Texas · Life, Accident & Health Sample Interactive Mind Map
Medicaid
A visual breakdown of Medicaid — one of the concepts you can count on seeing on the exam.
The TESTivity Interactive Mind Mapping Graphic we picked for the Texas Life & Health sample is Medicaid — and this is a concept you can count on seeing on your pre-licensing exam. Get the structure straight once and those questions turn into free points.
So explore it. Click through, see how the pieces relate, and let the layout do some of the remembering for you.
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Medicaid is a joint federal-STATE program for low-income people — and the single largest payer of long-term care in the U.S.
The exam loves the Medicare-vs-Medicaid contrast: one is about age and work history, the other about financial need.
The exam loves the Medicare-vs-Medicaid contrast: one is about age and work history, the other about financial need.
🏛️ Medicare
🤝 Medicaid
Who runs it
Federal program; uniform benefits nationwide.Who runs it
Joint federal-state; rules and benefits vary by state.Based on
Age (65+) or disability and work history (Medicare taxes).Based on
Financial need — low income and limited assets.Funding role
The senior/disability health program.Funding role
Primary payer for long-term nursing home care.
How it is funded: the federal government pays a share of each state’s costs (the FMAP), sets minimum standards, and lets states expand. The ACA expansion let states cover adults under 65 up to 138% of the Federal Poverty Level, with the feds paying 90% of expansion costs. Many states deliver benefits through managed care organizations (MCOs).
How they test thisA stem asks what distinguishes the two programs — Medicare is federal, age/disability-based; Medicaid is joint federal-state, income-based. And remember a person can qualify for both at once (dual eligibility).
Medicaid eligibility spans many groups — but long-term care eligibility adds a strict asset test and a 5-year look-back.
Give assets away too close to applying and Medicaid imposes a penalty period of ineligibility.
Give assets away too close to applying and Medicaid imposes a penalty period of ineligibility.
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Children & Pregnant Women
Children up to 138% FPL (CHIP covers somewhat higher incomes); pregnant women often qualify at higher thresholds for prenatal and delivery care.
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Expansion Adults
In expansion states, adults under 65 up to 138% FPL qualify regardless of other categorical factors.
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Elderly & Disabled
Low-income Medicare recipients may also get Medicaid — covering Medicare cost-sharing through the Medicare Savings Programs.
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The 5-Year Look-Back
For Medicaid long-term care, applicants face both income AND strict asset limits. Asset transfers within the 60-month (5-year) look-back period trigger a penalty period of LTC ineligibility — which is why Medicaid planning with an elder-law attorney matters for those anticipating care needs.
The trap they setA stem says someone gave money to family 2 years ago — that falls squarely inside the 5-year look-back, so a penalty period applies. Transfers to family get no automatic exemption, and the penalty is computed from the amount transferred.
Federal law sets a floor of MANDATORY services; states add OPTIONAL ones — and the line between them is tested.
Hospital care is mandatory; adult dental and vision are optional and vary by state.
Hospital care is mandatory; adult dental and vision are optional and vary by state.
✅ Mandatory (All States)
Inpatient & outpatient hospital services
Physician, lab, and X-ray services
Nursing facility services for adults
EPSDT for children (incl. dental & vision)
Family planning; FQHC services
❓ Optional (Varies by State)
Prescription drugs (near-universal, still optional)
Adult dental services
Adult vision services
Home & community-based services (HCBS waivers)
How they test thisAsked which service is mandatory, pick inpatient/outpatient hospital — not adult dental, adult vision, or even adult prescription drugs (technically optional, though nearly all states offer it). Children’s dental and vision are mandatory through EPSDT.
Dual eligibles have both programs — Medicare pays first, Medicaid fills the gaps behind it.
For many low-income seniors, Medicaid effectively acts like their Medigap plan.
For many low-income seniors, Medicaid effectively acts like their Medigap plan.
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Dual Eligibility — Who Pays What
Medicare primary, Medicaid secondary
- Medicare pays first for Medicare-covered services
- Medicaid pays second — covering cost-sharing (the 20% Part B coinsurance, SNF coinsurance after Day 20) and services Medicare doesn’t cover, especially long-term care
- Medicare Savings Programs (MSPs) — QMB, SLMB, QI, QDWI — help pay Medicare premiums and sometimes cost-sharing
- Dual eligibles automatically qualify for Extra Help (the Part D Low Income Subsidy)
The trap they setFor a dual eligible, Medicare always pays first — Medicaid never leads on a Medicare-covered service; it fills in behind. A stem suggesting Medicaid pays first “because it serves the lowest income” is the bait.
Medicaid pays for most U.S. nursing home days — but only after you spend down to near-zero assets.
Federal rules protect the spouse who stays home and require states to recover costs from the estate later.
Federal rules protect the spouse who stays home and require states to recover costs from the estate later.
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Spend-Down First
Residents pay privately (or via LTC insurance) until assets fall to a very low level (often around $2,000 in countable assets) before Medicaid LTC begins.
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Spousal Protection
The community spouse at home keeps a minimum monthly maintenance allowance and a portion of assets (the community spouse resource allowance) to avoid impoverishment.
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Estate Recovery
States must seek recovery of LTC costs from the estate after death — typically from the home, once the surviving spouse or dependents have died or moved.
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HCBS Waivers
Home and community-based services waivers let states deliver LTC at home or in the community rather than requiring a nursing facility.
How they test thisAn HCBS waiver lets a state provide LTC in the home/community instead of a nursing home — it is not a way to skip nursing-home coverage or expand income limits. And the community spouse is shielded from total impoverishment when the other spouse enters care.
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Top Exam Tips — Medicaid
1. Medicare vs Medicaid: Medicare is federal, age/disability-based; Medicaid is joint federal-state, income-based; a person can be dual eligible.
2. Medicaid is the primary payer for long-term nursing home care.
3. ACA expansion covers adults under 65 up to 138% FPL (feds pay 90%); the FMAP is the federal funding share.
4. Look-back period is 60 months (5 years) — transfers inside it trigger a penalty period; family transfers are not exempt.
5. Mandatory services include inpatient/outpatient hospital and EPSDT for children; adult dental and vision are optional.
6. For dual eligibles, Medicare pays first, Medicaid fills the gaps (acting like a Medigap plan).
7. Spend-down to ~$2,000 first; the community spouse is protected; states pursue estate recovery; HCBS waivers allow care at home.
2. Medicaid is the primary payer for long-term nursing home care.
3. ACA expansion covers adults under 65 up to 138% FPL (feds pay 90%); the FMAP is the federal funding share.
4. Look-back period is 60 months (5 years) — transfers inside it trigger a penalty period; family transfers are not exempt.
5. Mandatory services include inpatient/outpatient hospital and EPSDT for children; adult dental and vision are optional.
6. For dual eligibles, Medicare pays first, Medicaid fills the gaps (acting like a Medigap plan).
7. Spend-down to ~$2,000 first; the community spouse is protected; states pursue estate recovery; HCBS waivers allow care at home.
Exam vocabulary
Key Terms to Know
Medicaid
Joint federal-state health insurance program for low-income individuals; the primary payer for long-term nursing home care.
FMAP
Federal Medical Assistance Percentage — the federal share of each state’s Medicaid costs; varies by state wealth.
ACA Medicaid Expansion
Optional expansion covering adults under 65 up to 138% of the Federal Poverty Level; the federal government pays 90% of expansion costs.
Dual Eligible
An individual eligible for both Medicare and Medicaid; Medicare pays first, Medicaid fills the gaps behind it.
Medicare Savings Programs (MSPs)
Medicaid-funded programs (QMB, SLMB, QI, QDWI) that pay Medicare premiums and sometimes cost-sharing for low-income beneficiaries.
EPSDT
Early and Periodic Screening, Diagnostic, and Treatment — mandatory comprehensive pediatric screenings under Medicaid, including dental and vision for children.
Look-Back Period (Medicaid LTC)
60 months (5 years) during which asset transfers are reviewed; improper transfers trigger a penalty period of LTC ineligibility.
Community Spouse Resource Allowance
The portion of a couple’s assets the at-home spouse may retain when the other spouse applies for Medicaid nursing home coverage.
Medicaid Estate Recovery
State requirement to seek repayment of Medicaid long-term care costs from a deceased beneficiary’s estate, typically the home.
Spend-Down
Depleting personal assets to Medicaid eligibility levels, usually by paying privately for nursing home care first.
HCBS Waiver
Home and Community-Based Services waiver allowing a state to provide Medicaid long-term care at home or in the community instead of a nursing facility.
Like learning this way? There's a whole library of them.
If the old manual you inherited from the office breakroom isn't cutting it and this format fits how your brain actually works, you'll want the rest. There are 52 Interactive Mind Maps like this one in the TESTivity Platinum Life, Accident & Health package — covering the full curriculum, right alongside the practice questions, exam simulators, and study guides.
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