What is Medicaid?
Each state operates a Medicaid program that provides health coverage for lower-income people, families and children, the elderly, and people with disabilities.

The eligibility rules for Medicaid are different for each state, but most states offer coverage for adults with children at some income level. In addition, beginning in 2014, most adults under age 65 with individual incomes up to about $15,000 per year will qualify for Medicaid in every state.
How can I get Medicaid?
You may be eligible for benefits through Medicaid. Medicaid programs vary by state, so you will need to check with your state Medicaid office for more information.
•Eligibility: People with disabilities are eligible in every state. In some states, people with disabilities qualify automatically if they get Supplemental Security Income (SSI) benefits. In other states you may qualify depending on your income and resources (financial assets).

•“Buy-Ins”: Some states also have “buy-in” programs that allow people with disabilities with incomes above regular Medicaid limits to enroll in the Medicaid program. Children with disabilities can qualify for Medicaid either under these disability-related rules, or based on family income.

•Expansion in 2014. Starting in 2014, the Affordable Care Act will expand the Medicaid program to cover people under age 65, including people with disabilities, with income of about $15,000 for a single individual (higher incomes for couples and families with children).

•Help for disabled people: This expansion helps low-income adults who have disabilities but don’t meet the disability requirements of the SSI program. The expansion also helps those whose income is above their state’s current eligibility levels.
To learn more about your state Medicaid program and other options available to you, use the insurance and coverage finder.
What does Medicaid cost?
Medicaid coverage is designed to be affordable for everyone who is eligible. Cost sharing for Medicaid varies by state but is extremely limited for most participants.
What does Medicaid cover?
The benefits covered for adults through Medicaid are different in each state, but certain benefits are covered in every Medicaid program.

Doctor’s services that are covered by Medicaid include:

•Laboratory and X-ray services
•Inpatient hospital services
•Outpatient hospital services
•Health screenings for children and treatment if medical problems are identified
•Comprehensive dental and vision services for children
•Family planning services and supplies
•Long-term care services and supports
•Medical and surgical dental services for adults
•Pediatric and family nurse practitioner services
•Services provided in health clinics
•Nurse-midwife services
•Nursing facility services for adults
•Home health care services for certain people
•Prescription drugs
Other benefits your state must cover for children and may cover for adults:

•Physical, occupational, or speech therapy
•Eye doctor visits, eyeglasses
•Audiology, hearing aids
•Prosthetic devices
•Mental health services
•Respite and other in-home long-term care
•Case management
•Personal care services
•Hospice services
The Affordable Care Act will expand options for community-based care. There will be more opportunities for people of all ages who have a disability to get help with daily activities while remaining in their homes. The Medicaid program continues to move toward providing more community-based care options as an alternative to nursing homes.

What special Medicaid coverage is available to women?
Cancer Prevention and Treatment
Breast and Cervical Cancer Prevention and Treatment (BCCPT) Medicaid programs are available to eligible women who are diagnosed with either breast and/or cervical cancer through the state screening program. You may be eligible even if you have a higher income. States have flexibility to define what it means to have been diagnosed or screened under the program
Medicaid Options for Pregnant Women
Pregnant women may have special eligibility for Medicaid coverage for themselves and their infants at little or no cost if they have limited income.

Medicaid eligibility for pregnant women varies by state, but all states must cover pregnant women with incomes up to about $20,000 as an individual. Most states cover pregnant women under Medicaid with higher incomes, and some states cover pregnant women under the Children’s Health Insurance Program (CHIP).
How can I get Medicaid coverage for my children?
If you’re enrolled in Medicaid when your baby is born, your child is automatically eligible for Medicaid until your child’s first birthday. This means you don’t have to file a separate application for your new baby. He or she should be automatically enrolled after birth.

All states provide coverage for children through Medicaid and the Children’s Health Insurance Program (CHIP). In fact, your children are likely to be eligible for coverage if your income is up to about $45,000 per year (for a family of four).
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Tens of thousands could lose their jobs from Medicaid cuts

Tens of thousands could lose their jobs from Medicaid cuts included in a Republican budget proposal sponsored in April 2011 by Rep. Paul Ryan (R-Wis.), costing U.S. states $14 billion and effectively depressing spending among hospitals, nursing homes, and drug companies, among others, according to a study by Families USA.

“Such a drastic reduction would stifle business activity and job creation in states already struggling through the recession,” says the National Association of Public Hospitals and Health Systems, a Washington, D.C.-based industry group, in an Oct. 2011 Policy Brief.

The study outlines how states could be affected in terms of business activity and job loss in the event of 5%, 15% and 33% Medicaid cuts. Families USA notes that under the Republican debt reduction plan, Medicaid would be reduced by 5% in 2013, by 15% in 2014, and so on in incremental stages throughout the next ten years, culminating with 33% in 2021.

STATE CHANGES DEFICIT MEDICAID?

Medicaid and Health Care

In addition, state officials also are concerned about health-care costs. The super committee has the ability to cut programs such as Medicare and Medicaid. States have been using federal stimulus money to cover their health-care budget shortfalls, so any Medicaid cutbacks would be particularly problematic, Adkins says. State- and local-government layoffs could boost Medicaid caseloads just as federal stimulus funds dry up and the government cuts back. "It's almost a perfect storm for a fiscal crisis for states," he says.

States are significantly increasing their own Medicaid spending in order to meet federal requirements, according to the National Association of State Budget Officers. Medicaid general-fund spending is projected to increase by $16 billion in the 2012 fiscal year.

Amid the coming cutbacks, states will be hoping for more flexibility in Medicaid rules. "Whether it's pharmacy, provider reimbursement rates, who is eligible and what kind of coverage has to be provided, states will be looking at options to deal with increasing caseloads," Adkins says. "And there are so many unknowns on how new health-care reform will affect those programs."

Tim Keen, director of the Office of Budget and Management in Ohio agrees: "Now that we'll be getting fewer federal dollars, we're hopeful that Washington will provide states with greater flexibility to manage any changes."

skyrocketing cost of healthcare, Medicaid

Medicaid to Cease Payment for Some Medical Mistakes


By Anne-Marie Botek, June 24, 2011

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To manage the skyrocketing cost of healthcare, Medicaid, like its partner program, Medicare, plans to cease reimbursing hospitals for ‘never events' and the complications that arise from them.

A ‘never event,' as defined by the U.S. Department of Health and Human Services (HHS), is a mostly preventable, alarming medical mistake. Examples include surgery performed on the wrong body part; a patient who commits suicide in a health-care facility; and patient kidnapping.

The Centers for Medicare and Medicaid Services, a sub-agency of HHS, has projected that this initiative will slash $35 million from Medicaid's projected payouts over the next five years—but it will barely make a dent in the $364 billion Medicaid budget. The new rule becomes effective on July 1, 2012.

Medicaid's move has rekindled the debate that was ignited when Medicare announced in 2008 that they would cease payment for ‘never events.'

The American Medical Association (AMA) is concerned that Medicaid's decision may "have serious unintended consequences," including lower-quality care for Medicaid recipients, and may actually increase costs rather than reduce them.

In a March 2011 letter to Donald Berwick, an administrator for CMS, AMA Executive Vice President Michael Maves outlined why he thought the rule will be bad for both health-care providers and patients.

Health-care providers will be exposed to increased liability, which could lead to a "Catch 22" situation where physicians, wary of lawsuits, withhold treatments that have "unpredictable" consequences. For example, doctors may decide not to prescribe some antibiotics that are given post-operatively to prevent certain kinds of infections but can sometimes allow others to flourish.

The result, he wrote, "will place Medicaid patients at further risk of reduced access to care and increased financial costs, with unproven benefits, on an already over-stretched Medicaid program."

HOW MEDICAID EFFECTS FAMILIES

Letter

Protecting Medicaid

Published: June 23, 2011




ShareTO the editor:

It is a hopeful sign that 41 senators have spoken out in favor of sustaining the Medicaid program (“Signs of Life Spotted in the Senate,” editorial, June 19).

The middle class should not be lured into thinking that Medicaid is a program for the poor. Medicaid provides an important safety net for middle-class families when parents and grandparents need long-term services and supports.

At a cost of as much as $100,000 a year, it doesn’t take long to wipe out a lifetime’s worth of savings. Without Medicaid, adult children would have to take on these costs — often just at the time they are digging deeper to pay for college for their children.

And severely cutting Medicaid will most certainly hurt our nation’s ability to provide health coverage to America’s poor — including low-wage, direct-care workers who provide long-term services and supports but ironically often do not have health coverage themselves.

Protecting Medicaid is essential to the economic security of the vast majority of Americans.

STEVE EDELSTEIN
Bronx, June 20, 2011

The writer is national policy director of PHI, formerly the Paraprofessional Healthcare Institute.

MEDICAID FINANCING

Medicaid is financed jointly by the federal government and the states. When a state wants to modify its Medicaid program, it must amend its state Medicaid plan. The changes are subject to federal review and approval.

states survey Medicaid recipients

States must consult Medicaid recipients because, the rule says, their experience is “the most important indicator of whether access is sufficient.” Federal officials suggested that to see how much difficulty they had in scheduling doctor’s appointments.states survey Medicaid recipients

In addition, the rule says, states should compare Medicaid payment rates with the amounts paid by Medicare or commercial insurers, with providers’ costs or with their customary charges. Another important factor, it said, is the number and percentage of doctors who accept new Medicaid patients.

Medicaid Reform

In recent years Washington has taken an obsolete program, which covers health care for low-income Americans, and made it worse through restrictive rule-making that defies common sense. It is biased toward caring for people in nursing homes rather than in their own homes and neighborhoods. It lacks the flexibility to help patients who require some nursing services, but not round-the-clock care.

medicaidkaiser commissiononISSUEPAPERandtheuninsured1330

GMoney Follows the Person: A 2010 Snapshot EXECUTIVE SUMMARY With the passage of health reform, the Money Follows the Person (MFP) demonstration grant program was extended five years through 2016 giving states further options to transition Medicaid beneficiaries living in institutions back to the community. Enacted into law in 2006 as part of the Deficit Reduction Act (DRA), the MFP demonstration provides states with enhanced federal matching funds for twelve months for each Medicaid beneficiary transitioned from an institutional setting to a community-based setting. Twenty-nine states and DC are currently participating in this demonstration program and more states plan to apply for MFP grants in the coming year. In July 2010, the Kaiser Commission on Medicaid and the Uninsured (KCMU) surveyed states about the current status of their MFP program including trends in enrollment, services and per capita spending. This year’s survey is a follow-up to the 2008 KCMU MFP survey and highlights findings based on responses from twenty-six states. Key Findings:  As of July 2010, nearly 9,000 individuals have been transitioned back to the community and another 4,000 transitions are currently in progress. Although states were slow to start enrolling participants, with just under four hundred people transitioned by the summer of 2008,1 significant progress has been made over the past two years. The majority of transitions to-date have been persons with physical disabilities and seniors. People with mental illness, developmental disabilities, and dual eligibles are less likely to be candidates for transition. States also reported low rates of reinstitutionalization – 322 individuals have returned to an institutional setting.  States identified a wide range of pre-transition services to target potential MFP participants and to successfully transfer individuals back to the community. The most commonly reported key services included expanded case management to coordinate transition, help with home modifications and one-time housing expenses such as security deposits or household furnishings, use of assistive technology, transportation, and expanded access to DME. States also reported partnerships with key community stakeholders as key features of their MFP programs. Examples of these partnerships include collaboration with independent living centers, AAAs, and state housing authorities.  The average monthly cost of transitioning a MFP participant to the community is roughly $5,600 per person. Amounts ranged from a high of $15,000 to a low of $2,000 per person per month and varied based upon the population target. When asked to compare the cost of serving Medicaid beneficiaries who reside in institutions with MFP participants, twenty-two states said MFP per capita costs were lower and only one state reported that the costs were comparable. When asked to compare MFP costs with costs for other Medicaid HCBS beneficiaries, responses were split. Eight states reported lower per capita costs, seven states said costs were comparable, and six states reported higher MFP per capita costs

G.O.P. Blueprint Would Remake Health Policy

G.O.P. Blueprint Would Remake Health Policy
By ROBERT PEAR


WASHINGTON — The proposal to be unveiled by House Republicans on Tuesday to rein in the long-term costs of Medicaid and Medicare represents a fundamental rethinking of how the two programs work, an ambitious effort by conservatives to address the nation’s fiscal challenges, and a huge political risk.

House Republican aides said the budget blueprint to be issued by the chairman of the Budget Committee, Representative Paul D. Ryan of Wisconsin, would slice more than $5 trillion from projected federal spending in the coming decade. Health care accounts for much of the savings.

But while saving large sums for the federal government, the proposals on Medicaid and Medicare could shift some costs to beneficiaries and to the states.

Under the proposal, Medicaid would be transformed into a block grant, with a lump sum of federal money given to the states to care for low-income people. States would be given more discretion over use of the money than they have under the current federal-state partnership.

For future Medicare beneficiaries — people now under 55 — Mr. Ryan’s proposal calls for the federal government to contribute a specified amount of money toward the premium for private health coverage. Under the traditional Medicare program, the government reimburses doctors and hospitals directly.

Although many House Republicans see a need to revamp Social Security, too, they are not expected to press this week for comprehensive or specific changes in that program.

Democrats signaled that they would fight the health proposals, and the clash could well become a defining issue for both parties in the 2012 elections.

Republicans say the health care proposals would help the federal government predict and control its costs under Medicaid and Medicare, which insure more than 100 million people and account for more than one-fifth of the federal budget.

But if, as many economists predict, health costs continue to rise at a rapid clip, beneficiaries of these programs would be at risk for more of the costs.

Mr. Ryan said his Medicare proposal was similar to one he advanced in November with Alice M. Rivlin, a budget director in the Clinton administration. Analyzing that plan, the Congressional Budget Office said, “Federal payments would tend to grow more slowly under the proposal than projected costs per enrollee under current law.” As a result, the budget office said, “enrollees’ spending for health care — and the uncertainty surrounding that spending — would increase.”

Medicaid and Medicare are now open-ended entitlements. Anyone who meets the eligibility criteria is entitled to benefits defined in detail by federal law. The federal government and the states must pay the additional cost if more people become eligible for Medicaid, as happened in the recent recession.

Likewise, Medicare bears the cost if doctors perform more numerous, more complex and expensive tests and procedures. Some of those additional costs are passed on to beneficiaries in the form of higher premiums.

Republicans say they are taking the initiative on Medicaid and Medicare because President Obama has done nothing to put the programs on a solid fiscal footing. In his 2012 budget, Mr. Obama did not propose significant savings in Medicaid or Medicare, even though he and many fiscal experts say the programs are unsustainable in their current form.

Mr. Ryan and fellow House Republicans are wading into tricky waters, where many other politicians have run aground.

But with the nation’s fiscal problems looming larger, Republicans say the politics of the issue have shifted. They expect to receive credit from the public for trying to hold down the deficit and the debt.

“We have a moral obligation to the country to do this,” Mr. Ryan said in an interview last week.

Representative Jan Schakowsky, a Democrat and a former executive director of the Illinois State Council of Senior Citizens, said she was incensed by such claims. “Mr. Ryan and the Republicans are declaring war on entitlements — and war on the elderly and the poor,” Ms. Schakowsky said. “Beneficiaries will end up paying more.”

About half of Medicaid recipients are children. Nearly two-thirds of the money spent on Medicaid benefits is for low-income people who are 65 and older or disabled.

The government shutdown in 1995-96 stemmed, in part, from a conflict between President Bill Clinton and Congressional Republicans over what he described as “devastating cuts” in Medicaid and Medicare.

In his veto message in December 1995, Mr. Clinton listed 82 “objectionable provisions” of the Republicans’ budget bill. He complained that it “converts Medicaid into a block grant with drastically less spending.”

The Congressional Budget Office recently estimated that a Medicaid block grant, of the type proposed by Mr. Ryan and Ms. Rivlin, could save $180 billion over 10 years. House Republicans could save an additional $434 billion by eliminating the expansion in Medicaid eligibility scheduled to take place in 2014 under the new health care law.

Mr. Ryan said he was not cutting Medicaid and Medicare, but rather slowing their growth rate.

In addition, he insists he is not trying to convert Medicare to a voucher program because the money would be paid to insurance companies and health plans, not directly to beneficiaries. If health costs for a group of patients exceeded the federal payment in a given year, the insurer would have to absorb the cost.

Finally, Mr. Ryan says his proposal is equitable because Medicare would pay less on behalf of higher-income beneficiaries, and they would pay more of the cost of their health coverage.

But high-income Medicare beneficiaries already pay higher premiums, with an annual surcharge of more than $3,800 in premiums for some of the most affluent ones this year.

What Mr. Ryan and his committee plan to do this week is to approve a budget resolution, setting goals for spending and revenues. If approved by the House and the Senate in the same form, such a resolution would bind Congress in its deliberations, but it would not be presented to the president and would not become law.

There is almost no chance the Democratic-controlled Senate would adopt a resolution along the lines Mr. Ryan is proposing, although his counterpart in the Senate, Kent Conrad, Democrat of North Dakota, the chairman of the Senate Budget Committee, is working on a bipartisan plan to address entitlement spending as part of a broader package to reduce the budget deficit.

The budget resolution typically assumes changes in federal programs like Medicaid and Medicare. But those assumptions do not bind the House committees with power over those programs, which could choose to save the same amounts in other ways.