Medicaid and Medicare both are health insurance programs. The readers are cautioned that Medicare and Medicaid are two different programs serving different groups of people. Some people think that they are two different names of the same program. It is, however, possible to enroll in both Medicare and Medicaid. If you are eligible for both the programs, it is best to apply and have both programs because one program can cover the costs and fees of service not covered by the other program. For some seniors over 65 years of age Medicaid can also pay for Medicare premiums, deductibles and co-payments. Article on Medicare will appear soon.
WHAT IS MEDICAID?
Medicaid is a state and federal funded health insurance program that serves low income individuals of all ages. Though funded by both the federal and state money, Medicaid is administered by the state, and therefore, each stateís Medicaid program has different eligibility rules and benefits.
Who is Eligible for Medicaid?
It is important to know, as stated earlier, that eligibility for Medicaid differs from state to state. In order to find out if you are eligible, you can check with your State Medical Assistance Office (SMAO). Bear in mind that Medicaid pays for medical care and services for individuals and families with very limited assets and income who cannot afford to pay all their medical bills. It is especially valuable to older people with serious recurring health problems because they usually cannot meet all of their medical expenses from Medicare alone. A person may be eligible for partial assistance or for complete medical coverage depending upon his/her monthly income and assets. Some Medicaid recipients pay a co-payment for some services. You should check with your SMAO. In most states if you qualify for Supplemental Security Income (SSI), you are automatically qualified for Medicaid. It is always best to check with your State Medicaid Office.
The telephone numbers of the SMAOs in five states, where more than 50% Indian Americans out of a total of about 1.7 million in USA reside, are: California: 1-800-952-5253; New York: 1-518-486-9057; New Jersey: 1-800-356-1561 ( in-state calls only); Illinois: 1-800-252-8635 (in-state calls only); Texas: 1-800-252-8263.
Where to Enroll for Medicaid?
Normally, a person has to apply for Medicaid in person. If the person is unable to apply in person, his/her representative must do so. The County Department of Social Services is where a person has to enroll for Medicaid. Since the eligibility requirements and benefits differ from state to state, it is advisable to call the department and ask for a list of items needed to determine eligibility, as well as ask for an application and/or appointment.
What is Covered under Medicaid?
As stated earlier, benefits differ from state to state. When seeking services, it is important to find out if the agency/doctor accepts Medicaid payments. Payment is made directly to the health care provider. If the health care provider does not accept Medicaid, then the individual seeking care will be responsible for the payment. Though benefits differ from state to state, and they may change periodically, normally the Medicaid may pay for the following: ( taken from Nassau County in New York State publication: Long Term Care for Older Persons)
* Hospital inpatient and outpatient services
* Laboratory and X-ray services
* Care in a residential health care facility
* Care through home health agencies
* Treatment by physician, dentist and podiatrist
* Eye care and hearing aids
* Treatment in psychiatric hospitals and mental facilities
* Drugs, supplies, equipment
* Physical, occupational and speech therapy
* Private duty nursing
* Home health personal care services
* Transportation to Medicaid-covered services, depending on patientís physical condition.
In the issues on Medicare it had been stated that Medicare payment for Nursing Home Care is limited, and that Medicare does not pay for custodial care in a Residential Health Care Facility. To receive assistance under Medicaid with Residential Health Care Facility payment, a person must first spend his/her own assets until they have been reduced to the Medicaid eligibility level. Beware. Eligibility differs from state to state. It is, therefore, incumbent to call State Medicaid Office to find out if a person is eligible for Medicaid and the placement in a residential health care facility medically approved. Then the person may apply for Medicaid assistance to meet the monthly cost of care.
For specific question, you may send your question to National Indo-American Association for Senior Citizens (NIAASC ) at 7 Roberta Avenue, Farmingville NY 11738. NIAASC is an information, referral and advocacy organization and you can know more about it at its web site: www.niaasc.org