What Benefits Do You Get With Medicaid

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Q How Much Income Can I Receive And Still Be Eligible For Medicaid

Medicaid Benefits

A. Income is money that you get from working, or money that someone gives you, or checks that you receive, such as a Social Security check, unemployment benefits, child support, retirement benefits, or sick pay. Whether your income level qualifies you or your family for Medicaid depends on the size of your family and the Medicaid program for which you are applying.

Income limits are set each year by the federal government to define the Federal Poverty Level for different family sizes. In general, if your household income is at or below the current 100% Federal Poverty Level for your household size, your family is likely to be eligible for Medicaid. Children from age 1 to under age 6 can qualify for Medicaid benefits when household income is at or below 133% of the Federal Poverty Level. Pregnant women and infants under age 1 qualify for Medicaid with family income at or below the 200% Federal Poverty Level, and pregnant women count as 2 family members.

See our tables of income limits for applying for DMMA programs to find out where your family income is, in relation to these income benchmarks.

Medical assistance programs other than Medicaid have different income level requirements. For example, uninsured children under age 19 who live in families with incomes at or below the 200% Federal Poverty Level are eligible for low cost health insurance under the Delaware Healthy Children Program.

What Care Services Are Covered By Medicaid

Each state decides the full range of benefits that it covers under Medicaid. Federal law requires that states must provide certain benefits, which are called mandatory benefits. States may also choose to offer other benefits and services by Medicaid. These are called optional benefits. The chart below shows what are mandatory benefits and what are optional Medicaid benefits.

Mandatory Medicaid benefits

Early and periodic screening, diagnostic and treatment services

Physical therapy

Occupational therapy

Home health services

Speech, hearing and language disorder services

Physician services

Other diagnostic, screening, preventive and rehabilitative services

Federally qualified health center services

Podiatry services

Certified pediatric and family nurse practitioner services

Prosthetics

Freestanding birth center services

Eyeglasses

Tobacco cessation counseling for pregnant women

Other practitioner services

Services for individuals age 65 or older in an institution for mental disease

Services in an intermediate care facility for Individuals with intellectual disability

Self-directed personal assistance services

Inpatient psychiatric services for individuals under age 21

Other services approved by the Secretary of Health and Human Services

Health homes for enrollees with chronic conditions

Q Who Qualifies For Medicaid

A. Citizenship and Residency – To obtain full Medicaid benefits in Delaware, you must be a Delaware resident and either a U.S. citizen or a legally residing noncitizen. Full coverage for noncitizens which include DACA recipients is dependent on the availability of state funding. However, noncitizens can qualify for coverage for emergencies and labor & delivery services if income requirements are met.

Income Level – Qualifying for Medicaid is also based on need. Household income must be under certain limits as defined by the Federal Poverty Level and is based on family size. For Long Term Care programs, financial resources must also be under a certain amount. There are also specific programs for individuals who meet certain medical or disability tests, or who qualify due to age or pregnancy. To find out more about different Medicaid and other medical assistance programs, visit DMMA Programs & Services.

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Dental Benefits For Adults In Medicaid

States have flexibility to determine what dental benefits are provided to adult Medicaid enrollees. While most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental care. There are no minimum requirements for adult dental coverage.

Can You Get Social Security And Not Sign Up For Medicare

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Yes, many people receive Social Security without signing up for Medicare.

Most people arent eligible for Medicare until they turn 65. As you can start collecting Social Security retirement benefits at 62, individuals may have Social Security without Medicare for several years.

Most people enroll in Part B once they turn 65, but you may decide to delay enrolling in Part B if you or your spouse has health insurance through an employer. Be sure to learn more about how Medicare enrollment works in your specific case, though. If you delay enrollment in Medicare Part B when youre first eligible and you dont have other creditable coverage, you could face late enrollment penalties for the rest of the time that you have Part B once you sign up.

As most people dont pay a premium for Part A, theres no reason to cancel the coverage, even if you dont think you need it. You are free to decline other Medicare plans, such as Parts B and D, though again you should make sure you wont cause yourself to go without coverage or have to pay late enrollment penalties in the future.

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Q How Do I Join A Managed Care Organization

A. After being notified that you are eligible for Medicaid , you will receive in the mail a packet of information about the different MCO plan options for receiving your Medicaid benefits. You may choose any plan described in this mailing. You probably want to choose a Managed Care Organization to which your doctor belongs. If you need help making this decision, call the Health Benefit Manager at the phone number in the mailing.

How Did The Affordable Care Act Change Medicaid

Medicaid plays an even more important role in insuring low-income Americans due to the Affordable Care Act. As noted, the ACA provides coverage for poor and low-income adults by expanding eligibility for Medicaid to 138 percent of the poverty line. As of April 2020, 35 states plus the District of Columbia have implemented the Medicaid expansion to serve poor and low-income adults. By 2029, 14 million more low-income adults will have enrolled in Medicaid and gained access to affordable comprehensive health coverage due to the ACA, CBO estimates.

The expansion is a very good financial deal for states. After picking up all expansion costs for the first three years, the federal government now pays 90 percent of expansion costs on a permanent basis. And by greatly reducing the number of uninsured, the expansion will save states and localities substantial sums on uncompensated care for the uninsured. Some expansion states have also experienced savings in mental health programs, criminal justice systems, and other budget areas.

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How Does Automatic Enrolling In Medicare Work

Most people who collect Social Security benefits automatically receive Original Medicare coverage once they’re eligible.

If you receive benefits through the Railroad Retirement Board , youll receive the same Medicare coverage.

Youll become eligible for Medicare when one of the following events occur:

  • You turn 65
  • You have end-stage renal disease
  • You have Lou Gehrig’s Disease, amyotrophic lateral sclerosis
  • You have been on Social Security disability insurance for 24 months and have a qualifying condition. These include heart and lung issues, neurological disorders, cancer, kidney dysfunction and other severe health problems.

If you live in Puerto Rico and receive Social Security or RRB benefits, youll only become automatically enrolled in Medicare Part A. If you want Medicare Part B, youll need to apply for coverage.

Those receiving Social Security benefits who also qualify for both Medicare and Medicaid will also be awarded Medicare Part D prescription drug coverage automatically. If you don’t qualify for Medicare and Medicaid, you’ll need to compare Part D prescription drug plans or Medicare Advantage plans that include Part D coverage and enroll in a plan available where you live.

What Happens If You Dont Sign Up For Medicare

If I get Social Security disability benefits, will I get Medicaid?

Its always your choice whether you sign up for Medicare, but you should understand the consequences of not signing up for this health insurance, including:

  • Youll pay the full amount for all medical care unless you have private health insurance
  • You may face delays getting Medicare coverage in future
  • Youll face penalties if you change your mind and sign up for Medicare later

Automatic enrollment for Social Security beneficiaries makes getting Medicare easy. While you always have a choice about which Medicare plans you keep, consider their benefits now and in the future before making any decisions about your insurance-based coverage.

Zia Sherrell is a digital health journalist with over a decade of healthcare experience, a bachelors degree in science from the University of Leeds and a masters degree in public health from the University of Manchester. Her work has appeared in Netdoctor, Medical News Today, Healthline, Business Insider, Cosmopolitan, Yahoo, Harper’s Bazaar, Men’s Health and more.

When shes not typing madly, Zia enjoys traveling and chasing after her dogs.

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Understanding Different Medicaid Programs

Critical to understanding Medicaid, is understanding the difference between institutional Medicaid and Home and Community Based Services . Institutional Medicaid is provided in nursing homes. Home and Community Based Services, as implied by the name, are Medicaid services provided to individuals living at home or in the community. The phrase in the community includes adult foster care homes / adult family homes, adult day care, and assisted living residences, including assisted living specifically designed for persons with dementia called Memory Care or Alzheimers Care. HCBS are meant to prevent people living with dementia from premature nursing home admission due to the progression of the disease. As a side note, many states have their own names for their Medicaid program. For example, in California it is called Medi-Cal, in Massachusetts, MassHealth, and in Washington State, Apple Health.

Institutional Medicaid Institutional Medicaid, also called nursing home Medicaid, is an entitlement in all 50 U.S. states and the District of Columbia. This means, should the individual be eligible for Medicaid, the state must pay for their nursing home care.

Did You Know?

Health Coverage For People With Disabilities

If you have a disability, you have three options for health coverage through the government.

  • Medicaid provides free or low-cost medical benefits to people with disabilities. Learn about eligibility and how to apply.

  • Medicare provides medical health insurance to people under 65 with certain disabilities and any age with end-stage renal disease . Learn about eligibility, how to apply and coverage.

  • Affordable Care Act Marketplace offers options to people who have a disability, dont qualify for disability benefits, and need health coverage. Learn about the .

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Medicare For Ssi Recipients

Do you get Medicare coverage if you were approved for SSI? Claimants who are approved for SSI only typically receive Medicaid coverage in most states. And like SSI, Medicaid is subject to income and asset limitations. Medicaid is a needs-based, state- and county-administered program that provides for a number of doctor visits and prescriptions each month, as well as nursing home care under certain conditions.Can you ever get Medicare if you get SSI? Medicare coverage for SSI recipients does not occur until an individual reaches the age of 65 if they were only entitled to receive monthly SSI disability benefits. At the age of 65, these individuals are able to file an “uninsured Medicare claim,” which saves the state they reside in the cost of Medicaid coverage. Basically, the state pays the medical premiums for an uninsured individual to be in Medicare so that their costs in health coverage provided through Medicaid goes down.

For people with limited income and assets, Medicare offers “Extra Help” for prescription drug costs. This Extra Help covers the costs of a Medicare prescription drug plan — including monthly premiums and prescription co-pays. The application is online at www.socialsecurity.gov/prescriptionhelp. For more information, see Nolo’s article on the Extra Help subsidy.

What Medicaid Does Not Cover

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Although Medicaid will pay for some services that arent covered by Medicare, the program does have some coverage exclusions. Most items that arent covered fall into one of four categories:

  • The services are unreasonable or medically unnecessary
  • Charges were improperly bundled or billed through another allowance
  • Providers were reimbursed through another program
  • The particular service or test isnt covered

Medicaid wont pay for medical care provided outside of the United States, except in certain travel-related situations or when a foreign hospital is closer than domestic alternatives. Additionally, Medicaid will not pay for:

  • Durable medical equipment replaced through a warranty
  • Health care services provided by another government agency
  • Free health screenings or devices that are given away
  • Cosmetic surgery and any resulting complications
  • Personal comfort items, such as TVs and beautician services

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Is It Worth To Get Married

Research has shown that the “marriage benefits”the increases in health, wealth, and happiness that are often associated with the statusgo disproportionately to men. Married men are better off than single men. Moreover, women in marriages, but not in other relationships, reported lower levels of satisfaction.

Children’s Oral Health Initiative

The Centers for Medicare & Medicaid Services is committed to improving access to dental and oral health services for children enrolled in Medicaid and CHIP. We have been making considerable progress in our efforts to ensure that low-income children have access to oral health care. From 2007 to 2011, almost half of all states achieved at least a ten percentage point increase in the proportion of children enrolled in Medicaid and CHIP that received a preventive dental service during the reporting year. Yet, tooth decay remains one of the most common chronic childhood diseases.

To support continued progress, in 2010 CMS launched the Children’s Oral Health Initiative and set goals for improvement by FFY 2015. To achieve those goals, we have adopted a national oral health strategy through which we are working diligently with states and federal partners, as well as the dental provider community, children’s advocates and other stakeholders to improve children’s access to dental care.

To support state Medicaid and CHIP programs in achieving their improvement goals, we developed Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents . It provides an overview of the children’s dental benefit in Medicaid, support for evidence-based policies at the state level, and details of successful strategies with state examples.

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Texas Medicaid Wellness Program

The Texas Medicaid Wellness Program is a special health program for people who get Medicaid and have long-lasting or serious health conditions. These conditions can include asthma, diabetes, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease , and others.

People in this program can get help any time of day or night with:

  • Getting an answer to a health question.
  • Finding a main doctor.
  • Managing their health between doctor visits.
  • Learning more about their health conditions.
  • Knowing how to take their medicines.
  • Picking the best medical care for their health.

Learn more about the Wellness Program.

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3 Benefits For Disability Recipients Eligible For Medicaid & Medicare

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Medicaid Covers A Broad Range Of Health And Long

Medicaid covers a broad range of services to address the diverse needs of the populations it serves . In addition to covering the services required by federal Medicaid law, many states elect to cover optional services such as prescription drugs, physical therapy, eyeglasses, and dental care. Coverage for Medicaid expansion adults contains the ACAs ten essential health benefits which include preventive services and expanded mental health and substance use treatment services. Medicaid plays an important role in addressing the opioid epidemic and more broadly in connecting Medicaid beneficiaries to behavioral health services. Medicaid provides comprehensive benefits for children, known as Early Periodic Screening Diagnosis and Treatment services. EPSDT is especially important for children with disabilities because private insurance is often inadequate to meet their needs. Unlike commercial health insurance and Medicare, Medicaid also covers long-term care including both nursing home care and many home and community-based long-term services and supports. More than half of all Medicaid spending for long-term care is now for services provided in the home or community that enable seniors and people with disabilities to live independently rather than in institutions.

Figure 5: Medicaids benefits reflect the needs of the population it serves.

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