The idea of the Federal Government stepping in to help people is only right in the minds of some people while it is completely wrong in the minds of others. Some point to welfare programs and can’t stop talking about the amount of peril it has caused our society. Others point to these programs as a beacon of freedom and loving community. In this vein, what is Medicaid and who does it cover?
Firstly, understand that the government offers Medicare to people who are disabled or elderly as a way of getting insurance coverage where it may not be offered otherwise. With Medicaid the government has tried a different approach, being that you pay for an insurance plan through someone else and they help. This is a plan that teaches ownership and accountability.
Medicaid is only offered to those who are in financial peril, likely on the brink of total poverty and this is the only answer. Medicaid will not be offered to you just because you need help if it is not absolutely necessary. The main way to remember the difference between Medicare and Medicaid is that one provides a complete service while the other is simply holding you upright.
When looking for information to write each week there is a process of combing every piece of news and information possible. Right now, it is a critical time for the folks that depend on Medicaid or need to get it. I have friends with serious disabilities who have been denied in applying for Medicaid coverage.
We are not talking about small disabilities. We are talking about traumatic brain injury, degeneration or deterioration of joints and spines so they are unable to sit or stand for long periods and either use a cane, but usually a wheelchair.
It is unbelieveable that in this day and age they can't get the help they need. However, with the news that Medicaid may get a boost and be able to help more people, possibly those who are truly disabled and living under the poverty level, barely hanging on, would be able to be approved the next time around.
I am including the article below because I feel it will be encouraging to those people who are disabled and stuck right now. It was written by Michelle Diament from disabilityscoop.com and I feel it was worth reprinting. I hope it is encouraging to those who are trying to get Medicaid.
July 14, 2009
There was a health care reform bill introduced Tuesday by Democratic leaders in the House of Representatives. The bill would expand Medicaid and require mental health coverage for all Americans, however it leaves long term care quite lacking.
The bill was brought forth collectively by three House committees — Education and Labor, Ways and Means and Energy and Commerce — which have jurisdiction over health care.
As currently written, the bill would allow Americans to keep their current health insurance coverage and doctor, but would also provide a so-called “public option,” essentially a government-run insurance program that individuals or business could buy into.
Mental health coverage would be required under the bill no matter which insurance option is selected. Plus, insurers will not be allowed to deny anyone coverage due to a preexisting condition.
Medicaid would be expanded under the House bill to include families with incomes at or below 133 percent of the federal poverty level. Furthermore, reimbursement rates for primary care services provided to people on Medicaid would increase, with the federal government picking up the tab.
“We can’t afford to leave people in a system that looks to recruit the healthy and leave the sick uninsured, underinsured or uncertain about their insurance,” said Rep. John Dingell, D-Mich. “The current broken health care system will not fix itself and the people who made billions from it have no reason to change their ways unless we make them.”
Long-term care is not emphasized in the House bill. Neither the Community Living Assistance Services and Supports (CLASS) Act — which would create a government long-term care insurance program — or the Community Choice Act — which would allow people with disabilities the option to use Medicaid funding to pay for community-based rather than institutional care — are included.
Just last week Health and Human Services Secretary Kathleen Sebelius sent a letter to a Senate committee expressing the Obama Administration’s support of including the CLASS Act in health care reform legislation.
House committees will consider this proposal beginning this week. In order for any changes to take place, legislation must be approved by the House and Senate and be signed into law by the president who has indicated he would like to wrap up health care reform before Congress leaves for its August recess.
Recently, we have all been overwhelmed with talk about the proposed healthcare reform that many Democrats want to pass. President Barack Obama and volunteers that comprise of e-mail lists of the volunteers used during the elections and supporters of Barack Obama during the campaign have been on a major mission to pursuade patients, doctors, and politicians to join them.
The idea is to “cover all Americans”, mostly through government mandates to purchase insurance.
We currently have little information but still, there are already many supporters of the plan, but some others are not comfortable with parts of the proposed plans. Many who support the plan bring up the fact that there are many in this country who are uninsured.
This is where Medicare and Medicaid come up.
Medicare is a system of insurance that assists the elderly who are eligible for social security payments. While no system is infallible, many who are on Medicare are satisfied with it. For the elderly who wish to get what they consider better care, they are able to get supplemental insurance from many private insurers, often at a discount. Many senior citizens choose this option, and many who live in a single-payer system would also prefer to supplement their insurance with this option. Medicare is also available to the disabled.
Medicaid is a health insurance program for low-income people. States are required to cover many that wish to have insurance whose income is at or below the poverty level. They may cover those that make more as well, and often cover people with higher income levels if they are minors, are pregnant, infants, and others, and are required to cover children under 6 and pregnant women who make 133% of the poverty level or below. Children in foster care and some children who are adopted also receive Medicaid. Most states go beyond these federal mandates and choose to cover a much wider group of people.
The idea that all people who do not have insurance are too poor to afford it is not entirely true. Those that are too poor to afford insurance are covered by a state program, in the same way that people that are too poor to afford food are covered by programs to assist in that matter.
There may be some who have fallen on hard times and have bills to pay, but the idea of “repossessing” medical care will remain in science fiction movies and has not been a way of life for the American people, and people have bills of all sorts, not just those that are medical. The idea that someone is too poor to afford medical care, either in insurance form or with actual doctors, is more of a matter of personal opinion, as most who are actually poor are already covered with a government program.
This is where the issue comes in. I had a friend with two children and a mother who was ill. She took care of all of them - alone. They all went without health insurance for several years, even though the mother was very ill and had been in a serious accident leaving her with brain damage. With all that, high blood pressure and some other serious problems, the mother was denied medicare. The friend, who was taking care of her family made just enough so that they couldn't get medical help but she didn't qualify at work. When her son had to have emergency knee surgery, they finally gave her CHIP for her kids and gave her mother PCN which is a very, very, very scaled down version of Medicare - totally bare bones. Basically, it helped with her prescriptions.
At any rate, people think that the poor and the elderly are all insured and taken care of. That is not true. It is a fact that over 50% are, but it is also a fact that those who make even $10 too much are often denied care even if their doctor pleads for it.
Hopefully everyone from the president down on the left or the right will leave politics out of the heathcare issue and make sure everyone who needs it is taken care of with the new legislation.
In the near future, Louisiana could face an even larger shortfall than expected in the money needed to provide health care to the poor, elderly, uninsured and children. Tax collections inflated by the recovery from the 2005 hurricanes are the source of the problem, state Health Secretary Alan Levine said Monday.
Instead of paying 67.6 percent of Medicaid costs in Louisiana, the federal government is expected to only pay 63.1 percent beginning October 2010. Federal funding cuts also are projected for a children’s health-care program. The difference in the percentages amounts to millions of dollars.
“The problem is nobody — and I mean nobody including myself — thought the reduction … would be this large,” Levine said.
Governor Bobby Jindal and his administration is proposing a $26.7 billion budget that trims the state’s health-care costs by more than $400 million in the fiscal year that starts July 1. The reduction would decrease the state Medicaid budget from $6.5 billion to $6.18 billion, affecting hospitals, nursing homes, physicians and others.
The federal “stimulus” package is helping with some health-care expenses. From October 2009 to December 2010, states do not have to bear the cost of changes in the percentage of Medicaid expenses that the federal government pays. The “stimulus” will get the state through part of the 2010-2011 fiscal year, Levine said.
But once the money runs out, the state will have to deal with a shortfall that now is larger than anticipated, he said.
The Federal Funds Information for States estimates Louisiana stands to lose $268 million in health-care dollars in a single federal fiscal year. “This is a massive, massive impact to Louisiana,” Levine said.
The decrease is in the percentage of costs that the federal government picks up for the Medicaid and Children’s Health Insurance programs.
There are other states that are going through very similar plights, however, since Louisiana - and a few surrouding states - is still recovering in many ways, especially financially from Hurricane Katrina, there are difficult issues that have to be ironed out to get the situation together economically so that Medicaid coverage will drop as little as possible and the people that truly need it will be able to have it continuously.
Dual eligibility is a term that is heard but not always understood by Medicare beneficiaries. What it basically means to have dual eligibility is that a person qualifies for both Medicare and Medicaid.
To qualify for dual eligibility an individual must meet the requirements for both Medicare and Medicaid. Most individuals meet the requirements for only one or the other; however there are quite a number of people who also meet Medicaid guidelines based on income and assets.
Some people qualify for Medicare and partial dual eligibility, meaning that they have Medicare coverage and can also have Medicaid coverage if they pay a very small monthly premium for it. Others qualify for total dual eligibility, meaning that they can be covered by both Medicare and Medicaid and because their income and assets are below a certain point, they do not have to pay any Medicaid premiums.
The importance of having both Medicare and Medicaid is that they cover different things, and when an individual – especially with a low income – qualifies for both through dual coverage, they are basically covered for hospital care as well as doctor visits and medication with low or no copayments. In addition, certain features of dual coverage may help pay your Medicare Part D coverage premiums.
If you have questions about dual coverage, how it works, whether your state provides it and whether you qualify, you can get information from your local health department. You can also find an excellent explanation of how dual coverage works on the Centers for Medicare and Medicaid Services (CMS) website.
Medicaid is supposed to help low income and poor individuals, plus individuals with disabilities get medically necessary medical treatment. Like any program, Medicaid has its good points and bad. The bad pints can usually be attributed to limitations on services and quite often a very narrow view of what is medically necessary. In addition, every state develops its own Medicaid guidelines and determines what it will cover and what it will not.
One state that is dealing with a very serious case right now is Georgia. This is a particularly difficult case because it involves a 38 year old mother of eight children who needs a small intestine transplant in order to live much longer. The sad part is that if she lived in several other states, getting approval for this surgery would not be an issue. In fact, another state close to Georgia – the state of Florida – has offered to provide the hospital if there can be approval by Medicaid.
This is a situation where a woman is being fed by a tube 16 hours per day because she cannot eat, due to the fact that her intestines don’t work. She is in massive amounts of pain that rarely let up. Infection is an issue that has sent her back and forth to the hospital. Her husband and children – whose ages range from 10 to 20 years of age - keep the home running and take care of her IV feeding treatments. Her bedroom looks like a small town ER, stacked with bandages, medical tape, surgical gloves and more.
The operation that Ms. Holloway needs would cost somewhere between 200,000 to 450,000 dollars. Though that is a lot of money, doctors have stated that Medicaid will actually save money by addressing and correcting the problem once and for all. Instead of running up bills of $20,000 to $50,000 at a time with each visit to the hospital, the surgery could give her – and her family – her life back and eliminate the problem.
It will be interesting to see how this case and its appeal are handled. They may set a precedent as to whether states will refuse to look at the long term cost of keeping Holloway alive and in pain vs. the same cost for approving her surgery. Will states, such as Georgia cut off their nose to spite their face and let people die in the process? Only time will tell. Let’s hope that the Holloway family – Ms. Holloway, in particular – has enough time to wait.
Birth Control has become an intense topic during the past few decades. No matter what side of the debate you are on, there is some type of controversy. In response, there are a variety of birth control medications and procedures available to women today.
In the past, women who wanted or needed an effective method of birth control had few choices. They could take some form of birth control or they could have what amounted to major surgery. They could also use an intrauterine device called an IUD.
None of these methods were perfect. Whenever you are changing the systems in the body there can be a reaction. All of these birth control procedures had reactions ranging from pain and bleeding to nausea and headaches – plus everything in between.
There is a relatively new procedure available to women. The Essure procedure has been approved by the FDA since 2002, but until now it has not been covered under Medicaid.
The Essure procedure is non-invasive, can be done in a doctor’s office and takes only about 10 minutes. Instead of a hospital stay and a longer recovery time lasting 3 to 6 days, the recovery time is one day, and the procedure is done as an outpatient procedure.
In essence, the Essure procedure is a permanent procedure that replaces tubal ligation for women. The doctor inserts soft micro-inserts into the fallopian tubes through the cervix. This blocks the tubes and enables women to discontinue other forms of birth control. Eventually, the tube grows around the inserts, making this a permanent procedure that is 99.8% effective. This is the first and only sterilization procedure to have zero pregnancies in the clinical trial.
California is the latest state to embrace the procedure, with 45 other states having done so. The Essure procedure gives women a safer, permanent choice regarding birth control.
For further information you can check with Medicaid for your state or you can contact the Essure Information Center at 1-877-ESSURE-1 or at www.essure.com on the web.
