Posts filed under 'General-Medicaid'
There is a new twist in health insurance that some states have initiated to give Medicaid recipients an extra choice in their health care This new provision is called a Health Opportunity Account.
The Health Opportunity Account is an account an individual who has high-deductible health insurance or who has Medicaid can use to offset some medical expenses. This is an account that gives an individual more of a choice in how their health care dollars are spent.
The Health Opportunity Account is set up through a state system in the state you live in, and it can be used to pay for out-of-pocket health care costs. If you choose to set up a Health Opportunity Account, you will be offered Medicaid benefits. That means that if you are not insured now, this might be a plan to look into and see if your state offers this program and whether you qualify.
If you are in a state that has Health Opportunity Accounts, the state will set aside up to a total of $2,500 per eligible adult or $1,000 per eligible child toward deposits in the account. In the event that you enroll in the program and eventually become ineligible for Medicaid, if there is money left in your account, you would be allowed to use the money for up to three (3) years to pay for such things as health insurance premiums and medical expenses.
The program is mostly geared toward relatively healthy adults and children who are Medicaid recipients. There are some restrictions to the program. A person will not qualify if they are:
• Age 65 or older
• Pregnant
• Blind or disabled
• Eligible for Medicaid benefits, but have only been eligible for less than three (3 ) months
• Certain individuals in hospitals, medical facilities or other medical institutions or nursing homes
• Individuals entitled to any part of Medicare
• Individuals who are terminally ill and receiving benefits for hospice care
• Certain individuals who are medically frail or who have special medical needs
• Children receiving Title IV-E foster care or adoption assistance
There are a limited number of states participating in this program. If you are interested in more information or in participating, contact your state Medicaid office, visit www.medicaid.com and enter your state where prompted or call
1-800-MEDICAID.
The Arizona Hospital and Health Care Association launched a new web site Tuesday called the Hospital Choice Web Site. This is an innovative move to help consumers determine costs at hospitals throughout Arizona. The site compares average charges, lengths of stay, and the number of procedures performed at each hospital.
This is extremely important for the growing number of uninsured or underinsured individuals. It follows the pattern that Medicare started two years ago when they began posting information about their payments for medical procedures and the range of costs in each county, plus the number of procedures performed at each hospital.
Medicare also provides information online regarding how well hospitals take care of their patients, mortality rates, and how well they care for individuals who have had issues such as heart attacks and strokes.
The idea behind having this information readily available is so that it is easy for individuals – especially potential patients – to comparison shop just as they would at the grocery store or when buying a car. They can now decide - along with insurance or Medicare/Medicaid benefits, which hospital would be best to suit their financial and medical needs. As a result, they become more in charge of their own personal healthcare, rather than leaving it in the hands of a program and its administrator.
The hope is that the quality of care will continue to rise while costs diminish due to public scrutiny. With an easy to understand, transparent reporting system that is available to the public, it will be easier to hold hospitals accountable, and it will be in their best interests to create more or better quality control mechanisms so that they will hold themselves accountable.
Transparent reporting is a positive step in improving health care and increasing the dialogue between patients/consumers and providers to come up with real solutions for the short and long term.
Over ten years ago, a woman in New Jersey heeded home care with basic daily needs after a serious illness. Medicaid would pay for a home health worker to come into her home and help care for her; however the overtaxed New Jersey home health care system had no available workers.
The woman’s daughter did not know what else to do besides putting her in a nursing home. Before that happened, however, an alternative idea was that the Medicaid funds could be used for the woman to hire family to take care of her.
Through this first small step for Medicaid, but huge step for this individual’s family, the Cash and Counseling program began. Grants were given to New Jersey, Arkansas and Florida to pilot the program, and since that time in the late 1990’s, this program has spread to many states in the country.
It has been an excellent program for any reasons. One situation is that the individual is being taken care of at home by their family and not a stranger. They are in familiar place, where statistics show that they will have better resources, more interaction with family and friends, and less isolation and loneliness, all of which lead to faster and stronger recovery. In addition, staying at home and not in a nursing home is certainly much more cost effective and will definitely help the person’s health stay or become more stable.
The federal government has made it easier to participate in this program because it has eliminated the requirement for people to get a Medicaid waiver to participate. According to AARP, this will save a tremendous amount of money. AARP says that home health care costs about a half of what care in a nursing facility costs, and most individuals and their families prefer to stay at home to be cared for unless they are extremely ill or frail.
If you or someone in your family or circle of friends are in this situation, be sure to contact Medicaid at www.medicaid.gov to get further information. It is quite possible that health care can be continued at home with the comfort of being surrounded by family and friends.
The New England Journal of Medicine recently released an article regarding the place that Long Term Care will play in the future. Because it affects such a large part of the population, it is an important topic to tackle.
The article brought out that there are serious flaws in the long term care system and that these flaws expose the people who need the care the most to serious financial risk. How will those who cannot afford the financial risk be able to be taken care of? That is an important question that has not been addressed enough – even by the candidates that are currently running for office.
For now, of the nearly 10 million individuals who need assistance with daily living, most live at home and receive assistance from their family and friends. Because most Americans enter retirement without large sums of money set aside, they must be quite frugal regarding day-to-day living, much less money for extras, including medical care – especially long-term care.
State governments are struggling with the funding of long-term care through Medicaid. As costs for long term care get higher, Medicaid works to keep up the best it can, but with current flaws and no definite solutions in sight, Medicaid could very likely buckle under the strain
In addition, when Baby Boomers are factored into the equation, the picture becomes even more abstract. The solution is not cut and dried, nor is it an easy one. As we look at the legislators who will take office after the elections, it will be important for them to look at the issue of long-term care and raise awareness about it. There has to be a long look at where Medicare and Medicaid fit into long term care and acute care, as well. New approaches must be explored.
Most importantly, though, the discussion needs to begin and the questions need to be asked This should all be done in earnest with open minds truly looking for realistic answers to this situation.
Keep your eyes on the news and check with www.medicare.com and www.medicaid.com and AARP. Make sure you know what your situation is with regard to long-term care and your Medicaid or Medicare benefits.
During the past decade or more, there has been a push by citizens, advocates and, yes, even congress, to allow individuals to have home health care rather than staying in a facility. As many of us know, a person that can live at home and interact in the community, while being taken care of medically, will most likely live a longer and fuller life.
One state, Connecticut, has moved into the cadre of states who are working to allow individuals to stay at home, get home health care, and live full lives. Senators there have passed a bill that will move about 5,000 individuals who are elderly or disabled out of care facilities and institutions back to their homes and their communities.
This is vitally important. Statistics have shown that individuals that have community support and independent living, live longer and are healthier than those who are confined to hospitals, institutions and long-term care facilities. This does not mean that everyone is capable of living on their own and interacting in the community without assistance. Some individuals might be better in a variety of care settings. However, it has long been known that there are many individuals in facilities, hospitals and institutions that should really be able to live in the community.
This is a win-win situation. Medicaid will save money – it is much less costly to live in a group home or apartment and have a variety of supports defraying the costs, than it is to stay in a hospital, facility or institution where rates range (depending on the area the person lives in) from nearly $200 per day to over $1,000 per day.
I have personally worked in several states with individuals who were involved in independent living programs. Some lived in group homes and others lived in their own apartment. Still others were able to live at home with their families. Many of them had gainful employment, meaning that in many cases, they either needed less benefits and actually paid taxes, helping the economy; or they had small jobs that prepared them to move forward in the community and eventually be self-sufficient.
No matter what the situation, helping individuals that are able to integrate into the community and work toward independence is a huge step forward for the individual, the community they live in, and society in general.
At this time, it looks as though the trend has caught on and is continuing. In the long run, it can save Medicaid and communities millions of dollars. In the short term and the long run, it will heal individuals, families, and the community and make all of these entities stronger and richer for the progressive change.
Most people who are Medicaid recipients know that their income must stay below a certain level in order for them to maintain their Medicaid eligibility and benefits. Therefore, they must carefully check their finances so that they do not exceed that amount and lose their benefits. This is critical, since Medicaid is a lifeline for many who can’t otherwise get health care and need to continue treatment, medicine or both.
There has been a lot of confusion regarding the tax rebate checks that are being distributed right now. Individuals receiving Medicaid are worried about whether this extra money will count as income and cause them to lose their benefits.
The answer to this is, “No.” The economic stimulus rebate will not count as income; therefore will not cause individuals to lose their Medicaid, according to South Dakota State University.
Some Medicaid programs count resources as assets, so it is best to check the information at www.ssa.gov, which is the federal Social Security Administration website. Some nursing-home waiver and other SSI-related programs count resources as assets, so it is important to check the site to see if any of these situations apply to you. They could include Disabled Adult Children, Widow/Widower, Grandfathered Children or a few others. You can get specific information regarding these situations on the site.
If you or someone in your family is part of any of these programs, Medicaid will not count the tax rebate as income during the month the rebate is received or for two months afterward. That means that this money will not be counted when Medicaid is deciding whether a person is eligible for that month and the two months after the rebate is received. It is important, however, to note that if the money has not been spent or otherwise disbursed by the fourth month, it will be counted as a resource for the programs listed in the previous paragraph.
If you are a Medicaid recipient, hopefully this clears up the confusion so you can breathe a bit easier now. If you have further questions, go to www.medicaid.gov or www.ssa.gov for more information.
Many individuals with disabilities want to go to work and are able to work at a job. This is a very positive thing in many ways. It helps the individual to build their self-esteem and pride, helps them become a more integrated part of the community, it helps the individual become more self-sufficient and it helps the economy.
There is a drawback for many people with disabilities who want to work. The drawback is simply that individuals are worried that they will lose their benefits – especially their medical benefits – if they go to work. It can feel devastating to be willing and ready to work but have to choose between work and medical care.
The truth is, however, that an individual with a disability can begin – and continue – working and still maintain their benefits. States can extend Medicaid to people who are working but who are earning too much money to qualify for Medicaid under the current rules.
A person can qualify if their income is less that 250 times the national poverty level or if they meet the definition of “disabled” under the Social Security Act and would be eligible for Social Security Disability Insurance (SSDI) if they were not working and bringing in an income. An individual can qualify for the buy-in without receiving SSI, and the state would then have to determine whether or not the individual has a disability. The fact that an individual is working will not have a bearing as to whether they are disabled or not.
Another important piece of this equation is the Ticket to Work and Self-Sufficiency Program. In fact, this program is the foundation through which many of these benefits are protected when a person goes to work. The Ticket to Work program allows for and encourages states to cover individuals between age 16 and 65 years old who decide to go back to work and the states can provide Medicaid to individuals who are working who have improved enough to lose their coverage, but still qualify as being disabled.
So, if you are considering trying to work, find out about the Ticket to Work and find out about whether your state will continue your Medicaid benefits. Take the first step toward working by finding out how you can continue receiving your benefits. You can do this by contacting your State Medicaid Office or go online for information at www.cms.hhs.gov and look up Ticket to Work.
The information you discover may make the difference between you being able to work or not.
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.
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.
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.
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.
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.
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.
It is a fact that having good health is important for everyone. Whether you are rich or you are poor, having good health for both you and your family is very important. However, if you can’t pay for your medical bills, how will you be able to ensure you and your family’s health? Surely you can’t stop illnesses from happening and you definitely cannot predict what’s in store for you and your family in the future.
Because of this, more and more people are now enrolling in a state and federal government program called the Medicaid.
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First of all, getting health insurance is considered to be one of the most important investments that you can ever make. Besides, with the constant rise of health care cost, you too would find it difficult to pay for your medical and hospitalization bills even if you have a decent household income. So, what more if you can’t even afford to pay for the premiums of health insurances? What if you are one of the people out there who has a low household income level?
Because of this problem, both the state and federal government are now funding a health insurance program called Medicaid. This particular health insurance program that is funded by the state and federal government are designed for low income individuals or families, the disabled, children living with low income families, and also for the elderly.
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If you are pregnant, you know that it can be hard for you to spend for the supplies you need in order to ensure a healthy pregnancy. You also have to remember that the cost of hospitalization and delivery can be quite expensive. So, if you are in a low income family, you will want to apply for Medicaid that is specially designed for pregnant women and newborns.
Under this program, you will see that it will assist you with the expenses on hospitalization and even the regular check ups you need to ensure a healthy pregnancy.
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It is a fact that in today’s world, health insurance is very important. With the continuing rise of the cost of heath care, you too would definitely want to buy a health insurance policy. However, what if you are one of the low income families that can’t afford even the cheapest health insurance policy?
You have to face the fact that there are times in yours and your family’s life where emergency medical situations are necessary. You will never know what’s in store in your future. Because of this, you would want to try and get help from the federal and the state government regarding financial assistance for medical emergencies.
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