Individuals Under Age 21
EPSDT is Medicaid’s comprehensive child health program. The program’s focus is on prevention, early diagnosis, and treatment of medical conditions. EPSDT is a mandatory service required to be provided under a state’s Medicaid program.
Dental services must be provided at intervals that meet reasonable standards of dental practice, as determined by the state after consultation with recognized dental organizations involved in child health, and at such other intervals, as indicated by medical necessity, to determine the existence of a suspected illness or condition. Services must include at a minimum, relief of pain and infections, restoration of teeth and maintenance of dental health. Dental services may not be limited to emergency services for EPSDT recipients.
Oral screening may be part of a physical exam, but does not substitute for a dental examination performed by a dentist as a result of a direct referral to a dentist. A direct dental referral is required for every child in accordance with the periodicity schedule set by the state. The Centers for Medicare & Medicaid Services does not further define what specific dental services must be provided, however, EPSDT requires that all services coverable under the Medicaid program must be provided to EPSDT recipients if determined to be medically necessary. Under the Medicaid program, the state determines medical necessity.
Understanding What The Two Programs Are
September 23, 2021
Just when you think that Medicare itself cannot get any more confusing, it does. But, for some Americans, it becomes more confusing in a positive way. For many Americans who are close to retirement and qualify for Medicaid health assistance, the question about whether they will also qualify for Medicare health insurance is one theyre likely to consider, especially if they dont have the answer. And if its still a question you have, you can rest easy knowing that it will be answered by the end of this article.
This article is intended to answer your question about whether you qualify for both Medicare and Medicaid, what each is, how you can qualify for the two services and what their overall differences are.
Lets get into it by first understanding what the two programs are.
Whats The Difference Between Medicaid And Obamacare
Medicaid: The health insurance program is provided and run by the government.
Obamacare: This is the nickname for the Affordable Care Act, President Obamas health care reform bill that became law in 2010. The ACA expanded the Medicaid program and created subsidies so more people could afford health insurance. When people say I have Obamacare, what they actually mean is Im covered by a health plan made available through Obamacare. The government doesnt run Obamacare plans, but it helps you find affordable coverage through its health insurance exchange . In some cases, though, you may qualify for an Obamacare subsidy to help you pay part of your monthly health insurance premiums.
Important to note: plans offered by private insurers through the Marketplace sometimes differ from healthcare plans that those same private insurers offer outside the Marketplace . You can read more about those differences and why theyre different here.
You May Like: How To Apply For Medicaid When Pregnant In Florida
What If Im Turned Down By Medicaid
- You may be able to buy a private health plan through the Marketplace instead for the 2018 plan year in the fall. You may qualify for savings based on your income through a premium tax credit and savings on out-of-pocket costs.
- If you don’t qualify for either Marketplace or Medicaid savings, you still have options. Learn more here.
What Are Deductions And How Do They Affect Snap Eligibility
There are seven allowable deductions that you can consider when determining your net pay. To figure out your net income, you have to figure out which allowable deductions apply to your situations and deduct them from your gross income. The difference is your net income.
Each state outlines employment requirements as part of SNAP eligibility. These requirements include:
- Registering for work â some states will require you to provide proof that you are actively applying for work on a weekly basis.
- Not voluntarily quitting your job If you are unemployed, you need to prove that it was not your choice.
- Not purposely reducing your hours If your hours are cut making you income eligible, you will need to prove that the cut in hours was beyond your control.
- Taking a job if offered
- Participating in state-offered employment and training programs.
SNAP benefits will be discontinued if any of these employment requirements are not followed. There are people exempt from the employment requirements. This includes children, seniors, pregnant women, and individuals that are exempt from working for health reasons.
Employment requirements apply to applicants determined to be Able-Bodied Adults without Dependents . Under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, ABAWDs are limited to 3 months of SNAP benefits over a 36-month period unless they are doing at least one of the following:
Don’t Miss: New York State Medicaid Application
Who Qualifies For Medicaid
Medicaid qualification is different in every state. You must be a resident of the state in which you are applying for benefits and must be a U.S. citizen or otherwise qualified non-citizen such as a lawful permanent resident.
Federal law requires every state to provide Medicaid to the following mandatory eligibility groups that meet certain income and asset requirements:
As you can see from the federal guidelines, the only reference to age is in regards to children. Each state governs its own Medicare program in adherence to federal regulations. Some states may have an age requirement in order to qualify for its Medicaid program while other states may not.
You can find your states Medicaid eligibility requirements to learn more.
What Is The Supplemental Nutrition Assistance Program Snap
Eligibility for SNAP
- The gross monthly income must be equal to or fall under 130 percent of the national poverty line, about $25,400 a year or $2,116 a month for a household of three for 2014. The elderly or disabled are not required to meet this limit to receive food stamps for seniors.
- Monthly net income, applied for specific items like childcare and housing cost, must be equal or fall below the poverty line of $19,600 a year, or $1,626 a month for a household of three for the year 2014.
- The assets for each household must fall below certain amounts: households without the disabled or elderly must not own assets above the value of $2,000, and those with disabled or elderly family members must not own assets above the value $3,250.
How Can People Apply for SNAP?How Much Does SNAP Cost?How Efficient and Effective is SNAP?Additional References
Also Check: Do Chiropractors Take Medicaid In Nc
Two Categories Of Medicaid Eligibility
Before the Affordable Care Act, Medicaid eligibility was based on how much money you earned and how much you owned, e.g., your income, your assets, and your net worth. After the law was enacted, however, eligibility was split into two distinct groups.
Some people continued to qualify for Medicaid the old fashioned way, while others qualify based on their modified adjusted gross income .
Can An Uninsured Woman Enroll In Marketplace Coverage Upon Giving Birth
Maybe. If the baby is eligible for Marketplace coverage, then the baby qualifies for an SEP as a new dependent. In such instances, the regulations will also permit an SEP for the new mother, as someone who has gained a dependent through birth.
WOMEN ALREADY ENROLLED IN FULL-SCOPE OR EXPANSION MEDICAID
You May Like: Texas Children’s Health Plan Star Medicaid
Tips If Youre Unemployed And Need Health Care
It might be impossible to predict when your job could be coming to an end, but there are things you can do to keep yourself ahead of the game and have a backup plan if you suddenly find yourself out of work and out of health insurance.
1. Start to find new coverage as soon as possible.
Even before you leave a job, theres nothing wrong with talking to those helpful folks in Human Resources about your health insurance benefits and what will happen to them if you leave. Youll be able to find out how much COBRA coverage will cost you and use this info to decide whether to stick with COBRA or go it alone in the health insurance marketplace.
2. Have all your important details ready.
When youre all set to talk COBRA or marketplace or even Medicaid, heres the information you should have ready: your income, total household income, Social Security number, pay stubs, tax records, information about your current health insurance plan, and the number of dependents in your household.
3. Get advice from an independent insurance agent.
4. Keep your emergency fund full.
An emergency fund is a must no matter what your situation is in life! But its super important if youre out of work and out of health insurance coverage. Your emergency fund takes away the worry of those unpredictable trips to the doctor and routine checkups that come with out-of-pocket costs. Having a fully funded emergency fund will give you the ability to pay for insurance during a gap period without all the stress.
Do Medicaid And Chip Provide Pregnant Women With Comprehensive Health Coverage
Yes, in most but not all states. Full-scope Medicaid in every state provides comprehensive coverage, including prenatal care, labor and delivery, and any other medically necessary services.
Pregnancy-related Medicaid covers services necessary for the health of a pregnant woman and fetus, or that have become necessary as a result of the woman having been pregnant. Federal guidance from the Department of Health and Human Services clarified that the scope of covered services must be comprehensive because the womans health is intertwined with the fetus health, so it is difficult to determine which services are pregnancy-related. Federal statute requires coverage of prenatal care, delivery, postpartum care, and family planning, as well as services for conditions that may threaten carrying the fetus to full term or the fetus safe delivery. The state ultimately decides what broad set of services are covered. Forty-seven states provide pregnancy-related Medicaid that meets minimum essential coverage and thus is considered comprehensive. Pregnancy-related Medicaid in Arkansas, Idaho, and South Dakota does not meet MEC and is not comprehensive.
CHIP coverage for pregnant woman is also typically comprehensive. However, in states where services are being provided to the pregnant woman by covering the fetus, the services may not be comprehensive with respect to the health needs of the pregnant woman.
Don’t Miss: How Do I Find Out What Medicaid I Have
How Long Does Medicaid Or Chip Coverage For Pregnancy Last
Medicaid or CHIP coverage based on pregnancy lasts through the postpartum period, ending on the last day of the month in which the 60-day postpartum period ends, regardless of income changes during that time. Once the postpartum period ends, the state must evaluate the womans eligibility for any other Medicaid coverage categories.
7. Is abortion covered by Medicaid or CHIP?
The Hyde Amendment, an annual requirement added by Congress to a federal appropriations bill, prohibits using federal funds abortion coverage except when a pregnancy results from rape or incest, or when continuing the pregnancy endangers the womans life. However, states may use their own funds to cover abortions, and 17 states currently do.
Social Security Administration Services In Conway South Carolina
The services available at your local field office are fairly standard. You can perform simple services like requesting a replacement Social Security card or more complex things like applying for Social Security Disability benefits. Here are some of the services available at your local Conway, South Carolina office:
- Request a new or replacement Social Security card
- Request changes to your Social Security card
- Review your Social Security statement or earnings history
- Estimate your retirement benefits
Also Check: Florida Medicaid Primary Care Providers
What If Your Medicaid Application Is Denied
If your Medicaid application is denied, you will receive a letter explaining why, along with information on appealing your decision. It is not uncommon for people to be denied the first time they apply for Medicaid sometimes, the reason may be as simple as an error on their application paperwork. This can be resolved through an appeal, so if you’re denied, it’s always a good idea to review your denial letter to determine the reason. The denial letter includes information on appealing the decision.
Also, remember that if you’re not eligible now, you can always re-apply for Medicaid if your income status changes. Once you’re enrolled, Medicaid reviews your eligibility status annually.
Health First Colorado Buy
The Health First Colorado Buy-In Program for Working Adults with Disabilities lets adults with a disability who qualify to “buy-into” Health First Colorado . If you work and earn too much to qualify for Health First Colorado you may qualify. If you qualify, you pay a monthly premium. Your monthly premium is based on your income.
|Program Information Page
Don’t Miss: How To Get A Breast Pump Through Medicaid
Why Coordinate Medicaid And Snap Renewals
About three-quarters of SNAP households had at least one member receiving Medicaid or CHIP in 2014. To qualify for SNAP, households generally must have gross income below 130 percent of the poverty line. Medicaid eligibility varies among states and types of participant. In states that have expanded Medicaid for adults under the ACA, the minimum eligibility threshold is 138 percent of the poverty line. In most states that havent expanded Medicaid, adults without children arent eligible at all and parents are eligible at lower income levels. Children in all states are eligible for either Medicaid or CHIP at income levels higher than the SNAP eligibility threshold.
Similarities also exist between SNAPs and Medicaids processes for applying and determining eligibility. Households newly applying for Medicaid and/or SNAP must submit an application with information on who is in the household, their citizenship and immigration status, and what income they receive. State or county eligibility workers verify that information using available data sources as well as documentation the applicant submits, such as pay stubs. After approval, participants must report certain changes in their income or household situation, and states periodically renew eligibility by examining information the participants report as well as available data sources to determine if households remain eligible.
Who Is Eligible For Both Medicare And Medicaid
To qualify for Medicare, individuals generally need to be 65 or older or have a qualifying disability. There are several levels of assistance an individual can receive as a dual eligible beneficiary. The term full dual eligible refers to individuals who are enrolled in Medicare and receive full Medicaid benefits.
Recommended Reading: Can I Get A Breast Pump Through Medicaid
Q Where Do I Go To Apply For Medicaid
A. There are several ways to apply for Medicaid and other medical assistance programs:
- On the internet, you can use ASSIST to check your eligibility for several different assistance programs by completing a self-screening questionnaire. ASSIST then allows you to apply online.
- You may also print an Application for Health Insurance/Medicaid. The application form is also available in Spanish/en Español.
- By phone, you can contact Medicaid Customer Relations at 1-800-372-2022 or 255-9500 to be directed to the Division of Social Services office closest to where you live. DSS staff members will help you find out more about eligibility for Medicaid and other assistance programs. Then the appropriate information and application forms will be mailed to you. Complete, sign and date the application form in ink and mail it to the address provided.
- For Long Term Care applications, please call the Long Term Care Medicaid Unit listed for the county where you live.
What To Do If You Don’t Qualify For Medicaid
If you don’t qualify for Medicaid, you can possibly get subsidized health care through the Obamacare marketplaces during a special enrollment or open enrollment period. Americans who making more than 100% of the FPL qualify for a premium tax credit that can significantly lower the cost of a plan.
Federal open enrollment for 2022 health care plans runs until Jan. 15, 2022, though some state exchanges are open longer. Learn 2022 open enrollments dates by state. Healthcare.gov, the federal exchange, usually opens from November 1 to December 15 each year.
If you can’t find affordable health care on your marketplace during open enrollment, you have a few back-up options.
Short-term health insurance: Originally designed to prevent short-term health insurance gaps, these plans are cheaper, but much less comprehensive than traditional coverage. They don’t have to cover Obamacare’s 10 essential benefits or pre-existing conditions. Following changes by the Trump administration, short-term health plans can last from three months to potentially three years, though som estates have stricter limits.
Limited benefit plans: These plans cover a very small portion of the costs associated with certain “medical events,” like a doctor’s visit or ambulance ride. Both the number of events and dollar amounts covered are capped.
Prescription discount cards: While these cards won’t help you pay for inpatient or outpatient care, they do help you get medication at discounted rates.
Also Check: Can I Change Medicaid Plan
Colorado Dental Health Care Program For Low
The Colorado Dental Health Care Program for Low-Income Seniors provides discounted dental health care services to individuals 60 years of age or older whose income is insufficient to meet the costs of such care.
- You must be 60 or older
- You must be at or below 250% of the Federal Poverty Level
- You must be lawfully present in Colorado
- You cannot be eligible for dental services under Health First Colorado or the Old Age Pension Health and Medical Care Program
- You cannot have private dental insurance
- Discounted dental health care services provided by participating Qualified Grantees and Providers
- Services include, but are not limited to: oral examinations, x-rays, partial and full dentures, repair of permanent teeth, removal of permanent teeth, root canals, crowns, and much more
|Program Information Page