Posts tagged 'medicaid'
With deadlines looming, there has been much discussion between members of Congress, CMS, physicians groups, Medicare and Medicaid beneficiaries and others trying to sort out a decent bill that would be fair to all in light of the Bush Medicare cuts that are proposed.
One of the latest situations to crop up is that Senate Majority Leader Harry Reid, a Democrat from Nevada is warning that he will try to stop the debate about the proposed bill to delay the 10.6% cut in pay to physicians for 18 months. To stop the debate, he will invoke “cloture” and do what he can to let the bill pass.
There is legislation that has been introduced by Senate Finance Committee Chair Max Baucus, a Democrat from Montana that would delay the cuts from going through. The Baucus legislation would cost $20 million dollars, but would include some positive provisions including promoting electronic prescribing by physicians, expand some other services and require Medicare to pay pharmacies that provide for Medicare recipients with prompt payment. In addition, recipients who pay for Mental Health Services would have their copays lowered from 50% to 20%.
Some funding would be decreased, such as funding for certain education and marketing programs to get physicians and private health insurance to participate in or to accept Medicare, as these are not as essential as many of the provisions that the proposed legislation is trying to save or enhance.
It is no secret that Medicare and as a result, Medicaid are experiencing difficulties and that, from all reports – Republican and Democrat, alike – the outgoing administration has not made it better, but have weakened it substantially. To be fair, we can’ blame everything on this administration, and there are many things that have happened over the past decade or more that have weakened many services that should be available to the vulnerable individuals and families that need such services.
The debate may have many points of view, but there is little time left to enact some legislation to avoid eliminating even more benefits. It is important for us to watch what is happening to the benefits and services at stake and how Congress works to block these proposed cuts from going through. Keep on the watch.
There are many creative ways that are being explored to help individuals and families come off of Medicaid and subsidize their payments for employer sponsored health insurance if it is available to them. Utah is one of the states that will be working with Medicaid to have Medicaid help low-income families offset these premiums, as this would help people be able to buy their own insurance.
The question is whether these individuals and families will be better off. Will they actually have access to and actually be able to receive better care. Advocates are asking whether or not individuals will not only be able to get the care they need, but also receive it without limits on copayments and deductibles.
The plan that Utah is trying to put in place involves Utah’s Premium Partnership for Health Insurance (UPP) which presently provides up to $150 per family toward their premiums. The problem is that employer-sponsored health plans are not available to everyone, so in these cases, this pan could seriously limit these individuals’ and families’ access to health care. The aim is to provide coverage to about 5,000 adults and 1,000 children.
There are issues with this, however. One issue is that if adults enroll in the plan, their children would have to be enrolled, and this would exclude them from the Children’s Health Insurance Program (CHIP). The problem: there are cost protections built into CHIP that are not available with UPP. As a result, there could be unlimited out of pocket costs to parents of children whose illnesses or injuries are extremely expensive. With unlimited out or pocket expenses, children would be put at great risk if their families are unable to pay, and, in addition, family finances could be in great jeopardy.
Before the plan goes into effect permanently, it will be extremely important for these issues to be addressed and solved or families will potentially be in a worse situation than they are without these changes.
It has become common knowledge that people in different communities in different parts of the country receive better care and access to care, treatment and services than in other areas. That has prompted a study by the Robert Wood Johnson Foundation. The study tracked the number of black patients with diabetes that needed amputations vs. the number of white patients who did.
Overall numbers vary throughout the states, however, in the study; blacks needed more amputations than whites did. The study stated that individuals with diabetes need amputations partially because of the care they get and also because the difficulties they have receiving treatment. Other factors are also included, such as whether patients smoke or drink, and particularly, whether they can afford the special diabetic shoes that help with circulation and other factors which could lead to gangrene, thus eventually lead to possible amputation.
Except for Arizona and Kentucky, blacks were less likely to receive annual diabetes blood test than whites. They were also less likely – by quite a lot – to get mammograms, not only because they didn’t’ know about the need, but because they weren’t being told about the importance of the tests and given the prescriptions by doctors to go have them taken. The biggest disparity was in Colorado where 88% of whites were tested, vs. a little over 60% of blacks.
Part of the issue is the need for outreach and availability of Medicare and Medicaid coverage in the poor neighborhoods. Most of the people who are the poorest and live in areas and situations where they are not covered by Medicare are in very compromised health situations by the time they are able to get Medicare or Medicaid coverage.
It is no secret that there are disparities in coverage and treatment throughout the country. The unfortunate point is that people are losing a great deal of quality of life and even losing their lives because of these disparities.
In the wealthiest nation in the world, hopefully there will be a solution to the situation in the near future. Though issues are being looked at, this is a complicated issue, but, complicated or not, the results are overwhelming to the poor and vulnerable among us who deserve quality health care just like anyone else.
We have heard about the Medicare and Medicaid issues, including inequities and disparities throughout the country. One of the biggest disparities is between Los Angeles and surrounding areas in California and the rest of the country, particularly New York.
New York just got some great news – its new resource level for Medicaid applicants has been raised from $4,350 to $13,050 for individuals and from $6,400 to $19,200 for households of two. Medicare applicants and recipients now have more flexibility in terms of eligibility and access of care. The new legislation is retroactive to April, 2008, and is based on a New York Social Services Law through the 2008 Budget Bill. Previously, people who had to cash in insurance and burial policies in order to qualify for services can now qualify for benefits and keep the assets they will need in the event that they pass away, such as the burial policies. This is not only good business, it is a fair, dignified and equitable way treat people who are vulnerable and need services the most.
Aside from financial fairness, there is the emotional peace of mind that comes along with the new levels.
Now, let’s head to the opposite coast. In the South Los Angeles area, ever since Martin Luther King – Harbor Hospital – closed last summer, there are so many patients in need of care that they start lining up in front of the clinic between 6:00 and 6:30 A.M. each day. The clinic doesn’t open until 8:30 A.M. The number of patients has risen 70% since the hospital closed last year and only a hand full of clinics have replaced the hospital, which was once considered the jewel of hospitals for South Los Angeles.
King-Harbor Hospital was the 17th acute care facility to close in or around South Los Angeles in the recent past, leaving some of the most vulnerable, low-income, uninsured with few choices for care. It has been hard to attract doctors to the area and in an emergency, ambulances often take patients to three or four hospitals before they can get them into an emergency room.
Why the inequities? After all, there are poor and vulnerable individuals throughout the country, and New York is no exception. This is not speculation; it is simply a statement about the facts. In a country that is basically the richest in the world, there might be difference in care and benefits in various states or region for a number of reasons, but the extremes that can be seen in just these two cities are not just slight differences. They are major differences from one end of the scale to the other.
It is time to look at the entire picture and truly try to come up with some solutions for helping the most vulnerable individuals no matter where they live.
Many states do a poor job of regulating Medicaid fraud because it is a not a simple matter economically. After all, for ever dollar Medicaid brings into a state, there is a federal matching dollar hat the state receives. Some states even overpay Medicaid providers, collect matching federal funds, and collect kickbacks of overpayments, thus becoming part of the fraud problem.
The question then becomes, what is the sense behind turning the oversight of Medicaid over to the same government that is participating in the fraud? Their actions have created long waiting lists, rationing of care and poor delivery of not enough care, again controlled by the government.
There is another side to the issue, however. What happens when you need to make the numbers work? It’s important to look at the major problem. There are many honest and caring physicians who try to help as many individuals on Medicaid as possible. The problem is that even the busiest physicians that take Medicare can’t take more than about 28% of their caseload in Medicaid patients, they can’t afford to stay in business because the amount they are reimbursed is lower than the services provided. Therefore, if there are too many Medicaid patients seeing a particular doctor, he loses money until he can’t afford to stay in business any more.
We haven’t even talked about the number of children covered by Medicaid for various reasons. There are over 25 million kids that have various forms of Medicaid coverage. There are Targeted Case Workers and Case Management through Medicaid Rehabilitative Services who do all they can to deal with children’s’ physical and mental disabilities – getting help and services for them while keeping expenses to Medicaid and to physicians under control. A federal-state partnership that exists now to cover these expenses could be eliminated if some politicians get their way.
Looking at both sides, the hope is that the politicians will be able to work with the expenses while remembering that these issues are not only about finances, but at the heart of the issues are children and adults with vulnerabilities and disabilities that depend on the Medicaid system to help keep them well.
Walgreens Drug Stores agreed today to pay $35 million to the federal government for fraudulent activities regarding three prescription drugs. What was at the heart of the case was that Walgreen was switching out the prescribed drugs for more expensive brands and by switching these, they substantially increased the amount of money that Medicaid reimbursed them, thus substantially increasing their profits.
Medicaid recipients were unaware of this, and there has been no disclosure in the suit that any recipients were harmed, however, switching medication is not harmless. Just because it seems so far that nobody was hurt or killed in this situation, there are severe penalties for these practices because serious risks do exists. Plus, switching medications for profit is simply put, illegal.
Switching medications in this way is a violation of state and federal regulations that are designed to protect patients. In addition, pharmacies subject themselves to triple damages, civil penalties and attorneys’ fees. Usually, this, plus the willingness of insiders to report such fraudulent activities helps keep pharmacies in line with regulations, however, this case against Walgreens should be a warning that the government will pursue fraud aggressively.
For Medicaid recipients, it is important that you know that this what Walgreens did in this case is not the same as the pharmacy calling your doctor and asking if the medications could be switched. That is a practice that pharmacies use if they are trying to correctly fill a prescription with a substitute generic medication. In the Walgreens case, thousands of prescriptions were replaced without notifying anyone, and that is totally against regulations.
This case should let you know that if you receive Medicaid benefits, there are agencies looking out for your welfare and trying to protect you, and reassure you that most pharmacies try to help their clients by filling the right prescriptions and doing the right thing.
When elderly individuals go into a long term care facility or assisted living facility and self pay, the cost can be astronomical. Making sure that the person is comfortable, well cared for, in a clean environment and positive atmosphere is not a low budget issue. What happens, though, when a private pay individual converts to Medicaid?
Well, one would think that because all of the payments are now guaranteed, albeit possibly lower, that these facilities that have been raking in money from these individuals and their families, that they would leave grandma, grandpa or aunt Minnie in comfort and without worry without changing a thing.
Unfortunately, this doesn’t always happen. In fact, there is an investigation taking place in New Jersey regarding the company Assisted Living Concepts, owner of eight assisted living homes in southern New Jersey. The investigation was started by the Public Advocate for the state, who has filed papers against the company because of their alleged practice of discharging the elderly when they change from self pay to Medicaid.
Public Advocate Ronald K. Chen is asking for the names, admission and discharge summaries, as well as contact information for every resident of the company who is or has been a Medicaid beneficiary.
Chen says that the investigation was sparked because there is an indication that this company “is placing elderly vulnerable residents at risk by displacing them from their homes in violation of ALC’s state license. Our primary concern is to protect the safety well being and peace of mind of these residents.”
The representative of Assisted Living Concepts, Laurie Bebo, who is also the CEO of the company, refuses to cooperate with the subpoena and states that the company does not have any Medicaid conditions in their license; therefore, they do not have to honor Medicaid patients.
Chen says that state licenses for all eight facilities stipulate that at least 30% of the residents of each of the facilities are to be Medicaid eligible and no resident would be discharged because or if they spent all their money.
Assisted Living Concepts operates more than 200 assisted living residences in 17 sates, containing more than 8,000 units, so this is no small issue. New Jersey may just be the tip of the iceberg.
There is a lot of talk these days about reverse mortgages, especially for retirees. There have been good reports and bad.
This is how a reverse mortgage works. If you are 62 years old or older, you can apply for a reverse mortgage as long as you own your house outright or owe very little on it. The idea is that you would have the cash to be able to use if you needed it.
With a reverse mortgage there are no monthly repayments, so the good news is that you don’t risk losing your home. The way this works is that equity is taken out of the home each month and paid to the borrower. The borrower keeps the deed to the property – the lender does not get the deed like they would in a regular mortgage.
The program is federally insured, so that the government guarantees that the borrower will receive every bit of money they are entitled to no matter what. If the lender goes broke or can’t pay, the government will pay the money to the borrower. There are also government rules about how much money can be charged for fees. Period. There are several different ways that the payments can be made, depending on what the borrower chooses.
The important thing is that the payments are tax free, so they don’t affect your Social Security or Medicaid.
There are a few negative issues with reverse mortgages. There is a ceiling on the amount that can be borrowed. Up front costs can be high. If you are on SSI or Medicaid you can lose benefits if you don’t spend down your entire loan amount every month.
If you are thinking of opting for a reverse mortgage these are some important things to think about. There are others, as well, so be sure to do some research. Talk to an attorney, accountant and mortgage broker that you know and trust. Check the internet for reverse mortgages. Call AARP. Discuss and research the topic thoroughly so that you will feel comfortable with your decision.
Reverse mortgages have become extremely popular and are an excellent choice if you are in the right situation to take advantage of them.
A Medicaid plan proposed by the Division of Medicaid and the state hospital association in Mississippi was passed by the Mississippi Senate today. The debate took 24 hours until it was passed, and it still has to be discussed in the House on Thursday, 5/29.
The Senate spent the 24 hours discussing how the bill – or not passing the bill – would affect hospitals and patients in the state. Though there will be a 90 million dollar deficit, it has still been decided that this would be a better choice than not passing the bill.
For one thing, though there is a deficit, there will be taxes that offset the deficit. The hospitals will pay out taxes, but will receive more in return, so, in the end, the hospitals, the individuals that use the hospitals and the state itself, will end up better for the situation.
The hospitals in the state all have to pay an assessment tax to offset the shortfall of the 90 million dollars, but the federal government will pay the hospitals back at a rate of three to one. Therefore, for every three dollars that each hospital pays, they will receive two dollars in return in federal funds. The money is paid back to each hospital depending on the number of Medicaid patients they provide services to. The Lieutenant Governor of Mississippi, Phil Bryant has said that “this will help fund not only next year but in years to come.”
Though most hospitals will receive the money back, seventeen hospitals will have a shortfall, which will be reimbursed by the hospital association. State Senator Terry Burton says, “I think taxpayers have benefited as a result of this.”
Thursday will tell whether the House agrees with the Senate and passes the bill to help hospitals and patients who use them.
There have been quite a few accusations and questions about the Bush administration with regard to many issues. There’s the war, gas prices, the economy (in general) and now Medicaid tricks. President Bush has been trying for some time to go around Congress and push through a Medicaid regulation that would eliminate reimbursements to public hospitals, costing money, cutting services and probably costing lives. The sad part about this is that Congress made it clear that this was not to be even dealt with for at least on year because Congress had passed a moratorium on the resolution stating that not even the President could change it.
Unfortunately, President Bush and his administration tried to use a “rush through rule” to ignore the decision that Congress made. The Bush Administration tried to alter, and then process out – the moratorium. Fortunately for the public and for the public hospitals that serve the public, a Federal Judge was not fooled, nor was he impressed about what the Bush Administration tried to do. As a result, Federal Judge James Robertson of the United States District Court for the District of Columbia put a stop to this less than honest and sneaky move.
It is certain because of this action by the Bush Administration, that this is not the last we will hear about the situation. I addition, there are other cuts looming on the horizon. There are seven cuts that are proposed that Congress is trying to stop, or at least, stall until they can be discussed further. These cuts, if approved, could cost the states a tremendous amount of money and possibly destroy some medical care providers. Not to mention the fact that services would be cut for those who need the services most.
We are told all our lives that it is essential to follow the rules and obey the laws. This should include the President and members of his administration, no matter who they are, what they believe or whether they agree with decisions or not. The unfortunate situation is that individual citizens without special privileges pay sometimes serious consequences when they do not. It is good to see the example of a judge who was willing to stand up for an important decision that Congress made to protect the people who need it most.
Autism is a disability that affects hundreds of thousands of adults and children throughout the United States. It is a complicated disability and cannot be treated with a “one size fits all” formula.
Most states have services for children with autism through the school systems, and these services are available through twenty one years of age. At that point, most states have services available for adults.
Pennsylvania is a state that has been different. Though it has covered children with autism through age twenty one, Pennsylvania has been lacking in services for adults with autism. As a result, Pennsylvania has been granted the ability to use a portion of their federal Medicaid to fund services for adults with autism. $20 million will be made available annually to provide community and home services to benefit adults with autism. Some services will include respite care for families who are caregivers, as well as crisis intervention.
Individuals will be qualified for the program and benefits based on their income and the extent of their disability, giving them access to a variety of services. Pennsylvania Governor Ed Rendell stated “Prior to the establishment of this waiver program, there was nothing designed for people with autism once they reached the age of 21,.” This will also help more people with autism live in the community instead of in an institution.
According to Daniel Torisky, President of the Autism Society of Pittsburgh and secretary of the Autism Society’s state chapter, “The whole idea is to give them a jump start. It puts tem in line for significant and speedy improvement and accommodation to the complexities of our society.”
For those of us who know or have dealt with an individual who has autism and/or their family, this is a wonderful step forward in dealing with a disability that affects many people who can be helped to live a fuller life.
The idea of health fairs is not new. There are heath fairs in cities across the U.S. that provide everything from information about gentle dentistry to on the spot blood pressure and bone density tests, and everything in between.
The middle Alabama Area Agency on Aging (M4A) is sponsoring a health fair for seniors this Friday. This will be the first ever, and it will be entitled “A Walk in the Park” because it will be held in the local park. The event will honor Older Adults Month.
Part of the purpose of the event is to raise awareness about the M4A organization, its purpose, its services and how/who it can help. The event will have several types of screening available for seniors including blood pressure checks, blood sugar testing, and cholesterol checks.
Various health care organizations will be available to answer questions, including home health care organizations. There will also be information available about M4A including information they provide and assist seniors with, such as their nutrition program called Homebound Meals (similar to Meals on Wheels), assistance with prescriptions called Senior RX; and assistance with the Senior State Health Insurance Assistance Program (SHIP). SHIP helps with Medicaid, Medicare, Medicare Supplements and SSI, health insurance and long term care.
M4A has an ombudsman who checks into complaints and works to help solve problems. They have a great many friends and contacts in the community, so if there is a problem they can’t solve or a question they can’t answer, chances are they can connect you with someone who can answer those questions and walk you through, working with you to fix the problem if at all possible.
There have been more and more programs such as M4A in communities throughout the country. To find out if there will be any presentations or a senior health fair in your community, contact your local senior centers, chamber of commerce and your doctor or local hospital. The information at these health fairs is usually free and you can surely benefit from the information you will receive.
Medicaid was designed to cover low income individuals and their families for hospital services ( in and out patient), laboratory services, x rays, home nursing care, doctors services, physical therapy, hospice and rehabilitation care. Medicaid recipients must go to a Medicaid-approved doctor who is on the Medicaid list. Sometimes, in some areas, there are a limited number of doctors that accept Medicaid, so some individuals have to search carefully and, once they find the right physician that they are comfortable with that are Medicaid approved and accept Medicaid for payment. As a result, there is often a waiting list for an appointment, even if it’s an urgent situation. In a serious emergency, the doctor’s office may take you right away and “squeeze you in” to their schedule. More often, they send you to the emergency room, which ends up costing you, taxpayers, the community, the hospital and Medicaid more money than if Medicaid reimbursed good doctors enough money to be able to enroll and appoint more, thus eliminating some of the long waiting line.
Federal laws state that if you become eligible for Medicaid, which is based on income and need, the states may not reduce other welfare benefits you are receiving. In addition, we have been hearing a lot about trying to exclude legal immigrants from Medicaid system. The problem with this is that Medicaid only requires – by law – for an individual to establish and prove residency (and meet low income requirements) to apply for and, if approved, receive Medicaid benefits. States cannot impose citizenship requirements on anyone who needs Medicaid benefits. Regardless of age or whether or not the individual works is not a reason that Medicaid can use to eliminate you from the program.
Unfortunately, these situations are taking place in a number of states. If you or someone you know feels that they are not being treated fairly regarding Medicaid benefits, you can contact some places that can help. Information is available to you through www.seniorlaw.com.
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.
Whether you are a caregiver, a family member or a Medicare – Medicaid recipient, chances are that obtaining durable equipment has not been an easy task over the past few years. The wait is usually longer than what would be desirable or comfortable, the approval process often takes forever and then some – if the approval comes at all, and then comes the price and financial issues.
It is difficult enough to deal with a disability and many of the day-to-day issues surrounding taking care of yourself. When you add the rest of the red tape including approvals, reviews, appeals, finances and more, the difficulties become strong barriers for individuals needing the most help to understand and/or over-come.
There is good news that was just released from Centers for Medicare and Medicaid Services. CMS announced that there are 325 providers who have contracted with Medicare to provide certain services and equipment in 10 communities throughout the country including Kansas City. These providers will provide the services and equipment at much lower prices than Medicare pays now.
CMS sent out a press release stating that Medicare is pleased that beneficiaries living in the first round of 10 communities will be receiving high quality service and supplies they have been receiving, but it will be at a much more cost effective price.
All of the companies that are suppliers have to meet Medicare’s requirements. In addition, they must bid to receive contracts, and companies with the best combination of best bids and best products receive contracts with Medicare. This will save Medicare and Medicare recipients an average of 26%, especially because Medicare recipients must pay co-pays in a lot of situations, so the 26% they save could end up being substantial.
If you have any questions regarding this information, contact CMS. You can go on the internet at www.Medicare.gov, www.Medicaid.gov , or www.cms.gov .
Sometimes the age of computers is a wonder to behold. You can get work done and emailed 24/7. It’s convenient to shop on line, apply for jobs on line, send cards and gifts by using online services, and so much more. One drawback is that there is nobody “live” to talk to in many cases, so if there are questions or problems, you’re often stuck with them.
In addition, there are still other issues to be solved. Identity theft and fraud have become much more prevalent and inputting mistakes by you or the company you are dealing with can cost a tremendous amount of time and/or money.
The state of Indiana has some unique problems when it comes to dealing with welfare programs – including Medicaid – on line. One of the biggest issues is that automated eligibility and renewal services are not always accurate, but do not offer alternatives, such as live operators. Indiana has 92 counties and has stated that they will have at least one staffed office in each county.
In the meantime, waiting for the “de-bugging” of he system is creating some serious issues for Indiana Medicaid recipients and recipients of food stamps and other services. ACLU has filed a lawsuit to deal with some of these issues. For example, one woman with hearing problems and other disabilities lost her Medicaid. Why? She was told she could not meet in person with a state caseworker. Another mother lost her food stamps and subsidized health care for her children when the tax return she provided was missing one attachment. It’s hard to believe that she wasn’t simply asked to provide the paperwork. With so much riding on it, it seems logical that she would have provided it, if asked.
Gavin Rose, an ACLU Attorney has stated that there are thousands of these cases, and, of course, they affect the most vulnerable individuals and families. Mitch Roob, of the Indiana Family and Social Services Administration, has said that it is not improper to cut off benefits if the correct paperwork is not turned in. He has also, though, stated that the benefits of these and other people who lost benefits due to the new computerized system, need to have their benefits re-instated if they turn in the correct paperwork.
Rose, of the ACLU says that complete automation creates unfair obstacles for individual with mental illness and other mental health issues, as well as other disabilities, including those with limited education. In each of the cases involved in the lawsuit one of the biggest issues has been that all of the paperwork requested had previously been requested – and the agencies had originals and copies of this paperwork – and still, their benefits were terminated.
This is a situation which will take time to clear up. ACLU, Indiana Family and Social Services and even congress, are all looking into the situation to try to fix the system and overcome the obstacles as soon as possible. If you are having issues such as these – no matter what state you are living in – contact www.medicaid.gov or your local chapter of American Civil Liberties Union (ACLU), or your local Family and Social Services Administration.
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.
If you live in Indiana and you have children, there may be some good news coming your way. The Centers for Medicare and Medicaid Services (CMS) has expanded the Children’s Health Insurance Program. Under the expansion, if you are a family that earns less than 2 ½ times the poverty level, you can be eligible to enroll your children in the SCHIP.
The way the income amounts work out translate to families of two earning up to $35,000 annually or a family of four earning up to $53,000 annually. If your family fits into these financial guidelines and your children need to obtain health insurance, you can apply for the SCHIP program for them.
There are reasonable premiums for the program. The premiums range from approximately $22 to $70 monthly, depending on income and the number of children. Basically the premiums work on a sliding scale.
The expansion of the SCHIP program is a positive step toward making sure that as many children as possible have health insurance benefits. The eventual goal is to cover all children living in the state. The state of Indiana and the SCHIP program are actively trying to connect with families who fit the income limits and whose children are not insured.
Most states have some sort of Children’s Health Insurance Plan (CHIP). These are state-backed programs, usually approved by the federal government through the Centers for Medicare and Medicaid Services (CMS) and facilitated in your local area in conjunction with the county health departments.
For information regarding CHIP benefits in your state, or to see if you qualify, contact your local Social Services or Health Department. Even if you are not sure you qualify or you think your earnings are too high, don’t hesitate to check into CHIP coverage. Your circumstance might fit into some of the regulations that would allow you to participate. It is worth checking into. Remember, the states are trying to insure as many children as possible so no child will be left without necessary medical care
It may seem like New York doesn’t have many scams (just kidding), but one scam that is very real and is being addressed by New York’s Attorney General Andrew Cuomo is home health care fraud that is paid for with Medicaid dollars.
Cuomo has started “Operation Home Alone” which is a new program that is rooting out con artists that pose as home health care workers, but really are not. These scams have cost the taxpayers of New York millions of dollars.
The way it works is that a real home health care worker has to have 75 hours of training and be certified to work at home with individuals who need certain health services. The certification is very important because it means that an individual has been trained to treat wounds, feed, bathe and dress individuals and several other health procedures.
These uncertified home health care imposters are not only dishonest, and not only basically stealing millions of Medicaid dollars, but they are also dangerous. Since they are not trained, it is extremely risky for them to be helping individuals at risk with medical and other health issues. For instance, the average person does not know first aid or CPR. They do not know the correct way to lift someone to help them from a wheelchair to a bed, or vice-versa. They do not know how to take or read blood pressure or blood sugar or what to do in case of a seizure. And that’s the easy stuff!
Most individuals that need home health care receive it because they have health issues that they need help with. A home health care worker is taught how to keep track of and monitor all day-to-day symptoms, vital signs and issues that come up. They know how to track and record information that shows how a person’s health is progressing – for better or for worse. An untrained and un-certified individual usually knows few, if any, of these procedures.
So far, Andrew Cuomo has caught quite a few of these companies who are nothing more than rings of uncertified workers fleecing the system out of a lot of money and putting patients at risk. Cuomo has filed criminal and civil charges to the extent of the law and he is not backing down.
If you are a New Yorker, you can be happy and proud that your Attorney General is trying to protect your citizens – especially those most vulnerable – and protect the taxpayers’ money. If you feel that you have been the victim of this type of fraud by an uncertified healthcare worker, contact Medicaid at www.medicaid.gov or call Cuomo’s office, which is listed under State of New York, Attorney General.
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.
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