What Is Healthy Louisiana
Healthy Louisiana is the way most of Louisiana’s Medicaid recipients receive health care services. As soon as you or family members are eligible for Medicaid, you need to choose a Healthy Louisiana Health Plan to manage your or your family members health care. If you do not choose a health plan, Healthy Louisiana will choose one for you or your family. Compare health plans to find the best plan for you. If you have questions, call Healthy Louisiana at 1-855-229-6848 .
What About The Majority Of Kids Who Will Remain Eligible For Medicaid What Can Be Done To Protect Their Coverage
Recent estimates suggest that almost half of children who lose Medicaid or CHIP re-enroll within twelve months.26 While fluctuating income can result in temporary ineligibility, a significant share of gaps in enrollment are for procedural reasons where children remain eligible but lose coverage. Some families never receive the one and only notice the state sends or are confused about what, if anything, they need to do to retain coverage. These challenges are undoubtedly worse in families for whom English is not the parents primary language and who are less able to access culturally and linguistically competent consumer assistance worsening existing health disparities.27 The gaps in coverage created by churn and administrative barriers inhibit preventive care disrupt management of chronic conditions expose families to large medical bills impact the financial stability of providers serving large numbers of Medicaid enrollees increase administrative costs for states and health plans and undermine efforts to measure the quality of care.
Taking steps to minimize procedural disenrollments, outlined in Figure 3, should be a TOP priority for state and federal policymakers. Discussion on ways states can be better prepared for this mass event follows.
Childrens 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 Childrens 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, childrens advocates and other stakeholders to improve childrens 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 childrens 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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What Documents Are Required For A Medicaid Application
Medicaid applicants must prove that they have limited income and assets in order to be eligible for long-term care services. Before beginning the application process, it is helpful to understand what information you will be required to provide to prove your eligibility.
Medicaid is a state-run program, so the rules can vary from state to state, but in general applicants are not eligible for Medicaid benefits if the applicants income exceeds $2,523 a month . Applicants can also have no more than $2,000 in assets in most states.
Local Elder Law Attorneys in Your City
City, State
States require Medicaid applicants to provide the necessary information to prove that they are eligible for benefits. The burden of proof is on the Medicaid applicantnot on the state. In addition to needing to provide identifying information such as a birth certificate and proof of citizenship, following are some of the documents that you may have to provide to the Medicaid agency when you apply for benefits:
The state may use an electronic database to verify some of the information. Intentionally giving false information is a serious offense.
The state looks back five years to determine whether you transferred assets for less than market value within five years of applying for Medicaid. Applicants who gave away assets may be subject to a period of ineligibility.
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Medicaid Coverage Has Evolved Over Time
Under the original 1965 Medicaid law, Medicaid eligibility was tied to cash assistance or federal Supplemental Security Income starting in 1972) for parents, children and the poor aged, blind and people with disabilites. States could opt to provide coverage at income levels above cash assistance. Over time, Congress expanded federal minimum requirements and provided new coverage options for states especially for children, pregnant women, and people with disabilities. Congress also required Medicaid to help pay for premiums and cost-sharing for low-income Medicare beneficiaries and allowed states to offer an option to buy-in to Medicaid for working individuals with disabilities. Other coverage milestones included severing the link between Medicaid eligibility and welfare in 1996 and enacting the Childrens Health Insurance Program in 1997 to cover low-income children above the cut-off for Medicaid with an enhanced federal match rate. Following these policy changes, for the first time states conducted outreach campaigns and simplified enrollment procedures to enroll eligible children in both Medicaid and CHIP. Expansions in Medicaid coverage of children marked the beginning of later reforms that recast Medicaid as an income-based health coverage program.
Figure 3: Medicaid has evolved over time to meet changing needs.
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Apply For Medicaid Coverage Even If Your State Hasnt Expanded
Even if your state hasn’t expanded Medicaid and it looks like your income is below the level to qualify for financial help with a Marketplace plan, you should fill out a Marketplace application.
Each state has coverage options that could work for you particularly if you have children, are pregnant, or have a disability. And when you provide more detailed income information you may fall into the range to save.
New York State Medicaid
New York’s Medicaid program provides comprehensive health coverage to more than 7.3 million lower-income New Yorkers Medicaid pays for a wide-range of services, depending on your age, financial circumstances, family situation, or living arrangements. These services are provided through a large network of health care providers that you can access directly using your Medicaid card or through your managed care plan if you are enrolled in managed care. Some services may have small co-payments, which can be waived if you cannot afford them.
Use the link below to see which health insurance options are available to you, including if your income qualifies you for NYS Medicaid.
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Can I Get Medicaid And Medicare At The Same Time
You may in some situations. Medicare is a health insurance program for:
- People ages 65 and older
- People younger than age 65 who are disabled
- People with end-stage kidney disease
With Medicare, you have to pay monthly premiums and other costs, such as copays and deductibles, when you go for medical care. If you are on Medicare and have a limited income, you may qualify for help from Medicaid to pay the costs of Medicare. If you have both Medicaid and Medicare, you may hear people refer to you as being dually eligible.
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?
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About Medicaid For Adults
Medicaid offers healthcare coverage for adults that address a variety of health needs, including coverage for low-income adults, pregnant women, the elderly, and people with disabilities who meet certain income criteria.
- Women diagnosed with breast or cervical cancer through Women’s Health Check.
- People aged 65 or older who meet income requirements
- People who are blind or disabled
- Medicare Savings Program
- Basic Plan This plan provides health, prevention, and wellness benefits for adults who do not have special health needs. This plan includes annual physicals, immunizations, most prescriptions, doctor and hospital visits, and more.
- Enhanced Plan This plan is for individuals with disabilities or special health needs. This plan has all the benefits of the Basic Plan, plus additional benefits. Most of the time, individuals will need to be referred by a doctor to become eligible for the enhanced plan.
- Medicare-Medicaid Coordinated Plan Designed for people who are eligible and enrolled in both Medicare and Medicaid, . This plan has all the benefits of the Enhanced Plan, plus allows people to enroll in a managed care plan to help coordinate Medicare and Medicaid benefits. There are many advantages to enrolling in managed care, one of the most valuable is access to a care coordinator who helps people with complex medical conditions to achieve better health.
Steps to sign up for the PHA program
Medicaid Home Health Care And Residential Senior Care Coverage
Medicaid programs may also cover a variety of different Home- and Community-Based Services to help people stay living at home and active in the community. The level of support provided is typically based on the needs of the individual.
Examples of the types of home health care and residential senior care services provided as part of HBCS programs include:
- Personal care like showering
- Occupational, speech and physical therapy
- Managing diet and nutrition
- Home-delivered meals
- Home chores and housekeeping
Some HCBS services like skilled nursing care and occupational, physical or speech therapy are delivered by qualified and, in some cases, licensed professionals. Other services, such as doing chores around the house and making meals, can be provided by family members, friends or paid caregivers.
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How Can I Find A Provider Who Accepts Medicaid
Regardless of the state you live in, you can easily find doctors who accept Medicaid. Once you successfully enroll in this program, you can begin your research online. In fact, you can use the federal Physician Care search feature to begin looking. This tool is managed by the Center for Medicare and Medicaid Services. You can use this Medicaid find a provider database to locate professionals no matter where you live. However, if you reside near the border of another state, make sure you only use your benefits in the state where they were issued. Even though Medicaid is partially funded by the federal government, these benefits are also managed on the state level. This means that the benefits are not transferable across state lines.
If you do not have access to a reliable internet connection, you may wonder how to find Medicaid doctors in your city. Fortunately, your local program representatives may be able to help you. Usually your Medicaid office will offer a list of providers and clinics near you that accept benefits. Contact your office by phone or in person to learn more about doctors near you.
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What If I Am Not A U S Citizen
To be eligible for Medicaid in Louisiana, you must be resident of Louisiana and either U.S. citizen or a non-citizen who is lawfully present in the U.S. Non-citizens can qualify for coverage for emergencies and labor and delivery services if income requirements are met.Medicaid and LaCHIP coverage may be available to children up to age 19 who are lawfully residing and are otherwise eligible.
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How Does Medicaid Work
The Medicaid program does not provide health care services for everyone. Your application will be reviewed for all Medicaid programs. If you are found eligible for Medicaid, you will get:
- A letter in the mail from Medicaid telling you about your coverage
- A Medicaid ID card
- A Healthy Louisiana plan ID card, if you enroll in a plan.
Each time you go to your health care provider or pharmacy, take your Medicaid ID and Healthy LA plan ID cards with you. Show them at all medical visits before you receive any service. The health care provider or pharmacy will tell you if they accept your Medicaid benefits. You should also ask your health care provider or pharmacy if the service or prescription is covered by Medicaid before receiving the service or filling a prescription.
Medicaid does not pay money to you instead, it sends payments directly to your health care provider or pharmacy.
Im Single And Just Lost My Job Is Medicaid For Me
Maybe. Medicaid eligibility is based on where you live, how much money you make each year and the number of people in your household.
Its worth applying even if you dont think you qualify. Whether you have children, are pregnant or have a disability are all taken into consideration. You can check to see whats offered in your state through the Aetna Better Health website.
Do I qualify for Medicaid?
Those who earn less than a certain amount can qualify for Medicaid.
Depending on the state where you live, you can be covered if your income is below these ranges:
$16,970-$25,520 for a household of one
$22,929-$34,480 for a household of two
$28,887-$43,440 for a household of three
$34,846-$52,400 for a household of four
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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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Can I Get Medicaid
States have different rules to decide whos eligible for Medicaid. You may be eligible if:
Youre disabled. Your state may let you use Medicaid no matter how much money you make in a year. In other states, a disabled person may only qualify for Medicaid when their income falls below a cutoff level.
You already get Supplemental Security Income . In the majority of states, SSI eligibility automatically qualifies you for Medicaid unless your state uses more strict criteria. Those states are commonly called 209 states.
You dont make much money during a year. The rules are different in each state.
Check with your states Medicaid office to get the exact income requirements. You can also find out if you qualify by going online at www.healthcare.gov.
Some states have expanded their Medicaid program to allow more people to qualify. In those states, the income rules have loosened for adults without children. Other states have chosen not to expand Medicaid.
If your state has expanded Medicaid under the Affordable Care Act:
Youre eligible if:
- Youre single, dont have children, and make less than $17,609 a year.
- You have a family of three and make less than $29,974 a year.
If your state has NOT expanded Medicaid:
In Alaska and Hawaii, youâre able to make a slightly higher income than in other states and still qualify. Your state Medicaid office can help you with the specific income limits based on how many people are in your family.
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How To Get Your First Red White And Blue Medicare Card
Receiving your first Medicare card is easyenroll in Medicare and your card will be sent in the mail.1 If you still need to enroll, follow these tips to .
Other scenarios to consider:2
- If you qualify for Medicare through age, youll receive your Medicare card in the mail 3 months before your 65th birthday.
- If you qualify for Medicare through disability, youll receive your card in the mail 3 months before your 25th month of getting disability benefits.
- If you qualify for Medicare through ALS , you can get your Medicare card the same month your disability benefits begin.
Cms Learning Lab: Improving Oral Health Through Access
The Center for Medicaid and CHIP Services at the Centers for Medicare & Medicaid Services is hosting a series of webinars to support States and their collaborative partners to improve access to dental services for children enrolled in Medicaid and CHIP. The webinar materials are available below. For more information about the CMS Oral Health Initiative and the CMS Learning Lab webinars, see the .
Reducing Early Childhood Tooth Decay: Approaches in Medicaid May 27, 2015
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