Archive for April, 2008
Most states cover smoking cessation programs for Medicaid recipients. There are a few holdouts, however. Until recently, Arizona was one of those states.
There is good news for Medicaid recipients in Arizona these days – especially when it comes to trying to stop smoking. Governor Janet Napolitano signed a new bill - #1418 – into law Tuesday. This new law allows Arizona Healthcare Cost Containment System to cover smoking cessation costs for individuals who are enrolled.
Now that Arizona has created this law, there are only six states left in the country that do not cover the cost to quit smoking. Arizona now pays 14% of its budget – about $316 million – on smoking-related illness each year. This new law will help Arizona recover 67% of the costs involved through matching funds by the federal government.
As a result of dealing with smoking itself and eliminating it from peoples’ lives, the state hopes to save enough money so that there will be no negative financial impact on the general fund.
The law provides for nicotine replacement therapy and tobacco use reduction medications that are approved by the FDA. John Rivers, President and CEO of the Arizona Hospital and Healthcare Association stated that this is “a good fiscal policy because, over the long haul it will reduce the amount of money that the state will have to pay treating smoking-related diseases. The legislature and the Governor are to be commended for moving Arizona in the right direction.”
Approximately 36% of Medicaid recipients are smokers. Taxpayers pay the $316 million that has been being paid out. Getting people off tobacco will save money for the people and for the state, as well as helping Medicaid recipients to attain better health.
In addition to the program supporters that have already been mentioned, the American Cancer Society also supports the law to help get people off tobacco and help their health improve.
Many people throughout the country are eligible to receive Medicaid benefits. Unfortunately, there are a large number of individuals who are eligible for Medicaid who either don’t realize they are eligible or are not taking advantage of benefits that could be helpful to them, or both. How does a person find out whether or not they are eligible? One county in Ohio has created a unique program to try to locate about 30,000 residents that it thinks are eligible for Medicaid.
Hamilton County has joined forces with the FreestoreFoodbank to try to locate these individuals and enroll them in the program. The Over-The-Rhine-based food pantry has received a $1 million contract to help locate and sign up at least part of the individuals that are eligible, as well.
Hamilton County Commissioner, Todd Portune issued a press release in which he stated, “These residents are eligible for assistance that can provide them the care and preventive treatment they need to lead healthy, fulfilling lives; they just don’t know it. It is long past time that we reached out to them.”
This unique move is one of the positive things that are happening regarding the Medicaid program and supporting individuals who qualify. In addition, the pantry will be engaging local businesses with employees who are uninsured and either work part-time or have a low income. The program will also reach out to schools, health centers that serve low-income residents and social service agencies working with the poor and the elderly.
The program is made possible through the county’s Department of Job and Family Services, who is providing funding. Outreach will focus on children under the age of 19, pregnant women, adults age 65 and older, individuals with disabilities and homeless individuals.
This is a big step forward in one area of the country. It will be wonderful if this type of program catches on in other counties and states, and spreads throughout the country. With all the issues surrounding people who are uninsured, having programs such as this one could cut those numbers by a good amount and leave many thousands of people protected instead of vulnerable.
Since its introduction, Medicare Part D has improved some issues surrounding prescription drugs for seniors. Reports and surveys from 2004 through 2007, approximately 25,000 Medicare beneficiaries were surveyed and the results were positive, for the most part.
Harvard Medical School analyzed that data from these surveys and found that after the drug benefits were introduced, the number of individuals on Medicare Part D who skipped medication went down by nearly 4%, and the number of individuals who cut back on basic needs, such as food or housing decreased by about 4%, as well.
This is good news. There has been a negative side, however. Studies showed that individuals with some of the most serious illnesses and conditions were not affected positively by Medicare Part D, and they have continued skipping doses of medicine and cutting back on basic needs, as well.
Another study published by JAMA stated that even with Medicare Part D, many beneficiaries have changed their behavior and cut back on the number of refills they get or have changed to generics in order to cut costs. Research has also shown that 60% of all Medicare Part D participants are not aware of the fact that there is a gap in coverage as use of the plan increases. Cost sharing is involved in Plan D, but is misunderstood by this 60%, some of whom do not realize that there is a gap in coverage at all, or that they will be responsible for a higher amount of costs of prescriptions once they hit a certain amount that has been paid by Medicare Part D to cover those prescriptions.
It is important, then, that everyone on Medicare Part D, or planning to enroll in Part D, research carefully and obtain as much information as possible so that they know what their coverage will be and how it will work. There are numerous ways to get information. You can call the 1-800-MEDICARE or log on to www.medicare.gov.
Most of us think about Medicare in terms of types and amounts of plans and coverage. Sometimes we only think about it when we are feeling ill or having to visit the doctor or hospital.
This is not all that Medicare does. There are many types of information that Medicare collects and Medicare provides. One important type of information that Medicare tracks is information regarding nursing homes. Medicare has just released information and created a database that lists the lowest quality nursing homes in the country.
The Nursing Home Compare website now has a searchable database that gives the names the lowest 5% of nursing homes around the nation. In addition to the database, CMS provides a monthly update showing results of nursing home inspections.
CMS is working hard to provide Medicare recipients and others more access and easier access to information regarding nursing homes. There are senators and congressmen who are pushing for bills to disclose even more information regarding nursing homes and the nursing home community. This may take time, but it is an important issue and it is being looked at carefully and pushed forward.
Whether you are actually at the point where you are looking for a nursing home, or you are a relative, friend or caretaker of an individual looking for or needing one, the information that CMS/Medicare has released is essential.
There is much more information at www.medicare.com, including frequently asked questions with answers and links to other sites and further information.
If you are approaching retirement, already retired and on Medicare or just looking for answers about Medicare or nursing homes, take the time to explore the subject in advance. It could certainly keep you from ending up in the wrong place in a bad situation later on.
A disturbing article in the Press& Sun-Bulletin seems to echo a disturbing trend regarding Medicare and dental care providers. The Bulletin covers event in and around Binghamton, New York.
The article about the dental options told one man’s experience as follows:
…After showing up for his appointment at Wilson Dental, he was told that his Medicaid HMO dental benefit paid such low reimbursement rates that the private practice would not participate in the plan -- even though the clinic was set up to serve Medicaid patients who were being denied dental treatment elsewhere.
This is such a trend that many patients have severe infections, cavities, and missing teeth. One such patient ended up in the Howard University Hospital Emergency Room. The infection got so overwhelming that the elderly woman became extremely ill and unable to over come the infection had to be hospitalized.
Dentists around the country receive such low reimbursement that many of them have stopped accepting Medicaid patients all together. At this moment there is no foreseeable solution but perhaps in this election year politicians will address the issue after the campaign is over.
If you receive Medicaid, there have probably been some times that you wanted to go to a community health center but ended up having to go to the emergency room waiting for hours to get care. If you feel you have missed out on other services, such as education and non-emergency assistance, help is on the way.
A $50 million grant through the Centers for Medicare and Medicaid Services has been granted to be used by 20 states to provide alternative healthcare services and programs, such as establishing new community healthcare clinics, extend the hours of many existing clinics, create new services and provide electronic (computerized) sharing of information and more.
All of these are important improvements, and electronic sharing of information is critical because in the event that you live in a particular town – especially in a rural town – and a specialist in a large city 500 miles away can help you if he or she has your current information and tests, being able to share this information online could very well save you a 500 mile drive and save your life, as well. In fact, there are more and more reports of procedures – and even surgeries – have been done with electronic assistance.
It is important to note that this will not diminish or eliminate the benefits that you already have. The funding will help improve services and add additional ones.
They will also help individuals receiving services get the best services they can locally at a healthcare office instead of having to go to the hospital or having to go hours away.
If you want more information or have questions, click here or visit http://www.cms.hhs.gov/GrantsAlternaNonEmergServ/
If you have Medicare benefits and are confused about Medicare Part D, you are not alone. There are a great many individuals who do not understand Medicare Part D, which is prescription drug coverage.
Many individuals are getting into a situation where they are eligible for Part B of Medicare but they have limited income. As a result, they are worried about getting this important part of Medicare coverage.
Part B covers doctor visits and various outpatient services. If you find yourself in the situation where you cannot afford to pay for Part B, your state may be able to help you with premium payments, deductibles and co-pays.
There are several ways to get correct information regarding this issue. First, call your state or local office for medical assistance, social services or welfare. If they can’t give you all the specifics, they can at least get you started and give you some information. You can also call the Medicare hotline and ask about Medicare savings programs at 800-633-4227. For more information about the Medicare program, call 800-772-1213.
There are questions regarding help for prescription drug coverage for those who have a limited income. There is good, specific information regarding prescription coverage (Part D).
If you receive Medicare benefits you are eligible for prescription drug coverage, no matter what your income is. In addition, you can receive this coverage regardless of how healthy you are or the number or cost of the prescriptions you already take. If your income is limited, you may be able to get help paying your premiums.
If you are not sure whether or not you qualify for premium assistance, you can find out and sign up at 800-772-1213 or goon the internet to www.socialsecurity.gov/prescriptionhelp and you can find out. You can also go to www.Medicare.gov or call 1-800-MEDICARE to get information about Medicare prescription drug plans.
If you need assistance it is essential that you contact Medicare or Social Security to find out how they can help you. Don’t hesitate to call or visit them on the web. There is information and assistance available. Make sure that if you qualify for it, you receive it. Help is just a click or a call away.
There are estimates that at least 40% of individuals that have Medicare Part D do not understand their coverage.
Part D is designed to cover many of the drug/medication costs of individuals enrolled in the plan. Since Part D is not part of the original basic Medicare coverage, there is usually a premium charged. An individual can purchase a Medicare prescription drug plan or a Medicare Advantage Plan.
Both types of plan have limits to them, so it is essential that you research the plans that are available and find what is right for you. With most plans, you will pay a premium and they will pay part or all of your prescriptions. There is extra help for individuals on very limited income.
It is important to note that depending on the plan you choose you could be liable for up to $2,500 in prescription costs. It is important to consider the cost, the amount of co-pays and the amount of coverage you will have. Additionally, there are supplemental plans – often at little or no cost – from organizations such as AARP, Humana and many other companies. These plans cover some costs that Medicare Part D does not. Sometimes these plans offer a discount on prescriptions.
To research Medicare Part D, drug costs, which prescription plan is right for you, and other information, visit the official Medicare website at www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) and ask a representative for the information you need. You can also check for supplemental plans by checking the internet and type “Supplemental Prescription Medicare Coverage” into Google or any other search engine, and you will find several pages of plans.
Whatever you decide and whatever questions you have, take the time to do a little research so you can find the coverage you need – and so that you can understand the coverage you have.
Congress is in the midst of voting this week regarding changes to Medicaid that would cut services and cost the states millions of dollars.
This vote is extremely important – so much so that even though President Bush has threatened to veto, the Senate is still working to stop the Bush changes that would eliminate or greatly decrease services.
The House Energy and Commerce Commission voted last week – unanimously – to create a one year moratorium on the rules that Bush is pushing for, even though Bush could try to veto the vote.
States are worried that if the changes Bush wants actually come to pass, not only will services be cut, but states will have to pay out billions of dollars within the next five years, while at the same time experiencing serious disruptions in medical services and the Medicaid system.
Since Bush leaves office in January 2009, it is hoped that there will be a strong enough vote for the moratorium (2/3 of the House and Senate) to hold off until that time to re-address the issue.
Those who would be hurt most if Bush gets his way would be Children and Individuals with Disabilities. Special education services would be cut and services that allow individuals with disabilities to stay in their own homes and maintain home health services could lose essential benefits. In addition, indigent individuals would lose critical treatment and services.
Congress is fighting hard to stop President Bush from vetoing the moratorium. There is an excellent chance that Congress will win and the president will not be able to use his veto power.
This is an important issue to keep an eye on. Though states, communities and individuals will not feel the crunch immediately if the president has his way, it is still critical for all Medicaid recipients to stay aware of.
Many individuals receiving Medicare benefits rely on home health care as one of the main benefits they receive. Home Health Care for these individuals – usually seniors or individuals with disabilities – is their lifeline and an essential link in their services and well-being.
The Center for Medicare and Medicaid Services (CMS) has once again recognized the Joint Commission’s deeming authority for accrediting Home Health Care.
This is important to beneficiaries because more than 2.4 elderly individuals and individuals with disabilities receive Home Health Care services. In order to be able to provide such services, agencies need to be accredited and “deemed” as meeting Medicare and Medicaid requirements and standards. When a Home Health Care agency has “deemed status” by the Joint Commission, research shows that the particular agency usually exceeds the standards set out for Home Health Care Providers by CMS, providing a higher level of service.
Because more and more individuals and patients are trying to get treatment as outpatients and stay in their homes rather than hospitals, the partnership between the public CMS and private Joint Commission has become essential in helping to set the highest standards, therefore encouraging and ensuring the highest quality services.
The Joint Commission, which started granting deeming authority in 1993, accredits over 3,800 organizations. Accreditation is voluntary, and Home Health Care Agencies can seek deemed status by the Joint Commission, but it is not a requirement. They can also seek accreditation by state surveyors on behalf of CMS.
The Joint Commission works to continuously improve the quality of services to the public. It evaluates and accredits over 15,000 health care programs in the country, including hospitals, home care organizations, assisted living, ambulatory care services and laboratories. It also accredits organizations dealing with specific health issues, such as stroke centers, and it is a non-profit organization.
As you may or may not know, Medicaid is different than Medicare. With Medicare, when you turn 65 years of age, if you are receiving Social Security Benefits, you are almost always automatically enrolled in Medicare.
Medicaid is different. Information about whether or not you are eligible is determined by your state’s Department of Children and Families. This department helps determine whether children and/or their families have an income under a certain amount so that they can qualify for coverage.
Also, if you are on SSI or SSDI, you can get information through the Social Security Administration. Another important resource is your local Health Department or Department of Workforce Services. These two departments usually have information and phone numbers, as well as websites that will direct you to your state’s program. You will be able to discuss your individual situation with a representative who will help you with the qualification and enrollment process.
Most states also have a Social Security Insurance related fact sheet that will give you information about Medicaid eligibility for disabled, blind and aged individuals, including any Medicare cost-sharing information for Qualified Medicare Beneficiaries, Specific Low Income Beneficiaries and other Qualified Individuals.
It is also easy to find Medicaid information for your state by typing Medicaid in (your state’s name) into Google or other search engine. This will pull up several sites. Beware, however, to be careful that you are not searching sites that charge you or sites that are trying to sell you information or legal services. You should not have to pay for information regarding Medicaid eligibility.
No matter what Medicare Plan you are on, you have the right to appeal any decision about your Medicare coverage. If Medicare does not pay for an item or service that you feel you are entitled to, you can appeal that decision.
This is not necessarily an easy process; however, there are ways it can be done. For instance, there are various appeal forms depending upon what plan you are on. They are available by downloading from the internet or calling the Medicare program you are enrolled in. The information should be on your Medicare card and your monthly statement.
If you file an appeal, Medicare has a limited amount of time to respond to you and at least let you know that they are looking into the matter. Often, you will hear from them in 7 to 10 days.
If you are not satisfied with any decisions regarding your appeal, you will be advised as to the next level you can go to. It is similar to taking a matter to civil court, then superior court then district court then the Supreme Court. With Medicare, hopefully you won’t have to go all the way to court.
There are five levels to an appeal. First, redetermination by a Medicare carrier, intermediary, or Medicare Administrative Contractor. Second is review by a Qualified Independent Contractor. Third is hearing by an Administrative Law Judge in the Office of Medicare Hearings and Appeals. Fourth is review by Medicare Appeals Council, and Fifth is Judicial Review by Federal District Court. Most cases are settled long before they get to step number five.
No matter what your question, grievance or appeal is, try to start by getting information directly from your Medicare provider. This may take some work, research and time, but it can save a lot of time and effort in the long run if you do not have to go through the entire appeals process.
For questions or information, call Medicare at 1-800-MEDICARE.
Medigap plans are designed to cover the “gaps” or expenses that Medicare does not cover. They help pay for these services and are sold by private companies. It is important to research companies and plans if you are thinking of purchasing this type of coverage.
Another important thing to be aware of regarding Medigap coverage is that if you decide to purchase this type of coverage, you should do so within six months of getting Medicare Part B. The reason this is so important is that because during this six month period insurers cannot deny you Medigap coverage. In addition, they can not postpone the time when your coverage starts and they cannot charge you additional rates based on pre-existing health conditions – health problems that you already have. This is critical if you are dealing with serious or ongoing health issues, such as diabetes, high blood pressure, heart problems and more.
If you wait until after the six month period, you could be denied coverage; there is no guarantee that you will be able to be approved.
There is information available regarding Medigap insurance and it is a very good idea for you to research this information. There are a number of places to find this information by going on the internet. The easiest way is to go to Google and type in Medigap Insurance. In addition, go to www.ssa.gov and look under Medicare coverage and there will be links to Medigap information as well.
Medicare is designed for individuals 65 years old or older, and individuals with disabilities or on renal dialysis. Medicare Part A covers hospital and inpatient services, while Part B covers doctor visits and other services received as an outpatient (outside of the hospital).
Many people worry about how to enroll in Medicare. They worry that it will be difficult or confusing, but it doesn’t have to be, and it usually isn’t.
If you are receiving Social Security benefits, you will automatically be enrolled in Medicare Part A & B on the first day of the month that you have your 65th birthday. In other words, if you turn 65 on February 10th you will be enrolled at the beginning of February.
Your Medicare card will come in the mail up to three months before your 65th birthday. If you do not receive it in a timely manner, you should call the Social Security Administration at 1-800-772-1213 or visit them on the internet at www.ssa.gov. Either way, you will get assistance and can have the Medicare card sent to you.
If you are not receiving Social Security, you will need to sign up for Medicare. This is an easy process and you can do this a couple of ways. You can call Social Security Administration at 1-800-772-1213. They will take the information over the phone to get the process underway and then they will send you some paperwork in the mail.
If you prefer, you can go to your local Social Security office and apply in person. The advantage to this is that there is an individual there who will walk you through the entire process. Either way, it is your choice. You cannot, however sign up on line for Medicare only.
To sign up for both Medicare and Social Security Retirement Benefits together you can apply online at www.ssa.gov, or by phone at 1-800-772-1213, or go in person to your local Social Security office. Either way, you should be able to easily get enrolled for Medicare benefits without extra effort or worry.
Self-Directed Care has been discussed at length for well over a decade. There is often confusion regarding what self-directed care is. Specifically, self-directed care supports adults with functional disabilities who live in their own home, t direct their own health-related issues. For instance, an individual might have diabetes and need blood sugar monitored, but their functional disability doesn’t allow them to physically perform the necessary tasks to do this. This individual can choose to direct and supervise a paid personal aide or and Individual Provider to perform this and other tasks.
There have been studies, interviews, surveys, news releases and numerous reports since the increase of self-directed care, and the majority of them have stated that individuals – especially Medicaid and Medicare recipients – with disabilities benefit from directing their own personal care services. In a joint study with the Department of Health and Human Services and the Robert Wood Johnson Foundation, it was found that “with self-directed care, quality of life and recipients’ satisfaction were improved substantially and unmet needs for career reduced, without compromising health or safety.”
Previous HHS Secretary Tommy G. Thompson stated that Self-Directed Care gives people with disabilities more freedom and responsibility. In the same way that all of us want to be in charge of our lives and our choices, it lets the individuals themselves decide what to do with their Medicaid dollars.” The Center for Medicare and Medicaid Services has stated that “approaches like this will make Medicaid more cost effective and will serve people with disabilities better.”
Self-Directed Care can be an excellent option for many people receiving Medicaid.
One of the biggest worries that individuals with disabilities have when they attempt to work is the loss of benefits – especially health care coverage. They are worried that they will have no coverage at all or be forced into an employer’s plan that they cannot afford or that won’t cover their disability.
There are solutions to this dilemma, however. The solutions are found as part of the Social Security Act- especially part 1619b and Medicare. One of the most important provisions is the Medicaid Buy-in program. This program was designed to provide access to comprehensive health care for working people with disabilities. This is essential for many people with disabilities who find it difficult to find affordable and comprehensive coverage privately.
The Medicaid Buy-in program allows people with disability to pay a premium for coverage through their state’s Medicaid program, just as they would if they were buying private health coverage. The concept behind the buy-in was originally put forth in the Balanced Budget Act of 1997 to allow for individuals who lost SSI or SSDI benefits because they were making more money working. These individuals were able to support themselves without receiving SSI or SSDI checks because they were making enough money through their paychecks from work. However, they still needed health coverage, and Medicaid was the best choice for many situations. As long as the individuals continued to meet the Social Security definition of disability, they would be eligible for the buy-in program.
If you find yourself in this type of situation, there are several steps you can take. You can contact your county health department to determine what local programs are available; you can check with your state Medicaid office to see whether you qualify for the Medicaid Buy-in or other benefits; and you can check the Social Security Administration, Medicaid or Medicare websites for further information.
When you become eligible for Medicare at age 65 or because of a disability, you will automatically receive original Medicare benefits.
Something you may not realize is that depending upon the state you live in, you may be entitled to two other choices. These choices provide more coverage for issues that original, basic Medicare does not cover.
One choice is Original Medicare with supplemental insurance, such as a Medigap or retiree plan. The other choice is a Medicare Private Health Plan, also known as a Medicare Advantage Plan, such as a Health maintenance Organization (HMO), a Preferred Provider Organization (PPO), a Point of Service Plan (POS), a Provider Sponsored Organization (PSO), a Private Fee For Service Plan (PFFS), a Special Needs Plan (SNP) or a Medicare Medical Savings Account (MSA).
All of these plans provide various forms of coverage that is different than original Medicare. In addition to these plans, Medicare Part D is available to cover prescription drugs. If you are covered by original Medicare, it is important that you find additional coverage that will work well with your coverage. Often, a stand-alone prescription plan that only covers drugs (PDP) is the best choice.
A Medicare private health plan can be obtained to fulfill the health plan’s benefit package that covers drugs. If you join a PFFS without drug coverage or an MSA, you can get stand-alone drug coverage.
Regardless of which type of plan you decide on and depending upon what is available to you where you live, it is essential that you research available plans and coverage and decide what will be the best for your situation.
This is an important question, because there are a lot of recipients that want to work. There are provisions called “work incentives” for those individuals.
One provision is the Ticket to Work- Work Incentives. These include being able to work during a “Trial Work Period” which allows you to work and see how things turn out. You will NOT lose your benefits automatically during the Trial Work Period; you will receive full benefits no matter how much you earn. You only need to report your work activity.
The Trial Work Period lasts until you accumulate 9 months of work (not necessarily consecutive months) within a 60 month period of time. Once you have accumulated 9 months of work, you can earn up to $900 per month without losing your benefits. For additional 36 months after the Trial Work Period any time your income falls below $900 per month, your benefits will be automatically reinstated.
If you are disabled and working, your Medicare benefits continue for 4.5 years after you begin work, and there is no premium charge for Medicare Part A. Because of the work incentives, the coverage for individuals with disabilities trying to work, is FREE during that period of time.
If you are trying to work and receiving Medicaid, there are provisions available for most states to be able to provide any Medicaid recipients with disabilities. It is important that you check with your state Medicaid office to determine if you can maintain your Medicaid while working.
Medicaid has taken a giant and important leap recently. Because of this move forward, it is now possible that thousands of people will be able to get home-based care rather than being institutionalized. This new provision allows people to get care in their homes or in the community instead of an institutional setting.
The Deficit Reduction Act (DRA) allows states to provide people who qualify for Medicaid benefits to receive this care without having to apply for a demonstration waver to prove their eligibility. Having the option as to how an individual will receive long-term support is an historic step in leveling the playing field.
Individuals will now be able to receive person-centered care and have a part in the development and decision making about that care. Some of the services that states will be able to provide under this new provision will be case management, homemaker, home health aide, personal care, adult day health and respite care. In addition, individuals with chronic mental illness can receive day treatment, partial hospitalization, psychosocial rehabilitation and clinic services.
This new provision is an essential step in helping individuals with disabilities have the choice to be part of and participate in the community, stay in their own comfortable surroundings, make choices regarding services and have the support of a program that will offer them these options and more.
Many people have questions about Medicare and Medicaid including the question of what the differences are between the programs. There are some major differences between the two.
Medicare is funded by the federal government as an entitlement program, which mainly focuses on the older population. It is a social insurance program for individuals age 65 and over and it covers many individuals with disabilities. Medicare also covers individuals of all ages with end stage renal disease.
There are several parts to Medicare. Part A covers hospital bills, Part B covers medical insurance and Part D covers prescriptions.
Medicaid is different from Medicare in several ways. It is also an entitlement program, however, Medicaid is not funded only by federal government, there is a state component as well, and in some states, counties pay part of the cost.
Medicaid is based on need and social welfare, with eligibility based on income. If a person has limited income and/or financial resources, Medicaid covers a broader spectrum of services than Medicare does. It usually covers children, pregnant women, parents of eligible children, seniors and individuals with disabilities. Though poverty is used to determine eligibility, a person must fall into one of the coverage groups in addition to being determined eligible due to being in poverty. Medicaid benefits are paid directly to the provider of services. In addition to covering individuals who meet financial requirements, in some states Medicaid covers individuals who cannot otherwise afford insurance.
Some individuals qualify for coverage by both programs.
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