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:
State Pathways To Streamlined Eligibility And Enrollment
Medicaid agencies can use four pathways to streamline their eligibility and enrollment processes during the current crisis. Some of these pathways rely on authorities that are linked to the PHE declared by Health and Human Services Secretary Alex Azar on January 31 and the Stafford Act Emergency Declaration President Trump issued on March 13.
Families First Act Lets States Focus on Application Processing
The Families First Coronavirus Response Act provides an estimated $36 billion in additional federal Medicaid funding to states. To qualify for these funds, states must abide by a maintenance-of-effort provision thats designed to protect peoples access to health coverage during the crisis. Among other requirements, states are barred from ending Medicaid coverage during the national public health emergency, except for individuals who voluntarily end their coverage or move out of state.
In addition to protecting peoples coverage during the pandemic, this requirement allows states to free up resources to process new applications. In particular, states can free up staff time and other resources by ceasing renewals, stopping actions on periodic income checks, and ceasing implementation of restrictive waivers.
What Medicaid Covers For Medicare Enrollees
Medicare has four basic forms of coverage:
- Part A: Pays for hospitalization costs
- Part B: Pays for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services
- Part C: Medicare Advantage Plan offered by private companies approved by Medicare
- Part D: Assists with the cost of prescription drugs
Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid . Medicaid also covers additional services beyond those provided under Medicare, including nursing facility care beyond the 100-day limit or skilled nursing facility care that Medicare covers, prescription drugs, eyeglasses, and hearing aids. Services covered by both programs are first paid by Medicare with Medicaid filling in the difference up to the state’s payment limit.
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Impact Of The Affordable Care Act
The Affordable Care Act , enacted in 2010, had a significant impact on Medicaid eligibility, as it is what offered Medicaid Expansion to states. In exchange for federal funding, states agreed to expand Medicaid coverage to anyone with incomes up to 133% of the FPL, regardless of other factors. The remaining states continue to follow the traditional Medicaid eligibility guidelines.
Can I Be Enrolled In Medicare And Medicaid At The Same Time
Q: Can I be enrolled in Medicare and Medicaid at the same time?
A: In many cases, yes. Some Americans qualify for both Medicare and Medicaid, and when this happens, it usually means they dont have any out-of-pocket healthcare costs.
Beneficiaries with Medicare and Medicaid are known as dual eligibles and account for about 20 percent of Medicare beneficiaries . Dual eligibles are categorized based on whether they receive partial or full Medicaid benefits.
Full-benefit dual eligibles have comprehensive Medicaid coverage, while partial benefit dual eligibles receive help with Medicares premiums and cost sharing through a Medicare Savings Program .
The federal government oversees Medicare eligibility meaning it is the same in each state. But states set their own eligibility rules for Medicaid and the MSPs and income limits for these programs vary widely.
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Policy Basics: Introduction To Medicaid
In 2018, Medicaid provided health coverage for 97 million low-income Americans.
In 2018, Medicaid provided health coverage for 97 million low-income Americans over the course of the year. In any given month, Medicaid served 32 million children, 28 million adults , 6 million seniors, and 9 million people with disabilities, according to Congressional Budget Office estimates.
Children account for more than two-fifths of Medicaid enrollees but only one-fifth of Medicaid spending. Only one-fifth of Medicaid enrollees are seniors or people with disabilities, but because they need more health care services, they account for nearly half of Medicaid spending.
Medicaid is sometimes confused with Medicare, the federally administered, federally funded health insurance program for people over 65 and some people with disabilities. And there is overlap between the two programs: nearly 10 million low-income seniors and people with disabilities so-called dual eligibles are enrolled in both Medicare and Medicaid.
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?
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Expansion Under The Affordable Care Act
As of December 2019, 37 states and the District of Columbia have accepted the Affordable Care Act Medicaid extension. Among adults aged 18 to 64, states that expanded Medicaid had an uninsured rate of 7.3% in the first quarter of 2016, while non-expansion states had a 14.1% uninsured rate. Following a 2012 Supreme Court ruling, which held that states would not lose Medicaid funding if they did not expand Medicaid under ACA, several states rejected the option. Over half the national uninsured population lives in those states.
The Centers for Medicare and Medicaid Services estimated that the cost of expansion was $6,366 per person for 2015, about 49 percent above previous estimates. An estimated 9 to 10 million people had gained Medicaid coverage, mostly low-income adults. The Kaiser Family Foundation estimated in October 2015 that 3.1 million additional people were not covered in states that rejected the Medicaid expansion.
Studies of the impact of Medicaid expansion rejections calculated that up to 6.4 million people would have too much income for Medicaid but not qualify for exchange subsidies. Several states argued that they could not afford the 10% contribution in 2020. Some studies suggested that rejecting the expansion would cost more due to increased spending on uncompensated emergency care that otherwise would have been partially paid for by Medicaid coverage,
Outreach For Medicaid And Marketplace Enrollment
- Use plain language without technical jargon
- Focus more on how health insurance can benefit the individual that you are working with and meet his/her needs
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Do Individuals Have To Gather Lengthy Documentation To Apply
- The application process primarily relies on electronic sources, so there is a reduced need for paper documentation
- A single, electronic source known as The Hub helps process verifications for multiple sources including Homeland Security, the IRS, and SSA
- Testimony from the applicant can be used for most factors of eligibility
Am I Eligible For The Medicaid Waiver Program
Eligibility rules differ from state to state, but there are a few guidelines that are true in most states. One is that you must need a level of care similar to what youd receive in a nursing facility.
For most people, that means round-the-clock access to medical services, plus personal care services like help with dressing, bathing, and going to the bathroom.
What counts as a nursing home-level of care is different in every state. Contact your states Medicaid office to see if you or someone in your care is eligible.
Because HCBS waivers are not an entitlement, states are allowed to limit the number of people who can receive care through the program. That means you may be placed on a waiting list if your state has reached its cap on eligible participants.
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If You Already Receive Benefits From Social Security:
If you already get benefits from Social Security or the Railroad Retirement Board, you are automatically entitled to Medicare Part A and Part B starting the first day of the month you turn age 65. You will not need to do anything to enroll. Your Medicare card will be mailed to you about 3 months before your 65th birthday. If your 65th birthday is February 20, 2010, your Medicare effective date would be February 1, 2010.
Applying For Medicaid And Marketplace Coverage
- The National Health Insurance Marketplace call center: 1-800-318-2596 . Assistance is available in 150 languages.
- Staff at the call center help individuals go through the eligibility and enrollment process, and connect them with local in-person help
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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.
What Is The Income Level To Qualify For Medicaid
There are specific Medicaid eligibility income limits you need to review. These figures are based on Modified Adjusted Gross Income . Since different states have their own average costs of living, the income threshold you need to fall within varies depending on where you live.
There is a Medicaid income eligibility chart you can consult if you have questions regarding your earnings. Furthermore, keep in mind that the income level for Medicaid eligibility varies annually. This means that you could qualify one year but earn too much to enroll the next year. Make sure you are aware of these changes so you always know if you qualify.
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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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Where Can I Find A Medicare Advantage Plan When Im On Medicaid
Generally, it may be best to check with insurance companies that offer Medicare Advantage plans in your area to see if they offer Dual-Eligible SNPs or any Medicare Advantage plans that you may be eligible for while youre on Medicaid.
If you need help finding a Medicare Advantage plan when youre on Medicaid, I can help you. Use the links below to arrange a phone call with me or have me email you customized information. You can compare Medicare Advantage plans right away by clicking the Find Plans button on this page.
New To Medicare?
Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.
How Medicaid Works With Other Coverage
You may still qualify for Medicaid even if you have other health insurance coverage, and coordination of benefits rules decide who pays your bill first. In this case, your private insurance, whether through Medicare or employer-sponsored, will be the primary payer and pays your health care provider first. Medicaid comes in as second insurance to settle what your private insurance doesnt pay, up to its limit.
If you have both Medicaid and private health insurance, you should show both your private health insurance card and Medicaid card to your medical provider every time you receive services.
A health-service provider who accepts both your Medicaid and private insurance card wont bill you for copayments or deductibles.
Any money received from an insurance company or as compensation for a medical care lawsuit must be used to pay the health provider. If Medicaid already has covered the cost of care, you must make a refund to Medicaid. If your private insurance is through an employer-sponsored plan, you may be an eligible candidate for the Health Insurance Premium Payment program. HIPP is a voluntary program that may pay your insurance premium as long as you or a family member qualifies for Medicaid coverage.
If your service provider wont take your Medicaid and private insurance card, your insurance company may help you locate a doctor in its provider network.
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Medicare Advantage And Medicaid
You may be able to enroll in a Medicare Advantage plan when youre on Medicaid. For example, theres a type of Medicare Advantage plan called a Special Needs Plan, or SNP.
Special Needs Plans are geared for people in specific situations. One type of SNP is specifically for dual eligibles people eligible for both Medicare and Medicaid. Please note:
- Medicare SNPs cover the same services and supplies that all Medicare Advantage plans are required to cover.
- Make sure your doctor accepts Medicaid to make sure youre covered. Of course, the doctor must also accept Medicare assignment. Your Medicare Advantage plan should be able to help you find doctors who accept both.
- You need to be enrolled in both Medicare Part A and Part B to qualify for a Medicare Advantage plan. You must also live within the plans service area.
- With any kind of Medicare Advantage plan, in most cases you must continue paying your Medicare Part B premium. However, the Medicaid program might pay your premium.
What Is The Income Range For Beneficiaries Who Are Dual Eligibles
Generally, beneficiaries earning less than 135 percent of the federal poverty level are eligible for the MSP if they also have limited savings . This equates to $17,226 annually for single beneficiaries and $23,274 for married couples. Beneficiaries qualify for full Medicaid benefits if their incomes and assets are even lower .
Many seniors who live in nursing homes are dual eligible: they qualify for Medicare based on their age, and Medicaid because of their financial circumstances. It is also common for Medicare beneficiaries who are under 65 and live on Social Security Disability Insurance to receive Medicaid benefits.
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