Medicaid | Paying for Care

Medicaid

Medicaid is a health insurance program that is jointly administered by the federal and state governments. Although the federal government has general guidelines, the Medicaid program requirements are actually set by each state. Guidelines for Michigan's Medicaid program are covered in this section.

Medicaid is based on financial need and currently covers over 58 million Americans nationwide. While the program pays for needed health care services for several different categories of persons, the focus of this website is on Medicaid for individuals who are 65 or older or disabled. For a listing of all categories of persons eligible for Medicaid, see the brochure "Medicaid at a Glance."

Services covered by Michigan Medicaid
Medicaid covers medically necessary services such as ambulance, chiropractic, dental, doctor visits, hearing and speech, home health care, hospice care, hospital care, lab, x-ray, nursing home care, medical supplies, mental health, physical and occupational therapy, podiatry (foot care), substance abuse services, surgery, and vision.

Medicaid acts as a Medigap policy for people with Medicare, and pays for Medicare copayments and deductibles. The program provides prescription drug coverage through Medicare drug plans. Medicaid also covers the monthly Medicare premium.

Medicaid Eligibility
To qualify for the Medicaid program, you must pass three eligibility tests.

#1 Categorical eligibility
#2 Non-financial eligibility
#3 Financial eligibility

For questions regarding any of the eligibility tests, contact the Medicare Medicaid Assistance Program at 1-800-803-7174, or call the Michigan Department of Community Health (MDCH) at 517-373-3740. Hearing impaired callers should contact the Michigan Relay Center at 711 or 800-649-3777 and ask for MDCH main number.

1)Categorical eligibility requirements
While limited assets and income are one of the requirements for Medicaid eligibility, you must also fit into one of the following categories:

You are receiving Supplemental Security Income (SSI) benefits. Persons receiving SSI are automatically eligible for Medicaid. To qualify for SSI, your gross monthly income cannot exceed $637 if you are a single person or $956 for a married couple, and assets must be equal to or less than $2,000 if you are a single person or $3,000 for a couple.

You are age 65 and older.

You are disabled. You are considered disabled if you have a physical or mental disability which prevents you from being employed and has lasted or is expected to last for at least 12 consecutive months.
You are a former SSI recipient. Certain former SSI recipients who lost benefits because they received increased Social Security benefits may be eligible for Medicaid.

Michigan residence.

Citizenship and Alien status.

Social Security number.

# 3 Financial eligibility requirements

Medicare Savings Programs for Persons with Higher Assets or Income

#2 Non-financial eligibility requirements

Qualified Medicare Beneficiary (QMB). The QMB program may pay for the cost of your Medicare premiums, deductibles, and coinsurance. It is not full Medicaid coverage. To qualify for the QMB program, a single person cannot have more than $4,000 in assets, and a couple may not have more than $6,000 in assets. The monthly income limit in 2008 is $867 for an individual and $1,167 for a couple.
Specified Low Income Medicare Beneficiaries (SLMBs).If your income is too high to qualify for QMB, the SLMB program is available. In this program, Medicaid pays the cost of Medicare Part B premiums. SLMB coverage begins in the month of the application, and can be retroactive up to three months. To qualify for the SLMB program, a single person cannot have more than $4,000 in assets, and a couple may not have more than $6,000 in assets. The monthly income limit in 2008 is from $868 to $1,040 for an individual and between $1,168 and $1,400 for a couple.
Additional Low Income Medicare Beneficiaries (ALMBs). If you do not qualify for the QMB or SLMB program, ALMB may pay for your Medicare Part B premium. To qualify for the ALMB program, a single person cannot have more than $4,000 in assets, and a couple may not have more than $6,000 in assets. The monthly income limit in 2008 is from $1,041 to $1,170 for an individual and between $1,401 and $1,575 for a couple. This program is based on availability of funds. Even if you qualify for this program, you may not immediately receive benefits or may experience a delay until funds become available.

Medicaid Deductible. If you do not qualify for full Medicaid or Medicare Savings Programs (QMB, SLMB, or ALMB) because your income is too high, you may qualify for the Medicaid program if the cost of your health care services exceeds a certain amount. In order to qualify, your countable income is compared to the Protected Income Level, or the states determination of how much money is needed for basic living expenses in your county of residence. Any income in excess of the Protected Income Level is considered the amount of your Medicaid Deductible, and must first be used for medical expenses before Medicaid will provide assistance to you. Monthly requalification is required. The Medicaid deductible cannot be used to qualify for any of the Medicare Saving Program it can only be used for the full Medicaid program.

For information on the Medicaid deductible and health care costs that can be counted towards your deductible, see the brochure "Medicaid Deductible Information."

For more information, call the Medicare Medicaid Assistance Program at 1-800-803-7174, or contact the Michigan Department of Community Health (MDCH) at 517-373-3740. Hearing impaired callers should contact the Michigan Relay Center at 711 or 800-649-3777 and ask for MDCH main number.

Nursing Home Care
Few older adults can afford to pay for a long nursing home stay. At an annual cost averaging over $75,000, a nursing home stay can quickly deplete a lifetime of savings. After personal resources, Medicaid is the only source of assistance for most older individuals who need help paying for extended nursing home care.

Medicaid pays for room, board and services for persons requiring the level of care provided in a nursing home. There are special rules for evaluating the income and assets of persons who seek Medicaid to cover the cost of nursing home services. The following provides basic guidelines on nursing home eligibility. For more information on this topic, contact the Medicare Medicaid Assistance Program at 1-800-803-7174.

Eligibility for a Single Person.To be eligible for Medicaid coverage of nursing home costs, your monthly income may not exceed the monthly private-pay rate of the nursing home. $20 is the only deduction that can be taken off your countable income. For example, your monthly Social Security and pension income is $4,500. If the monthly private-pay rate of the nursing home is $4,480 ($4,500 - $20) or more, you will be eligible for Medicaid. The asset limit is $2,000 for persons who are single.

Eligibility for Persons with a Spouse in the Community.If you have a spouse at home in the community and you are applying for Medicaid for coverage of nursing home costs, different rules are used. The following steps are taken to determine how much of the couples assets may be retained by the spouse who will reside at home:

? Step One: All non-exempt assets owned by the couple as of the date of the first admission to the nursing home are considered countable assets.
? Step Two: The amount of countable assets that may be kept by the spouse in the community in 2008 is:

at least $20,880, OR

one-half of the total amount of countable assets, whichever is greater,

up to a maximum of $104,400.

The community spouse has the right to a Minimum Monthly Maintenance Needs Allowance (MMMNA). In the Michigan Medicaid program this allowance is known as the Community Spouse Income Allowance (CSIA). It is calculated by the Medicaid department to allow the community spouse to keep income of $1,719 minimum to $2,550 maximum per month.

Spending Down Assets to Become Eligible for Medicaid. When you have excess assets and cannot qualify for Medicaid, you have several options for spending down the excess assets to become eligible for Medicaid. These include:

?    spending the assets on nursing home care;
?    spending the assets on outstanding bills and normal living expenses;
?    spending the assets on assets that are not counted or excluded by Medicaid;
?    investing in an irrevocable, non-assignable annuity.

Before deciding how to spend down assets on anything other than nursing home bills or normal living expenses, it is advised that you seek the advice of an attorney who is well-versed in Medicaid policy, law, and regulations to make sure that the choices you make will not disqualify you from receiving Medicaid. The Area Agency on Aging 1-B has a list of attorneys that specialize in Medicaid law. Call 1-800-852-7795 for more information.

Applying for Medicaid
Anyone may apply for Medicaid. If you cannot apply yourself, your spouse, parent, legal guardian, adult child, stepchild, or any other person who is at least age 18 or older may apply on your behalf. Application for Medicaid may be made at any county Department of Human Services (DHS) office. To avoid unnecessary delays, it is best to file your application in the county where the person lives or resides in a nursing home. Click here to see a map of local Department of Human Services offices, and find the office closest to you. click on your county from the map at the following link:

People often have difficulty completing the application form. There are two ways that you can get help with the form. First, the DHS is required to provide help to people who request it. If you request help completing the application while you are at the DHS office, that help must be provided on the same day. If you are not able to visit a DHS office, your local office must provide you with assistance and be particularly sensitive to persons who are illiterate, disable, or not fluent in English. The other way that you can receive help with the application form is to contact the Medicare Medicaid Assistance Program at 1-800-803-7174. The Medicare Medicaid Assistance Program has trained counselors that are skilled in providing assistance with the Medicaid application process. There is no charge for this service.