QMC

What are the Different Types of Medicaid?

You may have heard of many different types of Medicaid coverage. And, in fact, thankfully there are a wide variety of Medicaid programs to help a wide variety of people. This article will give you a broad idea of the many types of Medicaid programs and covered services that are available to low income and low asset individuals in need. Medicaid is different from Medicare, Social Security and other entitlement programs in that all Medicaid programs are means-tested.

HOWEVER, it is important to note that QMC ONLY handles one type of Medicaid, what is called Vendor Medicaid, Medicaid designed to assist those in need of nursing home care to receive the health services they need in the nursing facility.

To review some of the other programs, and the Medicaid program at large:

Medicaid is a joint federal and state program that, together with the Children’s Health Insurance Program (CHIP), provides health coverage to over 77.9 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. Medicaid is the single largest source of health coverage in the United States.    

To participate in Medicaid, federal law requires states to cover certain groups of individuals. Low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups. States have additional options for coverage and may choose to cover other groups, such as individuals receiving home and community-based services and children in foster care who are not otherwise eligible.  

The Affordable Care Act of 2010 created the opportunity for states to expand Medicaid to cover nearly all low-income Americans under age 65. Eligibility for children was extended to at least 133% of the federal poverty level (FPL) in every state (most states cover children to higher income levels), and states were given the option to extend eligibility to adults with income at or below 133% of the FPL. Most states have chosen to expand coverage to adults, and those that have not yet expanded may choose to do so at any time.

Qualifying for these plans is, of course, fully based upon financial need. The Affordable Care Act established a new methodology for determining income eligibility for Medicaid, which is based on Modified Adjusted Gross Income (MAGI).  MAGI is used to determine financial eligibility for Medicaid, CHIP, and premium tax credits and cost sharing reductions available through the health insurance marketplace.  By using one set of income counting rules and a single application across programs, the Affordable Care Act made it easier for people to apply and enroll in the appropriate program.

MAGI is the basis for determining Medicaid income eligibility for most children, pregnant women, parents, and adults. The MAGI-based methodology considers taxable income and tax filing relationships to determine financial eligibility for Medicaid. MAGI replaced the former process for calculating Medicaid eligibility, which was based on the methodologies of the Aid to Families with Dependent Children program that ended in 1996. The MAGI-based methodology does not allow for income disregards that vary by state or by eligibility group and does not allow for an asset or resource test. From the Medicaid.gov website.

These Medicaid services and Medicaid benefits are different and separate from the assistance provided to Medicaid beneficiaries in need of nursing home care in a long-term care facility. One important difference: the Vendor (Long Term Care) Medicaid and Home Based Medicaid (HCB) (for home health) are the only Medicaid programs with restrictions on transfers of assets for less than fair market value prior to entering the assistance program. The Vendor Medicaid plan involves a large outlay of cash payments on the part of the state (as opposed to intermittent health insurance coverage payments or participation in a managed care plan for primary care or spend down program); for that reason the Vendor health care coverage plan has a much more restrictive eligibility requirements.

Leave a Reply

Your email address will not be published. Required fields are marked *

Shopping cart close