Medicaid 101. Presented by: Scott Crain Parent Mentor Hall County Schools

Transcription

1 Medicaid 101 Presented by: Scott Crain Parent Mentor Hall County Schools

2 There are two primary ways of receiving Medicaid benefits. SSI: (Supplemental Security Income) which comes with Medicaid Katie Beckett: This is Medicaid only (no Supplemental Security Income is included)

3 The Supplemental Security Income (SSI) program pays benefits to disabled adults and children who have limited income and resources. If you are approved for SSI, you are automatically approved for Medicaid. It is designed to help aged, blind, and disabled people, who have little or no income; and It provides cash to meet basic needs for food, clothing, and shelter. You do not have to have worked to get SSI payments. SSI payments are financed through general tax revenues, not through Social Security taxes.

4 Disability Starter Kits The Disability Starter Kit will help you get ready for your disability interview or online application. Kits are available for adults and for children under age 18.

5 You can apply for SSI benefits on line. You can apply over the phone You can apply in person. (In Gainesville) 2526 Thompson bridge Rd. #210 Gainesville, GA 30501

6 Proof of citizenship. (Birth certificate) Social Security Card Proof of income Proof of assets such as bank accounts, property, etc. Proof of expenses (paying rent will increase benefits)

7 Medical records Most recent psychological evaluation School records, IEP etc. Other evaluations: VR work evaluation, etc. The person actually applying for benefits.

8 Monthly Income Average monthly income from SSI is $ Medicaid Insurance Benefits include: ambulance; ambulatory surgical services, nurse anesthetists; diagnostic, screening and preventive services; dental; dialysis, durable medical equipment, family planning; early and periodic screening, diagnosis and treatment (EPSDT); Georgia Department of Community Health

9 Health insurance premium purchase program; home health, hospice, inpatient and outpatient hospital, care for the developmentally challenged; laboratory and radiology; Medicare crossovers; mental health; non-emergency transportation; maternity, nurses and nursing facility; oral surgery; orthotic and prosthetic; pharmacy, physician, podiatric services; preadmission screening/annual resident review, rural health clinic/ community health center; vision care. Georgia Department of Community Health

10 Katie Beckett was a young lady in Iowa born in Her medical condition caused her to be hospitalized for the first two years of her life. She was scheduled to go home when her parents learned she would lose her Medicaid because of their income. Hospital care for Katie at the time was costing $12,000 a month. Home care would cost 1/6 as much. In 1982 President Regan signed the Katie Beckett Waiver into Law. This legislation opened the door for home health care.

11 Katie Beckett is an eligibility category that allows certain children under age 19 who have long term disabilities or complex medical needs to become eligible for Medical Assistance coverage. Katie Beckett eligibility enables children to be cared for at home instead of in an institution. With Katie Beckett, only the child s income and resources, not the parents, are used to determine eligibility. Georgia Department of Community Health

12 Who is Eligible? To be eligible for Medical Assistance coverage through Katie Beckett, a child must: be under age 19 be a Georgia resident and U.S. citizen or eligible non-citizen meet the income and resource requirements meet the Social Security Administration s definition of disability live at home require a level of care at home that is typically provided in a hospital,nursing facility or an Intermediate Care Facility for Persons with Mental Retardation (ICF-MR) Georgia department of Community Health

13 Right from the Start Medicaid Project Centralized Katie Beckett Medicaid Team 5815 Live Oak Parkway Suite D-2 Norcross, GA (phone) (fax) Georgia Department of Community health

14 Medicaid usually pays for doctor appointments, hospital expenses, medicine, therapy, and some supplies and equipment. The waiver allows for Medicaid dollars to be used to pay for additional services. The Medicaid Waiver dollars are part state and part federal money. A Medicaid Waiver is money that may be used to pay for services for a person who has developmental disabilities. These services can take place in the person s home or in the community. Both children and adults can be supported by Medicaid Waiver Services. Dottie Adams, Georgia Council on Developmental Disabilities

15 The state has to write a plan that tells what kind of services will be provided under their Medicaid Programs. It has to be approved by Federal Medicaid. Each state s Medicaid program is different. A person can move around Georgia and their Medicaid Waiver will go with them. If you move out of state, it does not transfer with you. Once you receive a Medicaid Waiver, it remains yours for as long as you continue to meet the eligibility requirements and still need services. Dottie Adams, Georgia Council on Developmental Disabilities

16 SOURCE (Service Options Using Resources in a Community Environment) ICWP (Independent Care Waiver Program) CCSP (Community Care Services Program) NOW (New Options Waiver) COMP (Comprehensive Supports Waiver) GAPP (Medically Fragile Care) Pam Moore, Parent Mentor Madison County Schools

17 SOURCE Service Options Using Resources in a Community Environment (SOURCE) links primary medical care and case management with approved long-term health services in a person s home or community to prevent hospital and nursing home care. All SOURCE clients must be eligible for Medicaid and meet nursing home level of care. SOURCE serves aged, blind and disabled Georgians who are eligible for Supplemental Security Income/Medicaid (SSI). At the end of 2011, over 18,000 people were enrolled in the SOURCE program.

18 ICWP The Independent Care Waiver Program (ICWP) offers services that help a limited number of adult Medicaid recipients with physical disabilities live in their own homes or in the community instead of a hospital or nursing home. ICWP services are also available for persons with traumatic brain injuries (TBI). The program operates under a Home- and Community-Based Waiver (1915c) granted by the Centers for Medicare and Medicaid Services.

19 ICWP Continued Eligibility Criteria The Independent Care Waiver is for eligible Medicaid recipients who have severe physical disabilities, are between the ages of 21 and 64 when they apply, and meet the criteria below. They must: Be capable of directing their own services (individuals with TBI do not have to meet this criteria)

20 ICWP Continued Have a severe physical impairment and/or TBI that substantially limits one or more activities of daily living and requires the assistance of another individual; Be medically stable but at risk of placement in a hospital or nursing facility because communitybased support services are not available; and Be able to be safely placed in a home and community setting.

21 The NOW Waiver stands for New Options Waiver. It provides supports to people who do not need 24 hour care. It was designed for people with disabilities who live with family members or in their own home. There is a limit of $25, a year for services under the NOW Waiver. This waiver is for people who need less intensive services and supports. The COMP Waiver stands for COMPREHENSIVE SUPPORTS Waiver. It was designed for people who need a full range of outof home services or intensive in-home services. The COMP Waiver is also used for people who are transitioning out of institutions into community living Dottie Adams, Georgia Council on Developmental Disabilities

22 Features: INDIVIDUAL BUDGETS Every person on the waiver has an individual budget based on their needs. The family should be aware of how much money is available to purchase the supports needed. In the past, the dollars went to the providers to reimburse them for providing the services. SUPPORTS INTENSITY SCALE The tool that is used to determine the level of need for each person on the waiver is called the Supports Intensity Scale. The support coordinator has been trained to use this instrument to do an interview with people who know the individual well. By having a standard way to measure people s needs, the system can be more accurate and fair in how it allocates the funds for services. Dottie Adams, Georgia Council on Developmental Disabilities

23 UNBUNDLING SERVICES In the previous waivers, some services were bundled all together. Examples were Natural Support Enhancement and Day Supports. Federal Medicaid does not want the services to be bundled anymore so in the new waivers each service is separate and distinct. So what used to be one service under the old waiver may be 2-3 different services in the NOW/COMP waivers. FINANCIAL SUPPORT SERVICES If a family wants to be in control and direct their own services, then they can use the financial support services to draw down the Medicaid funds and pay the bills for them. The agency pays the taxes and social security, pays for the background checks, and provides W-2 forms and monthly budget reports. Dottie Adams, Georgia Council on Developmental Disabilities

24 NEW SERVICE - COMMUNITY GUIDE There is a new service under the NOW/COMP waivers called Community Guide. This service is available for people who want to self direct their services. There is a training program that community guides take in order to be certified to provide this service. They can help train people in self directing and can help make connections in the community. Dottie Adams, Georgia Council on Developmental Disabilities

25 Contact the Intake and Evaluation Team at the Regional Office to apply for Services. The Intake and Evaluation Team will do a screening to see if you are eligible for services. They will place your name on either a Long Term or a Short Term waiting list if you are eligible. Attaching a psychological evaluation along with your application can help speed the process. You must also show proof of citizenship (birth certificate, passport, or permanent resident card.) Dottie Adams, Georgia Council on Developmental Disabilities

26 The Short Term waiting list is designed for people who need services immediately or in the very near future. The Long term waiting list is designed for people needing services at some point in the future. People who are on the list are granted services by determining who is most in need. Dottie Adams, Georgia Council on Developmental Disabilities

27 Income and assets play a big role in getting and keeping your SSI and Medicaid SSI does not count all of your income when they decide whether you qualify for SSI. For example, they do not count: The first $20 a month of most income you receive; The first $65 a month you earn from working and half the amount over $65; Supplemental Nutrition Assistance Program (SNAP) benefits, formerly known as food stamps; Shelter you get from private nonprofit organizations; and Most home energy assistance.

28 Resources that we count in deciding whether you qualify for SSI include real estate, bank accounts, cash, stocks and bonds. You may be able to get SSI if your resources are worth no more than $2,000. A couple may be able to get SSI if they have resources worth no more than $3,000. If you own property that you are trying to sell, you may be able to get SSI while trying to sell it.

29 Do you have assets that total more that $2000 checking, savings etc? Is there a possibility for inheritance from grandparents, or parents? If the answer is yes, you need financial advice. How can I have assets and still protect my benefits?

30 A Special Needs Trust may be the answer to keeping your assets and SSI/Medicaid. A Special Needs Trust will allow the person to inherit money and assets upon the death of a parent or other relative. The will must state that all assets left to the SSI/Medicaid recipient be left to a Special Needs Trust for the benefit of that person.

31 This can include but is not limited to a house, car, money, stocks and bonds or precious metals. How can this money be used? Rent? Food? Entertainment?

32 Georgia Parent Mentor Partnership Parent to Parent of Georgia Georgia Council on Developmental Disabilities Georgia Advocacy Office

33 Institute on Human Development and Disability Center for Leadership in Disability Glass Financial Group Kevin J. Tharpe Special Needs Attorney

34 Questions?