Many people all over the country take advantage of the benefits that Medicaid provides for them. However, those same people may not even fully understand all of the benefits they are receiving or can receive, exactly what Medicaid covers, or they may lack a general understanding of Medicaid overall.

So, what is Medicaid? Simply put, Medicaid began in 1965 after it was signed into law as a joint state and federal program. The point of Medicaid was to provide health insurance to both low-income families as well as individuals. And while it began its life as a way to provide coverage to those recipients of government welfare, its reach has extended beyond simply low-income individuals and families to certain sections of the country’s elderly and disabled population. Today, there are approximately 60 million people on the receiving end of Medicaid benefits and CHIP benefits (Children’s Health Insurance Program), and is the largest health insurance program in the nation, costing upwards of $400 billion per year.

Eligibility for benefits is determined at state level and is based on income, so each individual and family should check the Medicaid site to find the policy for their state. Those adults without children, who are between 18 and 65, are eligible to receive coverage thanks to the Medicaid expansion in the Affordable Care Act, but there are some states that may not provide coverage to those individuals.

Those who live in states implementing the expansion will qualify for benefits if they earn up to 149% of the federal poverty level. Children, pregnant women, parents, seniors and those with disabilities will qualify so long as they meet both residency and immigration requirements and are documented citizens of the United States.

Benefits

All enrollees are entitled to receive the following mandatory benefits:

• Inpatient hospital services
• Outpatient hospital services
• EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services
• Nursing Facility Services
• Home health services
• Physician services
• Rural health clinic services
• Federally qualified health center services
• Laboratory and X-ray services
• Family planning services
• Nurse Midwife services
• Certified Pediatric and Family Nurse Practitioner services
• Freestanding Birth Center services (when licensed or otherwise recognized by the state)
• Transportation to medical care
• Tobacco cessation counseling for pregnant women

Some states also provide the following optional benefits as well:

• Prescription drugs
• Clinic services
• Physical therapy
• Occupational therapy
• Speech, hearing and language disorder services
• Respiratory care services
• Other diagnostic, screening, preventative and rehabilitative services
• Podiatry services
• Optometry services
• Dental services
• Dentures
• Prosthetics
• Eyeglasses
• Chiropractic services
• Other practitioner services
• Private duty nursing services
• Personal care
• Hospice
• Case management
• Services in an intermediate care facility for the mentally retarded
• Self-directed personal assistance services
• TB Related Services
• Inpatient psychiatric services for those under 21
• Other services approved by the Secretary

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.

Despite the name, a Medicaid bed isn’t an actual bed. Instead, it refers to what is known as a bed-hold policy. This means that certain residents of nursing homes can return to their beds if they are temporarily absent from the facility.

The Nursing Home Reform Act allows those who qualify for Medicaid benefits to take advantage of “Bed-Hold and Readmission rights. These rights are not available to Medicare beneficiaries, so what this means is that those who get Medicaid and who are required to leave the facility for hospitalization or therapeutic reasons, they have the right to return, and the nursing home must hold the bed for them for a certain period of time. Although, if the absence should go beyond the bed-hold period, and if the person still requires skilled or intermediate nursing care, he or she will then be entitled to the first bed available in a semi-private room at the facility.

There are both federal and state laws in place, along with regulations, that require nursing facilities to give out written information to the elder and his or her family members that goes into detail regarding the bed-hold policy as outlined in the State Medicaid plan. However, this isn’t normal procedure for those who get reimbursed by Medicare for their care. Those individuals might be required to pay any bed-hold fees that have been instituted by the facility.

This means that people insured by Medicare aren’t protected by the above rules and regulations. However, those who aren’t protected aren’t completely left out in the cold. They have the option too either pay the daily rate in order to keep the bed or take the chance that a bed will be available elsewhere once the elder is covered by Medicaid—though this is understandably more difficult.

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.