State Medicaid Programs

California Healthy Families Program: The Annual Eligibility Review (AER)

An annual eligibility review is required by California Medicaid to maintain your enrollment in the Healthy Families Program. The reason for this review is the department must be able to verify that you still fit the income requirements of the program. What will happen is that you will be contacted within 60 days of the review so that you can prepare the necessary paperwork to prove your income. Continue reading

Applying for the California Health Families Program

The California Healthy Families Program is a great option for families that need to get health insurance for their children and can’t get it another way. This program provides health, dental and vision insurance to these people and can be attained rather easily if you qualify. Here is a detailed list of who is able to apply for the California Healthy Families Program. Continue reading

California Medicaid: Do You Qualify for the California Health Families Program?

Medicaid is another government run, on the state level, program that helps with medical coverage for families in need. In order to get the coverage there are several different qualifications set by each state to make sure the right people get the benefits. The California Healthy Families program provides health, dental and vision to children that otherwise don’t have access to it. Here are some of the requirements for this program. Continue reading

What is “MIChild” in Michigan Medicaid?

Most state Medicaid programs will have special programs especially to ensure that your children have access to health insurance.  In Michigan this coverage is referred to as “MIChild” and there are some requirements that your children will have to meet to be covered.  If you have children under age 19, you may be able to get health and dental care for them through MIChild if they meet the following: Continue reading

What Coverage Does Michigan Medicaid Have for Pregnant Women and Infants?

When you are on Michigan Medicaid there will be several options to help you during your pregnancy until your baby arrives.  You may also qualify for Maternal Support Services (MSS) and Infant Support Services (ISS) to help you during your pregnancy and after your baby is born.  If you do happen to qualify for this program there are a few services that you should know about. Continue reading

What is the Difference in Texas for Children’s Medicaid and CHIP?

Texas Medicaid, like many states, has a few options to make sure that the children of the state are taken care of from a health insurance angle.  To understand when your child may be insured you should understand the difference between the two major coverage options.  Here is the difference between Children’s Medicaid and CHIP (Children’s Health Insurance Program) in Texas. Continue reading

Texas Medicaid Coverage for Prenatal

There are times where you or a loved one may not be able to qualify for benefits from Medicaid or Medicare but you can get partial benefits.  This is something to look in to, especially if you happen to be pregnant in the state of Texas and you don’t have health insurance.  The following is a look at a few of the benefits from Texas Medicaid and their “CHIP Prenatal” coverage: Continue reading

Florida Medicaid and Eligibility for Pregnant Women

As Medicaid was established to help low income families obtain health insurance coverage there are stipulations for people in certain situations.  One of those that is of interest to the government and society as a whole is pregnant women and how they are covered.  Here is a look at a program in Florida called SEPW (Simplified Eligibility for Pregnant Women). Continue reading

What is the Florida KidCare Medicaid System?

Medicaid is intended to help mostly the low income families who cannot otherwise get access to health insurance for a variety of reasons.  Many states have special guidelines for children and Medicaid as they intend to have as many kids covered in the system as possible.  There are four basic options for kids in Florida on the “KidCare” system for coverage under Medicaid. Continue reading

What do You need to apply for Medicaid in New York?

To get Medicaid in New York there are some things that you will need to provide to be able to apply for the coverage.  The lack of any or all of this information could delay or terminate your ability to get the coverage so being prepared is very important.  Put the following things together before you make any visits to start your coverage. Continue reading

How to know if you qualify for New York Medicaid

Getting access to Medicaid can change your life if you need it and do not otherwise have access to insurance coverage.  As this is the nature of the world around us it is always important to make sure that you have exhausted all of your options to have coverage.  When you live in New York there are a few things you must do to qualify for Medicaid coverage. Continue reading

Florida Medicaid Offers Asset Preservation Program

Medicaid, like most federally funded programs, has a lot of programs to help you qualify for the coverage as long as you meet certain guidelines.  Once these guidelines have been met your coverage will kick in and you will be in good shape.  One such guideline is that your assets must drop to a certain limit before you can receive federal and state aid from Medicaid.

Florida Medicaid offers “asset preservation” courses and seminars to people who could qualify but don’t based on current requirements.  These courses will show the individual how to reorganize their assets in order to meet the pre-determined Medicaid requirement for personal assets.  If you believe that you or a loved one would qualify then you should seek out the service through Florida Medicaid.

One important thing to remember about your assets is the amount of gifts that you give in the period before applying for Medicaid.  Many elderly people give gifts to family to help pay for large purchases.  These can be detrimental to enrollment and should be discussed with a Medicaid expert before being completed.

Is Your California Medicaid Coverage Mandatory?

Many people do not know the difference between Medicaid and Medicare and tend to assume that they are the same thing.  While it is health care coverage that is provided by the government, they are run by different kinds of government.  Medicare is federally funded, while Medicaid is a combination of state and federal funding.  To receive federal funding the state must abide by certain guidelines.

Here is a brief overview of who is mandatorily covered by Medicaid per the Federal Government:

• Low-income families participating in CalWORKs, and those who meet financial standards for Aid to Families with Dependent Children (AFDC) that were in effect in July 1996.

• Seniors and people with disabilities participating in the Supplemental Security Income (SSI) program.

• Pregnant women and children with family incomes below specified levels.

• Children receiving foster care and adoption assistance.

• Certain low-income Medicare beneficiaries.

If you feel you belong in one of these groups and you have been denied coverage to Medicaid you should contact your local government representative.  These guidelines are tied to state funding for the program and the state can face penalties for non-cooperation.

Just When Alaska Medicaid Thought it was Safe…

Just as congress is trying to pass legislation which will give Medicaid a boost, Alaska has been put on a moratorium by the federal government and CMS due to noncompliance when it comes to enforcing Medicaid rules. This is temporary, however there is no guess as to how temporary it will be.

Because of this moratorium, many people who need to sign up for Medicaid need to wait until this is over. The review raised concerns that the state Medicaid agency has not taken necessary safeguards “to protect the health and welfare of the recipients of the services.” Continue reading

Legal Rights for Medicaid Recipients in Missouri

Imagine having medical services performed, thinking you are covered by Medicaid, but instead, finding out that you have a lien against you instead.

This has happened to some people in Missouri who have become part of a class action lawsuit to eliminate the liens and get the financial situation resolved.

 

The Plaintiffs in the case are claiming that the liens are against monies that are not compensation for past medical bills and services and the liens are a violation against the plaintiffs, who are asking the supreme court for help in settling the situation.

 

The court granted a Class Certification because the money in dispute which resulted in liens is Workers’ Compensation funding that several hundred individuals received after accidents or injuries that kept them from working.  Their contention is that the Workers’ Compensation payments, which mainly replace lost salary, have absolutely nothing to do with Medicaid benefits, which are for medical expenses.  Another reason for the class action suit is to be sure that all of the plaintiffs will be treated the same and treated fairly.

 

Medicaid has said that many of the claims should be barred due to the fact that the statute of limitations eliminates them from being able to participate in a class-action lawsuit.  The court ruled that this issue could be determined later, as well as issues of class certification.

 

In the meantime, this will be an interesting issue to watch.  It is not a situation that comes up often, however with cuts in Medicaid budgets and services, as well as  states who are dealing with tight budgets and fiscal cuts, issues – especially precedent-setting lawsuits such as this one – important precedents are being set for the future and could affect q great many people – even you.  If you need information regarding your rights regarding Medicare or Medicaid, not only can you check with www.medicare.gov and www.medicaid.gov, but also AARP, The Disability Law Center in your area and the Medicaid Legal Information Institute at Cornell University on the internet at topics.law.cornell.edu/wex/Medicaid.

What About Documented Aliens?

The issue of immigrants and aliens in this country has been heated for years.  It is something that has been discussed as the population has changed – especially in the past decade.  Sometimes, however, both sides of the debate seem to forget that this is a nation that, other than Native Americans, was largely built by immigrants.  Yet, these days, there are big questions that keep coming up about immigrants, aliens and paying taxes or having certain types of benefits, especially health insurance coverage. 

One state that has a huge issue with aliens is California, due to many factors.  Many of the state’s citizens are individuals that are aliens, and though the insurance coverage controversy is limited to aliens that are legally here – green cards and all – there is still a huge issue surrounding these individuals and their benefits.

To offset budget issues, Governor Schwarzenegger has proposed and is fighting for limiting or eliminating health care coverage for immigrants/aliens that have had a green card for less than five years.  This proposal would supposedly save $85 million or more by eliminating many preventative services for those individuals and their families.  The problem with this is that, once again, it’s great to look at the short term but the long term must be addressed.  If people do not have Medicaid coverage (called Medi-Cal in California), to help them stay healthy, studies throughout the count.ry in various states have shown that the costs are often much more in the long term because without preventative and basic care, people wait until their health situation is acute before they deal with it.  Because people wait until they can wait no longer, they end up in an emergency room instead of a doctor’s office, therefore incurring a cost that can be up to an average of 7 to 10 times that of a preventative or even an acute visit to the doctors office.  A doctors visit at a local clinic usually costs between $10 and $25; and a doctors visit at a private doctor’s office can be $35 to $100 depending on what area of the country a person is in.  With Medicaid, a doctor’s  visit would  cost a co-pay of $10 to $20.  All of these are far less than the average emergency room visit which can cost from about $200 to $2000, depending on where you are and the procedures that have to be done.  The likelihood of a low-income individual paying the doctors visit or working out payments with or without insurance, is much better than them paying for the hospital visit.  Too many times, the hospital gets stuck providing care and receiving little or nothing because the person truly has no money and the hospital is obligated not to turn anyone away.

It is important to keep an eye on California to see how the Governor’s bill turns out.  Let’s remember that aliens that are legal and have green cards have taxes taken out of their paychecks, thus contributing to the economy.  It is essential to weigh the pros and cons as well as the financial impact of cutting these individuals out of insurance benefits/Medicaid coverage that could essentially keep them and keep the economy healthier.

Low Cost Health Policies In Florida Could Help Other States

Governor Charlie Christ, Florida’s Governor has been traveling throughout Florida from one end of the state to the other to sign a groundbreaking bill that will offer low-cost insurance to low income individuals and families throughout the state.  The policies will be stripped down, but will still cover the necessities. 

At this time 21% of Florida’s residents are uninsured, and the bill will help them immensely.  At this rate of uninsured residents, Florida is the fourth highest ranking uninsured state in the country.  The Governor is most excited about the new insurance bill because of what he feels is one of its best features: it will not cost taxpayers a cent.  To be able to provide insurance coverage for those in need and save the taxpayers money is a stunning feat.

Because budgets in most states throughout the country are strained, at best, the states are looking at Florida’s innovative ideas regarding insurance coverage for those who need it most.  States are looking to Florida to see how – and if – this can truly work, and whether the plans can work without creating any costs for taxpayers.

Some states are looking at lowering the cost of healthcare rather than covering the uninsured, which may be less expensive on one hand for the states considering this way of dealing with the issue, however, it could actually cost states more because most states have laws that state that hospitals must treat everyone, regardless of whether or not they have insurance coverage or the cash or credit to pay for treatment.  As a result, rather than states spending a smaller amount on outpatient services to keep people healthy, they are having to provide much more expensive hospital expenses when people’s conditions become acute and their only remedy is rushing to the emergency room.

Florida is trying to deal with the short term and the long term by covering people and making services available so that they are able to stay healthier and avoid catastrophic health issues, therefore saving the state, the taxpayers and the hospitals substantial amounts of money.

It will be interesting to see how Florida’s new system of covering low income uninsured individuals and families turn out.  If Florida is successful n this endeavor, and since it is the state with the fourth highest uninsured rate in the country, their success could lead the way to help people in need of insurance coverage in other states throughout the country.   

Arizona’s Hospital Choice Website Compares More Than Just Prices

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. 

Medicaid Offers New Home Health Option

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. 



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