer: Brand-name drugs that are designated as “innovator” products

25. In a Medicaid Managed Care model, the MCO receives a ________ payment from the state for each member.

  • fee-for-service
  • capitation (per-member per-month)
  • retrospective
  • bundled

Answer: capitation (per-member per-month)

26. If a drug is not on the Medicaid PDL, the pharmacist should:

  • Refuse to fill the prescription
  • Tell the patient to pay cash
  • Inform the prescriber that a prior authorization may be required
  • Dispense a different drug without consulting the prescriber

Answer: Inform the prescriber that a prior authorization may be required

27. Children’s Health Insurance Program (CHIP) provides low-cost health coverage to:

  • All children, regardless of family income
  • Children in families who earn too much to qualify for Medicaid but cannot afford private insurance
  • Adults over the age of 65
  • College students only


Answer: Children in families who earn too much to qualify for Medicaid but cannot afford private insurance

28. A retrospective DUR program might identify and alert prescribers about:

  • Patients who are receiving prescriptions for the same drug class from multiple doctors
  • A single drug-drug interaction at the point of sale
  • The need for a prior authorization
  • The cost of a new medication


Answer: Patients who are receiving prescriptions for the same drug class from multiple doctors

29. The federal statute that provides the broad authority for the Medicaid program is:

  • The Health Insurance Portability and Accountability Act (HIPAA)
  • The Social Security Act
  • The Food, Drug, and Cosmetic Act
  • The Controlled Substances Act


Answer: The Social Security Act

30. Which of the following services is considered a mandatory benefit that all state Medicaid programs must cover?

  • Cosmetic surgery
  • Inpatient hospital services
  • Experimental treatments
  • Over-the-counter vitamins


Answer: Inpatient hospital services

31. The primary purpose of the Medicaid Drug Rebate Program is to:

  • Ensure Medicaid pays the lowest possible price for outpatient prescription drugs
  • Increase manufacturer profits
  • Fund the FDA’s new drug approval process
  • Pay for pharmacist counseling services

Answer: Ensure Medicaid pays the lowest possible price for outpatient prescription drugs

32. A pharmacist providing care to a Medicaid beneficiary should be aware that:

  • Coverage and preferred drugs can differ significantly from private insurance plans
  • All states have identical Medicaid programs
  • No prescription drugs are covered by Medicaid
  • Patient counseling is not permitted

Answer: Coverage and preferred drugs can differ significantly from private insurance plans

33. The expansion of Medicaid under the ACA primarily increased eligibility for which group?

  • Pregnant women
  • Children
  • Non-elderly adults with income up to 138% of the federal poverty level
  • Individuals with end-stage renal disease

Answer: Non-elderly adults with income up to 138% of the federal poverty level

34. Medicaid is considered a “means-tested” program, which means eligibility is based on:

  • Age
  • Health status
  • Income and assets
  • Geographic location

Answer: Income and assets

35. A state Medicaid agency has the authority to:

  • Approve new drugs for use in the United States
  • Set its own eligibility standards and benefits within federal guidelines
  • Regulate the practice of medicine
  • Fund the entire Medicare program

Answer: Set its own eligibility standards and benefits within federal guidelines

36. For a PharmD student, understanding the Medicaid program is important for a career in:

  • Community pharmacy
  • Hospital pharmacy
  • Managed care
  • All of the above


Answer: All of the above

37. When a state contracts with a Medicaid MCO, the MCO assumes the ________ for providing care to the enrolled members.

  • administrative risk only
  • financial risk
  • clinical risk only
  • no risk

Answer: financial risk

38. The patient counseling standards established by OBRA ’90 apply to:

  • All patients, but were mandated specifically for the Medicaid program
  • Only cash-paying patients
  • Only Medicare beneficiaries
  • Only patients with private insurance

Answer: All patients, but were mandated specifically for the Medicaid program

39. Compared to commercial plans, state Medicaid formularies often have a strong preference for:

  • New, high-cost brand-name drugs
  • Generic medications
  • Over-the-counter products
  • Drugs with limited clinical data

Answer: Generic medications

40. A pharmacist can be an important advocate for a Medicaid patient by:

  • Helping them navigate the prior authorization process
  • Telling them their insurance will not cover anything
  • Recommending they do not fill their prescriptions
  • Charging them the full cash price for all medications

Answer: Helping them navigate the prior authorization process

41. The federal government establishes ________ requirements for the Medicaid program that all states must follow.

  • minimum
  • maximum
  • no
  • optional


Answer: minimum

42. A key component of a state’s DUR board, which oversees the drug use review program, is the inclusion of:

  • Practicing pharmacists and physicians
  • Only state legislators
  • Only pharmaceutical company representatives
  • Only patient advocates


Answer: Practicing pharmacists and physicians

43. The “best price” provision of the Medicaid Drug Rebate Program ensures that:

  • Medicaid receives the best price offered by a manufacturer to most other purchasers
  • Patients pay the lowest price in the country
  • Manufacturers charge Medicaid the highest price
  • Pharmacies receive the highest reimbursement


Answer: Medicaid receives the best price offered by a manufacturer to most other purchasers

44. What is a primary challenge for patients navigating the Medicaid system?

  • The simplicity and consistency of the program across all states
  • The complexity of eligibility rules and the process of enrollment and re-enrollment
  • The lack of any covered healthcare services
  • The high monthly premiums


Answer: The complexity of eligibility rules and the process of enrollment and re-enrollment

45. For a pharmacist, a common source of frustration when serving the Medicaid population can be:

  • The low reimbursement rates and administrative burdens
  • The simplicity of the billing process
  • The high adherence rates of all patients
  • The lack of any formulary restrictions

Answer: The low reimbursement rates and administrative burdens

46. Which of the following is an example of a service covered under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children?

  • Cosmetic procedures
  • Routine dental check-ups
  • Experimental gene therapy
  • A luxury hospital room


Answer: Routine dental check-ups

47. A state’s decision to use a single, statewide Preferred Drug List versus allowing each MCO to have its own is a key difference in:

  • Medicaid pharmacy benefit management strategies
  • Federal law
  • Medicare policy
  • The pharmacy’s daily workflow

Answer: Medicaid pharmacy benefit management strategies

48. Why is it important for a pharmacist to know if a patient is dual-eligible?

  • To understand the coordination of benefits between Medicare and Medicaid
  • To charge the patient a higher price
  • To refuse to provide any services
  • It is not important for the pharmacist to know


Answer: To understand the coordination of benefits between Medicare and Medicaid

49. A major goal of Medicaid managed care is to:

  • Increase emergency room visits
  • Improve health outcomes and control costs through care coordination
  • Limit access to primary care physicians
  • Encourage the use of expensive brand-name drugs

Answer: Improve health outcomes and control costs through care coordination

50. Medicaid’s role as a major payer for long-term care services, such as nursing homes, makes it a critical program for which population?

  • Young, healthy adults
  • Children
  • The elderly and individuals with disabilities
  • Professional athletes

Answer: The elderly and individuals with disabilities

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