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An Introduction to Medicaid
Here is some information on eligibility and
the application process that will help you access Medicaid benefits
for your clients who are homeless.
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Tips:
For more information about Medicaid, scroll down.
Determine
Your Client's Status
Medicaid is available to individuals and families who can demonstrate
need as established through income and asset standards. Your client
must also be a child, have dependent children, be pregnant, blind,
disabled, or age 65 or older. Determine if your client falls into one
of these categories.
Find Out
If Your Client Has Already Applied for Supplemental Security Income (SSI)
or Social Security Disability Insurance (SSDI)
Recognize that your client
may need to establish disability to qualify for
Medicaid. Find out if your client has already
applied for benefits for SSI or SSDI. If no medical
record is available, begin the process of establishing
one. Submit an application for Medicaid as soon
as possible, even if your client does not have
complete documentation. In many cases, the date
you submit the application is the date benefits
begin, even if it takes a while to complete the
application.
Medicaid May Pay for Some Medicare Costs
If your client is a low-income
elderly or disabled Medicare beneficiary, the
Medicaid program may pay Medicare premiums. In
some cases, Medicaid may even pay the Medicare
co-payments and deductibles.
Clients with Tuberculosis or Breast or Cervical Cancer May Be Eligible
for Medicaid Benefits
Keep in mind, states may offer Medicaid benefits if your client falls
into one of the following categories:
- Tuberculosis (TB)-infected clients who
would be financially eligible for Medicaid at the Supplemental Security
Income (SSI) level (only for TB-related ambulatory services and TB
drugs/antibiotics)
- Low-income,
uninsured women screened and diagnosed through
the
National Breast and Cervical
Cancer Early Detection Program
of the Centers’ for
Disease Control and Prevention and determined to be in need of treatment
for breast or cervical cancer. For more information, visit www.cms.hhs.gov/bccpt.
Recognize That Your Local Medicaid Program May Have a Different Name
Medicaid is a program that is run jointly by
the states and Federal government and varies
from state to state. This is important to remember
because your local program may be called something
other than Medicaid. For example, in California
the Medicaid program is referred to as “MediCal,” in
Northern Virginia it is referred to as “Unicare,” and
in Georgia it is referred to as “Georgia
Better.” To find out what the Medicaid
program is called in your state, visit www.herc.research.med.va.gov/FAQ_I14.htm.
Contact Your State Health Insurance Assistance Program For Help
There is a State Health Insurance Assistance Program
(SHIP) in your state with volunteers who are available
to discuss your client's situation and provide
information on available options. For more information
about the SHIP in your state, visit www.medicare.gov/contacts/related/ships.asp.
Apply Through Your State or Local Office
Your state or local office will be responsible
for the processing of Medicaid applications -
they are the contact for getting applications
and answering your questions. Some states allow
individuals to apply on the Internet, by telephone,
or at locations in the community, such as health
centers.
Expedite
the Process By Being Your Client's Authorized
Representative
Being your client’s authorized representative
may ensure that the application or renewal does
not get stalled in the event your client may
not receive or respond to the mail. If your program
permits you to act as a representative, ask your
client to authorize you to be his/her representative.
You may need to have your client sign a form
in order to make the transaction legal.
Processing a Medicaid Application Takes Time
The state must process a complete regular Medicaid application
within 45 days. However, the state has 90 days to process
a complete application based on disability. Many unsuccessful
applications are denied due to lack of documentation or incompleteness.
Check Out Experimental, Pilot or Demonstration Projects in Your State
Some states operate experimental, pilot, or demonstration
projects (sometimes called waivers) that allow for the expansion
of eligibility for those who would otherwise not be eligible
for the Medicaid program and/or for the provision of services
that are not otherwise covered by Medicaid. For more information
on what may be available in your state, visit www.cms.hhs.gov/medicaid/waivers/waivermap.asp.
Once
Your Client Acquires Medicaid Eligibility, Help
Him/Her Keep It
Keep a record of when your client became eligible
for Medicaid. Prior to the time when your client’s
eligibility is ending, you should assist him/her
with the renewal process.
Your Client Can Appeal Any Medicaid Decision
Your client can appeal any Medicaid decision, particularly
those related to eligibility. Your client may even file an
appeal if there is a delay in making an eligibility determination.
There will be information on how to appeal printed on the
decision notice your client receives in the mail.
Some Hospitals Provide Care While A Medicaid Application
Is Pending
Some hospitals will provide “free” medical
care to your clients even if his/her application
is pending.
Look into Medicaid HMOs In Your
State
Check with the local Medicaid office about Medicaid Health Maintenance
Organizations (HMOs) in your state. If your client is eligible for
Medicaid, he/she may be able to enroll in a Medicaid HMO and may, thus,
have access to expanded benefits.
> More
information on Medicaid:
Benefits Your Client May
Receive
What Makes
Your Client Eligible
What Your Client
Needs to Apply
If Your Client
is an Immigrant
Contact Information
Medicaid Program
Q & A
Medicaid
Fact Sheet
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