California Medicaid

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

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.

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.

California Medicaid System: A Look into the California State Medicaid Program

In California, like in every other state, the state and federal government in partnership offers Medi-Cal. For starters, the name of California’s Medicaid program is Medi-Cal. Unlike Medicare, Medicaid is a health insurance program where the state and federal government participates in the funding and administration of the health insurance. This health insurance program is primarily designed for the low income individuals, families, and the disabled.

The fact that medical assistance is now getting more and more expensive, low income families with dependent children are left out of getting the best health care programs to treat various illnesses. However, with Medi-Cal, you will see that even low income families and individuals will now be able to access high quality medical care at a fraction of the cost.

Medi-Cal for the disabled and for the aged may include coverage for hospital fees, professional fees, medical supplies, prescription drugs, adult day care, long term nursing care in the beneficiary’s home, home health assistance, transportation that is medically related and many other services related to the physical and mental well-being of the patient.

Usually, Medi-Cal can cover 100 percent of the total amount of medical expenses incurred by the patient. However, there are some cases where Medi-Cal may require co-payment.

One co-payment program is when the elderly or the disabled enters nursing home for the purpose of health care. Here, there are cases where you may be required to cover some of the costs that you will accumulate in nursing homes. This is called share of cost.

This program is a part expenditures that you need to pay for your long-term care. However, Medi-Cal will usually pay off most of the expenses that you will incur. The great thing about this is that the needy individual will be able to deduct the total amount of medical expenses and will only pay a part of the medical expenses that is also considered to be affordable.

Another great thing about it is that the share of cost that you will be required to pay will vary depending on your income every month. If you have a particularly low income level, then Medi-Cal will pay more of the long term health care services that you get.

You have to remember that Medicare and Medi-Cal are different health care programs. Unlike Medi-Cal or Medicaid, Medicare is mostly funded by the federal government and it is included in the benefits that you will get on your social security. Medicare also requires monthly payments for the deductibles, premiums and it also provides you with coinsurance as part of the benefit. However, Medi-Cal or Medicaid is funded by both the state and federal government. It is not tied to your social security benefits and it will never require you to pay monthly premiums.

Medi-Cal can cover up to 100 percent of coverage on medical expenses. Adding to that, hospitals or medical professionals who accept Medi-Cal for payment will never be able to charge you with additional fees as it can on people with Medicare.

The great thing about Medicaid in California or Medi-Cal is that they allow you to have Medicare as your health insurance and still be qualified for Medi-Cal. However, you will never generally need any Medicare supplemental or a health insurance provided by a private company once you qualify for Medi-Cal. This is because Medi-Cal can cover 100 percent of all the cost you incur when you get hospitalized or you need medical attention.

These are the benefits that you can get with Medi-Cal. As you can see, Medi-Cal can definitely help you with all your medical needs. With it, you will never be burdened with the high medical cost that is continuing to rise every day.



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