Expert Q&A: Medicaid and health reform
Many of you have sent in questions about how the new health care law will affect you and your family. We’ve compiled answers for select questions to our experts in a short series to help you navigate changes to the health care system. Here's the latest:
Question: I currently have Medicaid and would like to know how health reform affects my Medicaid?
First off, rest assured, all individuals who are currently covered under Medicaid will continue to receive coverage. Health reform prevents states from enacting Medicaid eligibility cuts between now and 2014. It also prevents your state from making any changes to the program that would make it more difficult for you to keep your Medicaid coverage, such as requiring more frequent recertifications or imposing any additional documentation requirements. In 2014, Medicaid will be expanded to cover all non-elderly Americans with incomes below 133 percent of the federal poverty level (approximately $24,350 for a family of three in 2010). Millions more Americans will be eligible for Medicaid as a result of this expansion.
Health reform should not cause any other immediate changes to your Medicaid coverage, but over time, the network of providers available to you may grow. This is because Medicaid’s physician reimbursement levels for primary care services will be increased (to be equal to provider reimbursement rates in Medicare), which may incentivize more doctors to accept Medicaid patients.
For more Q&A with the experts, please visit Mom's Rising here.
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rebecca
Claudia Fetter
tracy kitchenmaster
Janie Woods
Erin
States are required to have plans for recovering from estates amounts spent by Medicaid for long-term care and related drug costs, and what Medicaid spent on hospital benefits, including the Medicare cost-sharing that Medicaid paid. This rule applies to estates of Medicaid beneficiaries who were 55 or older when they received Medicaid benefits or were permanently institutionalized, regardless of age. States have the option of recovering all Medicaid service costs. So the amount that can be recovered will depend on where someone lives.
States cannot recover more the amount Medicaid spent on a person's care or the amount remaining in the estate after claims of other creditors and debts have been settled. When an estate includes a home, the home equity becomes part of the estate that is available for Medicaid estate recovery. Surviving family members cannot be asked to use their funds to repay Medicaid. There is an exception to that, if family members do not want to sell a home that is part of an estate. In that case, they may have to use their own assets to make up the home equity that is part of the estate.
States are prohibited from making estate recoveries in several circumstances:
- During the lifetime of a surviving spouse.
- From a surviving child under 21 or a child who is blind or disabled, based on Social Security Administration/Medicaid definitions.
- There are circumstances where a state is prohibited from including a former home in the estate if a sibling or adult child of the deceased has lived in the home recently. There are residency rules that apply.
States can waive estate recovery when it is not considered cost-effective. States have their own rules for defining this. There are also hardship waivers and special recovery provisions for persons with long-term care insurance through state Long-Term Care Partnership programs. Many states have these programs. Policies obtained through these programs can exempt amounts of individual estates from recovery. That only applies to policies bought through Partnership programs.
These are just some of the rules. To find out what the rules are in your state, you can contact the state Medicaid office. You might also want to check with the state Long-Term Care Partnership Program, if your state has one.
William koop
Richard Dean
anna petersen
Bob Felts
Jean Robart
Amy Malandro
Susan Filyaw
How can I check to see if I qualifys for medicaid and food stamps?
Susan Filyaw
How can I check to see if I qualifys for medicaid and food stamps?
ron baird
Doris Jaques
Paul
Thank you
Erin
To get help determining what program you may qualify for, contact your state Medicaid agency or call your local State Health Insurance Assistance Program (SHIP). You can use this website to find a SHIP near you. https://www.shiptalk.org/About/SHIProfileSearchForm.aspx?mf=Display
There are 3 different programs that are available to help people pay for Medicare Part B related costs. The Qualified Medicare Beneficiary (QMB) program covers the Medicare Part B monthly premiums, deductible, and coinsurance. In most states, people whose income is below $908 a month (individual) or $1226 a month (couple) and who have assets less than $6,680 (individual) or $10,020 (couple), qualify for QMB. The Service Limited Medicare Beneficiary (SLMB) program helps pay the Medicare Part B monthly premium. People with incomes below $1090 a month (individual) or $1471 a month (couple) and assets below $6,680 (individual) or $10,020 (couple) may qualify for SLMB. The last program is the Qualified Individual (QI) program. This program also helps pay the monthly Part B premium. To qualify you may need to have income below $1,226 a month (individual) or $1655 a month (couple) and assets below $6,680 (individual) or $10,020 (couple). However, states are permitted to have higher income and asset limits, so make sure you check with your state to find out what the rules are in your state.
Erin
There is nothing wrong with someone having Medicaid and other insurance, as long as they only turn to Medicaid for coverage when the other insurance has paid everything it will cover.
Medicaid is a program for low-income individuals and people in Medicaid have very limited income and assets and cannot afford to pay a portion of medical care. Some of these people may have other insurance--senior citizens can have Medicare and Medicaid, and about 13 percent of people in Medicaid have private health insurance for at least part of the year. For example, they may work at a job that provides health benefits but not make very much money.
There's nothing wrong with that, as long as Medicaid is used as the "payer of last resort," meaning that the other insurance pays first. People who are eligible for Medicaid but have other insurance generally can't afford to pay any medical care costs that would be left over if their other insurance doesn't pay for everything. Medicaid picks up what's left over. That makes sure people in Medicaid can still access doctors, and doctors and other medical professionals get paid for care they provide.
Patricia
Vanessa Matos
bob
Susan
raymond l sosh
Rose Soper
Jane Neighbors
Janice Johnson
Abigail
sheila stiles
Wilma Hicks
Why are there no more. Also can I use a Doctor from New York that works in New Jersey with my New Jersey Plan.
Marsha Brown
What do I need to do?
Ray Prince
Leesa Crapa
Victoria
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