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What Consumers Need to Know About Medicaid

Life Belt with Stethoscope

Medicaid is a lifeline to millions of people with limited income and resources who need access to health care coverage and long-term services and supports (LTSS). Also referred to as long-term care, LTSS encompasses help with daily tasks like bathing, dressing, eating; assistance with housekeeping, transportation, paying bills and meals; and help with complex care needs like managing medications and wound care (e.g., changing bandages or applying medications to surgical incisions).

Since its inception in 1965, Medicaid has evolved to meet the changing needs of the people it serves, the providers who deliver services, the states that directly administer their program, and the federal government itself, as it works in partnering with states to fund and run the program. Medicaid coverage has helped to drive down the nation’s uninsured rates to record lows and reduced uncompensated care.

As a decades-old program effectively fulfilling a key need every day, Medicaid is not always fully understood. Moreover, the program continues to evolve.  Here are some things you should know about this popular and proven program:

Medicaid is the Nation’s Largest Public Health Insurance Program.

State Medicaid programs provide access to critical health  and long-term care  for nearly 68 million people including children, parents, low-income adults, older adults and people with disabilities. Medicaid covers prenatal care for millions of women so that their babies can be born health, as well as check-ups for more than three in four children in low-income families, so they can get off to a healthy start in life.

The program is also a lifeline for about 15 percent of older adults, who may receive services not covered by Medicare; and close to half of all adults with disabilities who may receive LTSS to help them stay in their homes and communities where they prefer to age.

Medicaid Benefits Vary by State.

Where you live matters in terms of your eligibility for Medicaid coverage and what benefits you can receive.  While states are required to provide Medicaid coverage to most low-income older adults and individuals living with a disability, they can choose to extend coverage to other populations, including people who spend so much of their income paying for their own care—often on LTSS— that they ultimately qualify for Medicaid.

Benefits that state Medicaid programs must provide include inpatient and outpatient hospital care, physician services, lab and x-ray services, home health care, rural health clinic services, and nursing home care for people ages 21 and older. States can choose, but are not required, to cover other optional benefits, like prescription drugs, dental and vision services, and home and community-based services like personal care (e.g., help with bathing, toileting, and dressing).

Many States Have Alternative Names for Medicaid.

Because each state administers its own Medicaid program—with the federal government sharing the cost—many states use alternative names for their programs. For example, California calls its program Medi-Cal, in Connecticut the program is known as HuskyHealth, and Wisconsin’s program goes by BadgerCare Plus.  To learn if your state’s program goes by another name, click here.

Medicaid is the Largest Public Payer of Long-Term Services and Supports (LTSS).

The vast majority of older adults and people with disabilities prefer to live and receive services in their homes and communities for as long as possible. Yet while federal Medicaid law requires states to provide nursing facility care for all who are eligible, they are not required to do so for home and community based services (HCBS), which enable people to age in place, and often limit the number of people who may receive such services.

In 2016, Medicaid LTSS spending (combined federal and state) totaled $154.4 billion, accounting for 30.6 percent of all program spending.  However, less than half of the spending for older adults and individuals with disabilities went to HCBS, while the majority (55 percent) went to nursing facilities.  You can learn more about how your state is performing by visiting AARP’s Long-Term Services and Supports Scorecard (http://www.longtermscorecard.org/).  This interactive tool encompasses everything from the availability of home and community-based services to access to transportation within a community.  

Medicaid Provides Extra Help to Low-Income Medicare Beneficiaries.

Many Medicare beneficiaries have incomes so low that they qualify for Medicaid in addition to Medicare. In 2016, about 10 million low-income Medicare beneficiaries qualified for Medicaid. Seven (7) million qualified as full dual eligibles—meaning that in addition to their Medicare benefits, they were entitled to receive help paying their Medicare premiums and cost sharing (e.g., copays) as well as the full Medicaid benefit package. The remaining 3 million individuals qualified as partial dual eligibles, entitled to financial help with their Medicare premiums only. This is a tremendously important benefit for Medicare beneficiaries with very low-incomes.

Each state has a State Health Insurance Assistance (SHIP) program that provides free, independent counselling to help Medicare beneficiaries and their families or caregivers find out what benefits they may be eligible for.  To find your local SHIP, visit:

https://www.seniorsresourceguide.com/directories/National/SHIP/

Millions Have Benefitted from Recent Medicaid Expansions

Since the beginning of 2014, states have been taking advantage of the opportunity to provide coverage to millions of low-income adults who were previously uninsured.  As of January 2019, more than half the states (37 states including the District of Columbia) had expanded their Medicaid programs, giving almost 13 million low-income adults access to needed health care. Recently, three more states—Idaho, Nebraska, and Utah—passed ballot measures to expand their programs. As a result, close to 300,000 more people are expected to gain coverage. The opportunity to expand coverage in three more states—Kansas, Maine, and Wisconsin—may have gained traction with new governors taking office on those states. If you live in a state with a recently passed ballot measure, or a new governor, be sure to follow the news closely to learn whether your state has begun offering Medicaid to new groups or if it is planning to do so. 

New Requirements Pose a Threat to the Program.

Some States are seeking—and in some cases being  granted—federal authority for a range of new Medicaid eligibility restrictions like work requirements and/or requiring people with very low incomes to pay premiums. People could lose or be denied Medicaid coverage if they do not comply with these new rules. Although the vast majority of adults enrolled in Medicaid are either working (60 percent) or in a family with at least one worker (78 percent), those who are not working likely have significant health problems or are caring for a family member.

These types of policies can lead to people losing Medicaid coverage even if they work and pay their premiums.  The reasons: many may not be aware of the requirement(s), may not know how to prove they meet the requirements, or may not have access to the means (e.g. a computer) necessary to report their compliance to the state. In Arkansas, the first state to implement work requirements, nearly 17,000 people have been disenrolled due to the new requirements as of December 2018.

Consumers, therefore, need to know whether their state has implemented, or is considering implementing, these types of requirements and how to make sure that they or someone they know does not lose Medicaid coverage because of them.  The Medicaid Waiver Tracker, a handy tracking service, can help you keep up on the latest. The site is regularly updated, so make sure you check it frequently.

Medicaid is a Very Popular Program

Medicaid provides tremendous value to consumers and their families and friends. The program enjoys broad public support with 6 in 10 saying that the Medicaid is important to them and their families. Policymakers should be sure to listen. 

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