What Is Covered During Presumptive Eligibility
Your temporary coverage will depend upon your situation:
- If you qualify as a parent/caretaker, infant, child, or former foster child, you will be eligible for all services covered under Hoosier Healthwise Package A. If you would like more information about the services covered, you should refer to what is covered by Hoosier Healthwise.
- If you qualify as a pregnant woman, you will be eligible for doctor visits, tests, lab work and other care for your pregnancy through fee for service. You will also have coverage for prescription drugs, and transportation services to doctor appointments. This will not cover labor and delivery costs.
- If you qualify for family planning coverage, you will only be eligible for services covered by the family planning eligibility program. These services include family planning visits, laboratory tests, pap smears, condoms and birth control. If you would like more information about the services covered, you should refer to the family planning eligibility program.
- If you qualify for PE Adults, you will be eligible for services covered under the HIP Basic Plan. You will be required to pay copays for all services. If you’d like to learn more about the services covered under HIP Basic, you should refer to the Healthy Indiana Plan website.
How To Apply For Medicaid
If you are 18 or older, you can apply for Medicaid through your local Home and Community Services office or online.
There are three main parts to the application process:
How To Apply For Medicaid In Pennsylvania
Several methods exist for applying for coverage in Pennsylvania. Many people use the online option as a quick way to fill out the application and get approval or denial notifications fast. The COMPASS website offers an easy-to-use application form. Applicants may also call 1-866-550-4355 to apply by telephone, visit their local county office, or download the forms and send them to their local office.
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Income Requirements For Pennsylvania Medicaid
Household size, the total of outgoing bills, and eligibility requirements help determine the income requirements for each family applying for Medicaid in Pennsylvania. The amount varies for everyone based on these details. Single adults between the ages of 19 and 64 must have an income that falls below 133% of the federal poverty guidelines to be eligible. A maximum income of $15,800 per year, or roughly $1,317 per month, is designated to an individual.
Why Should I Submit A Medicaid Application
Approval for PE is NOT the same as being approved for ongoing health coverage. Your PE coverage is only temporary while you submit an Indiana application for health coverage and your application is pending. Your PE will be discontinued if you do not apply for coverage by the last day of the month following the month your PE was established.
It is very important that you respond promptly to all requests from the state following your application. If you do not apply and respond, you will not be eligible for coverage, and you will be responsible for paying all of your labor and delivery costs.
For pregnant women many health care services are not covered under Presumptive Eligibility for Pregnant Women. If you do not begin the application process for full coverage , you will lose your PEPW and be responsible for the cost of the care when you are admitted to the hospital, including labor and delivery, and any services that are not for your pregnancy or for the health of your baby. The costs of your continuing prenatal care, as well as labor and delivery, will only be covered if your application is submitted and approved. For your health and the health of your baby, take the next step and complete the Indiana application for health coverage right away.
The same doctor’s office or clinic that helped you with your PE determination can help in filling out and submitting your application.
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Full Retirement Age By Year
Full retirement age is the age you begin to receive full Social Security benefits. If you start to draw your Social Security benefits before reaching your full retirement age, the payment you receive will be less.
An easy way to think about full benefits and retirement age is this,
- Social Security will reduce your payments if you choose to receive your benefit before full retirement age. The percentage of reduced amount is highest at age 62 and decreases until you reach full retirement age.
- If you choose to receive Social Security payments when you reach full retirement, you will get the total amount.
- Suppose you choose not to receive Social Security payments when you reach full retirement and delay your benefit. In that case, you can increase the amount of your payment by earning delayed retirement credits.
If youre not sure when you reach full retirement age, our table provides the years and months you need to know for full retirement.
Cost And Coverage Of Medicaid In Pennsylvania
Low-income families may not be able to afford regular health care coverage. Medicaid combats that problem, giving those who cannot pay an opportunity to receive medical care and be seen by a regular physician. The state takes on the expenses so the people do not have to pay anything. Adults who are capable of working and paying at least a portion of the costs may have a set copay amount for emergency room visits, clinic appointments, and also for prescriptions, usually around $3 each. People who receive general assistance may have a higher payment, up to $6.
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How To File For Medicaid If You Lose Your Job
Medicaid is the most affordable option for people who have lost their health care coverage due to a job loss. But you must meet stringent eligibility requirements.
You cant earn more than 138% of the federal poverty level to be eligible for Medicaid. You also must live in one of the 37 states that have elected the Medicaid expansion through the Affordable Care Act. If you qualify, you get free Medicaid coverage with no premiums or deductibles.
Applying for Medicaid should be your first option after you lose your job, said Karen Politz, a senior fellow at the Kaiser Family Foundation, a nonprofit that focuses on national health issues. Medicaid is also a good option for those who didnt have employer-sponsored insurance before.
Some people are still worried that Medicaid is for really poor people. Theres a stigma, Politz said. But it really is for everybody. Its for people who fall on hard times and arent earning any income for now.
Q How Will I Receive My Medical Care
A. In Delaware, Medicaid benefits are provided mainly through a managed care organization, or MCO, under contract with the state. Managed care is an organized way to ensure that people receive the quality medical care they need in the most cost-effective manner. Some Medicaid recipients in Delaware those who also receive Medicare and those in Long Term Care Medicaid programs such as the Nursing Facility program do not receive their medical care through a managed care organization.
DMMA provides a choice of managed care organizations so you can select the MCO plan that is best for you and your family. Delaware contracts with two managed care plans AmeriHealth Caritas and Highmark Health Options.
The Medicaid MCO provides almost all of the care for Medicaid members who join their plan. Prescription and non-emergency medical transportation services are covered directly by Medicaid, not through the MCO. Medicaid recipients need to show their Medicaid card to pharmacies and transportation providers when receiving these services.
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Medicaid Is The Nations Public Health Insurance Program For People With Low Income
Medicaid is the nations public health insurance program for people with low income. The Medicaid program covers 1 in 5 Americans, including many with complex and costly needs for care. The program is the principal source of long-term care coverage for Americans. The vast majority of Medicaid enrollees lack access to other affordable health insurance. Medicaid covers a broad array of health services and limits enrollee out-of-pocket costs. Medicaid finances nearly a fifth of all personal health care spending in the U.S., providing significant financing for hospitals, community health centers, physicians, nursing homes, and jobs in the health care sector. Title XIX of the Social Security Act and a large body of federal regulations govern the program, defining federal Medicaid requirements and state options and authorities. The Centers for Medicare and Medicaid Services within the Department of Health and Human Services is responsible for implementing Medicaid .
Figure 1: Medicaid plays a central role in our health care system.
Are There Special Medicaid Programs For Women
Yes, if you have been diagnosed with breast or cervical cancer through a state screening program and you have a low income. You can get medical treatment through your state’s Breast and Cervical Cancer Prevention and Treatment Program.
Most states will cover pregnant women and may allow you to get Medicaid, even if you have a higher income than what is required to be eligible for the program.
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How Much Does Medicaid Cost In Pennsylvania
The federal government, partnered with the state of Pennsylvania, spends a total of more than $27 billion per year on Medicaid costs. Thirty-seven percent of the states budget is allocated to these funds. Plans to expand the program are in the works, meaning even more people will get access to some of the funds for medical coverage.
Medicaid Is Structured As A Federal
Subject to federal standards, states administer Medicaid programs and have flexibility to determine covered populations, covered services, health care delivery models, and methods for paying physicians and hospitals. States can also obtain Section 1115 waivers to test and implement approaches that differ from what is required by federal statute but that the Secretary of HHS determines advance program objectives. Because of this flexibility, there is significant variation across state Medicaid programs.
The Medicaid entitlement is based on two guarantees: first, all Americans who meet Medicaid eligibility requirements are guaranteed coverage, and second, states are guaranteed federal matching dollars without a cap for qualified services provided to eligible enrollees. The match rate for most Medicaid enrollees is determined by a formula in the law that provides a match of at least 50% and provides a higher federal match rate for poorer states .
Figure 2: The basic foundations of Medicaid are related to the entitlement and the federal-state partnership.
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What Is The Medicaid Program
Good health is important to everyone. If you can’t afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy and stay healthy.
Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you instead, it sends payments directly to your health care providers. Depending on your state’s rules, you may also be asked to pay a small part of the cost for some medical services. In general, you should apply for Medicaid if you have limited income and resources. You must match one of the descriptions below:
I Have Pe But What’s Next
Approval for PE is NOT the same as being approved for Medicaid or the Healthy Indiana Plan. Your PE coverage is only temporary while you submit a full application and your application is pending. Your PE will end if you do not apply for coverage by end of the next month.
It is very important that you respond promptly to all requests regarding your application. If you do not respond to our questions and requests for documentation, your application will not be processed. You will not be eligible for coverage under the Medicaid program or Healthy Indiana Plan, and you will be responsible for paying all of your health care costs after your PE period has ended.
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Social Security Work Incentives
Dont let concerns about SSI benefits stop you from encouraging your child to find an employment setting that is right for them. Parents of youth with disabilities are very aware of the importance of healthcare for their children. Many have heard that SSI recipients will lose their Medicaid coverage if they earn any money. As a result, some families discourage their young adults from joining the workforce. This is not true. Be aware that the Social Security Administration has Work Incentive programs that allow young adults with disabilities to continue to receive Medicaid coverage while they explore careers or attend postsecondary education or job training.
Make an informed choice. If your son or daughter receives SSI, contact a Work Incentives Planning and Assistance Project in your state to see how they can continue to receive health coverage through Medicaid while they work. WIPA projects are community-based organizations that receive grants from SSA to provide all Social Security and Supplemental Security Income disability beneficiaries with free work incentives planning and assistance.
WIPA services are available in every state, the District of Columbia, and the U.S. Territories of American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands. Call 1-866-968-7842 or 1-866-833-2967 for locations WIPA organizations or see the online SSA service provider directory.
Medicaid Facilitates Access To Care
A large body of research shows that Medicaid beneficiaries have far better access to care than the uninsured and are less likely to postpone or go without needed care due to cost. Moreover, rates of access to care and satisfaction with care among Medicaid enrollees are comparable to rates for people with private insurance . Medicaid coverage of low-income pregnant women and children has contributed to dramatic in the U.S. A growing body of research indicates that Medicaid eligibility during childhood is associated with reduced teen mortality, improved long-run educational attainment, reduced disability, and lower rates of hospitalization and emergency department visits in later life. Benefits also include second-order fiscal effects such as increased tax collections due to higher earnings in adulthood. Research findings show that state Medicaid expansions to adults are associated with increased access to care, improved self-reported health, and reduced mortality among adults.
Figure 7: Nationally, Medicaid is comparable to private insurance for access to care the uninsured fare far less well.
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How Soon Can I Get Medicaid
In order to be eligible for Medicaid benefits a nursing home resident may have no more than $2,000 in “countable” assets . Note that Medicaid is a state-run program, so the rules are somewhat different in each state, although there are federal guidelines that the states must follow.
The spouse of a nursing home resident — called the “community spouse” — is limited to one-half of the couple’s joint assets up to $117,240 in “countable” assets. This figure changes each year to reflect inflation. Called the “community spouse resource allowance,” this is the most that a state may allow a community spouse to retain without a hearing or a court order. The least that a state may allow a community spouse to retain is $23,448 .
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Example: If a couple has $100,000 in countable assets on the date the applicant enters a nursing home, he or she will be eligible for Medicaid once the couple’s assets have been reduced to a combined figure of $52,000 — $2,000 for the applicant and $50,000 for the community spouse.
Some states, however, are more generous toward the community spouse. In these states, the community spouse may keep up to $117,240 , regardless of whether or not this represents half the couple’s assets. For example, if the couple had $100,000 in countable assets, the community spouse could keep the entire amount, instead of being limited to half.
For more information about Medicaids rules .
What Does Medicaid Cover
In each state, Medicaid must cover:
- Birth control medicine and devices
- Care at rural and federally qualified health clinics
- Care at many childbirth centers
- Care from a pediatrician or family nurse practitioner
- Early Periodic Screening, Diagnostic, and Treatment Services , which includes an array of services for children and adolescents
- Nurse midwife care during pregnancy and childbirth
- Preventive care and immunizations for children under age 21
- Quit-smoking programs
- Transportation to medical care
Many states offer more care, such as checkups and cancer screening tests for adults, physical therapy, and occupational therapy.
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Medicaid For Pregnant Women & Chip Perinatal
Pregnant women might be able to get free health coverage during their pregnancy through Medicaid for Pregnant Women or the CHIP Perinatal program.
Medicaid provides health coverage to low-income pregnant women during pregnancy and up to two months after the birth of the baby.
CHIP Perinatal provides similar coverage for women who can’t get Medicaid and don’t have health insurance.
To get Medicaid for Pregnant Women or CHIP Perinatal, you must be a Texas resident. You must be a U.S. citizen or qualified non-citizen to get Medicaid for Pregnant Women.
If you have other health insurance, you are not eligible for the CHIP Perinatal program.
When you apply, we’ll ask about your family’s monthly income to see if you can get Medicaid or CHIP Perinatal.
