Posts filed under 'State Medicaid Programs'
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.
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 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."
Until the review is done, there can be no more individuals added to the Medicaid rolls. The review has been called for because of several areas of non-compliance. For instance, form 27 to 2009 the state reported 27 Alaskans died while waiting for initial assessments and 227 died while waiting to be reassessed.
The system should work much faster than that. The state says that it was behind in assessments because it did not have enough nurses. The review also found the state is not in compliance with requirements for all waivers.
"CMS has determined, in order for us to develop our business processes and refine those that we have in place, that a moratorium is necessary," Rebecca Hilgendorf, director of Senior and Disabilities Services said.
Theresa Bovey, CEO of Trinion Quality Care Services, which provides in-home personal care in Anchorage, says this moratorium could have a huge impact on those who need Medicaid and won't be able to get it now.
It is hopeful that these issues can be resolved quickly and enrollment can begin again after the moratorium is lifted, however, the review is not scheduled until March. In the meantime, the state must create a plan that shows what they will do to improve their Medicaid services. This plan must be presented to CMS before they will consider ending the moratorium.
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.
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.
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.
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.
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.
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.
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.
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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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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First of all, it is important to understand that Medicaid is entirely different from Medicare. Although Medicaid and Medicare are both funded by the government and are both health insurance programs, Medicaid is not automatic like Medicare. In Medicare, you will become automatically eligible when you reach the age of 65 or you become disabled.
To put it in other words, Medicare concentrates more on giving the benefits to the elderly and to the disabled. Also, Medicare is funded by the federal government which gets its funds from the taxes you pay. It is very much like your Social Security where you have every right to enjoy because you are one of the millions of people who are funding it during your working life.
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In 1966 the Congress approved Medicaid as a health insurance program provided by both the state and federal government. Since then, it helped millions of people get the proper and high quality medical care that they deserve.
Medicaid is also considered to be the largest health insurance programs that the state and federal government funds. Originally, Medicaid was designed to let people with low income levels afford high quality medical care. The main point of Medicaid is to provide financial help for people in need of medical care.
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For starters, everyone needs medical insurance. With it, you will be able to get the necessary medical treatment you need even without having the cash for it. One kind of medical assistance that many Americans are benefiting from today is called the Medicaid.
Created by the congress in 1965, Medicaid continues to provide health care and financial assistance to low income families all over the United States. This particular government program is a federal and state partnership that was originally designed to give cash as part of the nation’s welfare program. However, as the program expanded, the eligibility, requirements and also the rules for getting financial assistance through Medicaid changed.
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