If I Lose My Job Or Find A New Job Will I Lose My Medicaid Coverage How About My Family Members
No. Unlike employer-sponsored plans, Medicaid is not tied to your job. Youll still have it even if you lose your job because of COVID-19 or for any other reason. If you find a job, your new financial situation will determine whether you qualify for Medicaid. Your eligibility is based on income, age, residency, citizenship, ability, pregnancy, family size and the role you play in your household.
What Services Does Medicaid Cover
Medicaid covers more than 60 percent of all nursing home residents and roughly 50 percent of costs for long-term care services and supports.
Federal rules require state Medicaid programs to cover certain mandatory services, such as hospital and physician care, laboratory and X-ray services, home health services, and nursing facility services for adults. States are also required to provide a more comprehensive set of services, known as the Early and Periodic Screening, Diagnostic, and Treatment benefit, for children under age 21.
States can and all do cover certain additional services as well. All states cover prescription drugs, and most cover other common optional benefits include dental care, vision services, hearing aids, and personal care services for frail seniors and people with disabilities. These services, though considered optional because states are not required to provide them, are critical to meeting the health needs of Medicaid beneficiaries.
About three-quarters of all Medicaid spending on services pays for acute-care services such as hospital care, physician services, and prescription drugs the rest pays for nursing home and other long-term care services and supports. Medicaid covers more than 60 percent of all nursing home residents and roughly 50 percent of costs for long-term care services and supports.
How Much Does Medicaid Cost? How Is It Financed?
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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Learn About Medicaid Asset Limits And Eligibility Requirements
Although Medicaid is federally funded, it is administered at the state level, and each state has its own set of rules and regulations for this program. The income and asset levels allowed differ from one state to another, so be sure to find out where your balance sheet falls in relation to the threshold.
If you are single, you generally cannot have more than $2,000 worth of cash or other assets outside of your residence, vehicle, and other necessary items unless your state has a higher limit.
If you are married and your spouse is still able to live independently, they are allowed to retain 50% of your joint assets up to a threshold of $130,380 as of January 2021. Your single or joint income usually cannot exceed 138% of the federal poverty level, although several states have thresholds above this amount.
In nearly all cases, you will also have to prove via medical documents that you are disabled. However, certain exceptions apply . You must also be either a U.S. citizen or have a green card and prove your residency within the state.
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How Do I Apply For Medicaid
You can apply for Medicaid in any one of the following ways:
- Write, phone, or go to your local department of social services.
- In New York City, contact the Human Resources Administration by calling 557-1399.
- Pregnant individuals and children can apply at many clinics, hospitals, and provider offices. Call your local department of social services to find out where you can apply.
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Get Important News & Updates
Sign up for email and/or text notices of Medicaid and other FSSA news, reminders, and other important information. When registering your email, check the category on the drop-down list to receive notices of Medicaid updates check other areas of interest on the drop-down list to receive notices for other types of FSSA updates.
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Who Can Get Medicaid
- No matter your state, you may qualify for Medicaid based on your income, household size, disability, family status, and other factors. But if your state has expanded Medicaid coverage, you can qualify based on your income alone.
- Enter your household size and state. We’ll tell you who is eligible for Medicaid, if your state expanded and if you qualify for Medicaid based only on your income.
- If you think you have Medicaid eligibility, you can create an account and fill out a Marketplace application. If it looks like anyone in your household qualifies for Medicaid or CHIP, we’ll send your information to your state agency. They’ll contact you about enrollment. You can apply any time of year.
- If you don’t qualify for Medicaid, we’ll tell you if you qualify for financial help to buy a Marketplace health plan instead.
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Medicaid Covers 1 In 5 Americans And Serves Diverse Populations
Medicaid provides health and long-term care for millions of Americas poorest and most vulnerable people, acting as a high risk pool for the private insurance market. In FY 2017, Medicaid covered over 75 million low-income Americans. As of February 2019, 37 states have adopted the Medicaid expansion. Data as of FY 2017 show that 12.6 million were newly eligible in the expansion group. Children account for more than four in ten of all Medicaid enrollees, and the elderly and people with disabilities account for about one in four enrollees.
Medicaid plays an especially critical role for certain populations covering: nearly half of all births in the typical state 83% of poor children 48% of children with special health care needs and 45% of nonelderly adults with disabilities and more than six in ten nursing home residents. States can opt to provide Medicaid for children with significant disabilities in higher-income families to fill gaps in private health insurance and limit out-of-pocket financial burden. Medicaid also assists nearly 1 in 5 Medicare beneficiaries with their Medicare premiums and cost-sharing and provides many of them with benefits not covered by Medicare, especially long-term care .
Figure 4: Medicaid plays a key role for selected populations.
What You Need To Apply:
- The name, address, contact info, and birth date for everyone in your household
- Social security numbers and/or immigration documents
- Employer and income information for everyone in your household. Examples include pay stubs or W2 forms.
- Other income information including Social Security Administration or Supplemental Security Income payments and mentions
- Information about current health coverage for members of your household, including coverage through an employer, a spouseâs employer, or Medicare
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How Much Will Medicaid Cost Me
It depends. Every state is different. You will probably not have to pay a monthly premium for Medicaid, but most people do have some out-of-pocket costs.2 Emergency services, family-planning services, pregnancy-related services and preventive care for children are all fully covered with no additional cost to you.
Reduced Coverage / Medicare Cost Sharing Or Premium Payment
Qualified Medicare BeneficiariesCovered group: individuals covered by MedicareIncome limits: Income cannot exceed 100% of the federal poverty level. For more information, view the Guidelines for Medicare Cost-Sharing Programs brochure.Age: Medicare beneficiaries of any ageQualifications: Individuals must be eligible for Medicare Part A hospital insurance.
Specified Low-Income Medicare BeneficiariesCovered group: individuals covered by MedicareIncome limits: Income cannot exceed 135% of the federal poverty level. For more information, view the Guidelines for Medicare Cost-Sharing Programs brochure.Age: Medicare beneficiaries of any ageQualifications: Individuals must have Medicare Part A
Qualified IndividualsCovered group: individuals covered by MedicareIncome limits: Income cannot exceed 135% of the federal poverty level. For more information, view the Guidelines for Medicare Cost-Sharing Programs brochure.Age: Medicare beneficiaries of any ageQualifications: Individuals must have Medicare Part A
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Services Covered By Medicaid And Chip
- Regular checkups at the doctor and dentist
- Medicine and vaccines
- Access to medical specialists and mental health care
- Treatment of special health needs and pre-existing conditions
These services are provided by health plans. If your child gets Medicaid or CHIP, you will choose a plan from the ones available in your service area.
The Majority Of The Public Holds Favorable Views Of Medicaid
Public opinion polling suggests that Medicaid has broad support. Seven in ten Americans say they have ever had a connection with Medicaid including three in ten who were ever covered themselves. Even across political parties, majorities have a favorable opinion of Medicaid and say that the program is working well . In addition, polling shows that few Americans want decreases in federal Medicaid funding. In addition to broad-based support, Medicaid has very strong support among those who are disproportionately served by Medicaid including children with special health care needs, seniors, and people with disabilities.
Figure 10: Large Shares Across Parties Say They Have a Favorable Opinion of Medicaid
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How Will The Social Security Increase Help People
The impact could be enormous, experts say. The average retired person will see a monthly increase of around $144 in payments, according to the SSA, and the average monthly payment to a retired beneficiary will be $1,827.
The more than 70 million Americans who receive Social Security payments, Supplemental Security Income payments or both will start to see that increase beginning in either December or January.
According to the SSA, 55 percent of Social Security recipients in 2021 were women. And though the vast majority of those Americans are retired, around 3 million children also receive Social Security payments. Others who get payments include people with disabilities and people who have lost spouses.
Of the 70 million Americans who receive Social Security benefits, more than three-quarters are 65 or older. Graphic by Jenna Cohen and Megan McGrew.
The estimated average payment for a widow with two children will jump from $3,238 to $3,520, according to the SSA, and the average payment for disabled workers will increase from $1,364 to $1,483.
Another important change will be the decrease in Medicare Part B premiums, said Mary Johnson, Social Security and Medicare policy analyst at the Senior Citizens League.
We have not seen that combination ever, and this may be the one and only time we ever see it, Johnson said. So Im encouraging everybody to appreciate it.
Do I Have To Spend My Assets Before Medicaid Will Pay For My Spouses Nursing Home
Dear Harry,
My spouse is going to have to move to a nursing home. When spending down assets for the sick spouse to qualify for Medicaid does it have to be done before sick spouse is sent to a nursing home or can it be done even after the sick spouse is admitted to a nursing home?
Dear Reader,
Unfortunately, the rules for Medicaid coverage of nursing home care are very complicated and contain many traps for the unwary. Medicaid is the federal-state safety net program for healthcare. Unlike most health insurance, it pays for nursing home care. But to qualify, nursing home residents must prove that they are impoverished under Medicaids arcane rules. To complicate things further, the rules differ somewhat from state to state.
In most states, in order to be eligible, the nursing home residents must have countable assets of less than $2,000. Almost all assets are counted against this limit except for the residents home, which is not countable as long as its fair market value is less than $955,000 .
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But as is often the case in the field of Medicaid planning, the best strategy may be different in different situations.
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Most Medicaid Enrollees Get Care Through Private Managed Care Plans
Over two-thirds of Medicaid beneficiaries are enrolled in private managed care plans that contract with states to provide comprehensive services, and others receive their care in the fee-for-service system . Managed care plans are responsible for ensuring access to Medicaid services through their networks of providers and are at financial risk for their costs. In the past, states limited managed care to children and families, but they are increasingly expanding managed care to individuals with complex needs. Close to half the states now cover long-term services and supports through risk-based managed care arrangements. Most states are engaged in a variety of delivery system and payment reforms to control costs and improve quality including implementation of patient-centered medical homes, better integration of physical and behavioral health care, and development of value-based purchasing approaches that tie Medicaid provider payments to health outcomes and other performance metrics. Community health centers are a key source of primary care, and safety-net hospitals, including public hospitals and academic medical centers, provide a lot of emergency and inpatient hospital care for Medicaid enrollees.
Figure 6: Over two-thirds of all Medicaid beneficiaries receive their care in comprehensive risk-based MCOs.
Chip Does Not Cover Long
If you have a child with a disability and make too much money to get Medicaid, you might be able to get coverage through the Medicaid Buy-In for Children program. MBIC allows families of children with disabilities to make a monthly payment to get Medicaid coverage.
Learn about other programs and services for people with disabilities.
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What You Need To Know About The New Social Security Benefit Increase
For the 70 million Americans who receive Social Security, experts say the significant increase in benefits slated for 2023 is much-anticipated and much-welcomed.
Social Security recipients, most of whom are over age 65, have seen their payments increase almost every year for more than four decades to keep up with the cost of inflation. When inflation is low as its been over the past decade or so those cost-of-living adjustments, or COLAs, have been fairly mild. But last year, the increase was big, and this year its even bigger.
To help cover the rising cost of food, housing, health care and other essentials, the Social Security Administration announced Thursday that beneficiaries would receive an 8.7-percent increase in their monthly payments. In a sign that the Federal Reserves efforts have not yet worked to puncture the elevated inflation rate, the Bureau of Labor Statistics also released its consumer price index for September on Thursday, showing prices rose 8.2 percent over the last year.
The 8.7 percent cost-of-living increase to Social Security payments for 2023 will be the largest jump in more than 40 years. Graphic by Jenna Cohen and Megan McGrew.
The COLA for 2023 is the largest increase since 1981 when inflation was even higher than it is today and is the fourth-largest jump ever.
Can I Qualify Even If My State Does Not Have Expanded Medicaid
In states that have not expanded Medicaid, eligibility levels are lower than in states that have expanded. Even if your state hasnât 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.
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How Many People Are On Medicaid
According to the Centers for Medicare & Medicaid Services, as of July 2020, here are the number of people enrolled in Medicaid and Chip in the entire United States:
- 75,521,263 individuals were enrolled in Medicaid and CHIP
- 68,826,573 individuals were enrolled in Medicaid
- 6,694,690 individuals were enrolled in CHIP
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Check The Status Of An Application
The Division of Family Resources provides tools to strengthen families through services that focus on prevention, early intervention, self-sufficiency, family support, and preservation.
You can check the status of your application online by clicking on your county of residence or by calling 1-800-403-0864. You will need to have your case number to check the status of your application.
Please remember that your application must be completed and all required documentation submitted before DFR can begin processing your application.
Pursuant to HIPAA and other applicable federal regulations, DFR is committed to respecting the privacy of each client. For that reason, DFR will not share or disclose information about your case without a signed release. You may download the DFR online.
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How To Apply For Ny Medicaid
You may apply for Medicaid in the following ways:
- Enrollment Assistors offer free personalized help.
- To speak with the Marketplace Customer Service Center call 355-5777
- Through a Managed Care Organization
- Call the Medicaid Helpline 541-2831
- Through your Local Department of Social Services Office
Where you apply for Medicaid will depend on your category of eligibility. Certain applicants may apply through NY State of Health while others may need to apply through their Local Department of Social Service . No matter where you start, representatives will help make sure you are able to apply in the correct location. For more information on determining your category of eligibility and where you should apply read on.
NY State of Health determines eligibility using Modified Adjusted Gross Income Rules. In general, income is counted with the same rules as the Internal Revenue Service with minor variations. Individuals who are part of the MAGI eligibility groups listed below should apply with NY State of Health.
- Adults 19-64 years of age and not eligible for Medicare,
- Children 1 – 18 years of age
- Pregnant Individuals,
- Parents and Caretaker Relatives of any age
Individuals who are part of the non-MAGI eligibility groups listed below should apply with their Local Department of Social Services .
Other factors that may affect your eligibility include:
- State Residency
- Family or Household size
Medicaid Application for Non-MAGI Eligibility Group
Supplement A
