Comparison of the Medicaid eligibility requirements and covered services of Mississippi state of residence to those of California State
User Rating: 0 / 5
- Details
- Hits: 101819
Comparison of the Medicaid eligibility requirements and covered services of Mississippi state of residence to those of California State
Medicaid was established by Title XIX of the Social Security Act (Kilgore, 2013). It is funded by the federal government and the states (Kaiser, 2013). It caters for low income people who fall into specific categories or groups. Eligibility requirements and covered services vary from state to state. The Division of Medicaid administers the Medicaid program in Mississippi under the office of the Governor. This division determines the eligibility of applicants and administers payments for medical services directly to healthcare (Kilgore, 2013). The Medicaid program does not directly provide healthcare and does not provide beneficiaries with money to purchase healthcare services; it instead reimburses participating providers.
California on the other hand provides a Medicaid program referred to as Med-cal. The program pays for a variety of medical services for children and adults whose income and resources are limited. In both states, those who are eligible must be citizens of the United States. In Mississippi, applicants must be residents of the state. In case they are aliens, they must be lawfully admitted for permanent residence. For the California state, one must be a resident of the state, be a United States national, a citizen, permanent resident or legal alien in need of healthcare or insurance assistance. The applicants’ financial status must be classified as low income or very low income. One must also be pregnant, blind or have a disability or a family member in the household with a disability, be responsible for children under 19 years or be 65 years of age or older. The program in Mississippi has been expanded to cover uninsured people under the age of 65 whose gross income is 138% of federal poverty level (Kilgore, 2013).
The services covered in Mississippi include Supplementary Security Income (SSI). This is available for individuals aged 65 and above. It also covers those who are blind or disabled according to Social Security Administration Standards (Kilgore 2013). There is also the Medicaid Long-term Care that covers more than half of all nursing home care. This service is available for custodial care that consists of the observation and helping the patient with the activities of daily living in the nursing home setting (Kilgore 2013). In this service, Medicaid is unlimited in terms of the number of days of coverage. Eligibility is 65 years and above, blind or disabled under Social Security Administration rules. Certification by a physician that the nursing facility level of care is needed is also required. The nursing facility or home health agency must be qualified Medicaid provider.
Mississippi State has a service that caters for disabled children living at home. To be eligible under this program, the child should be under 19 years of age. The disability is determined using the Social Security disability rules. The program requires a level of care at home typically provided in a hospital or nursing facility or intermediate care facility. It also ensures that the beneficiaries can be provided safe and appropriate care in the family. An individual should not have income or assets in his or her name in excess of the current standards for a child living in an institution.
The other program caters for Qualified Medicare Beneficiaries. These are able to pay Medicare premiums, deductibles and coinsure. It caters for specific low income Medicare beneficiaries. The beneficiary must have Medicare part A (Hospital Insurance) and do not receive Medicaid. They should also be working and disabled. They work at least 40 hours per month and are proved disabled. Their gross monthly earned income should be less than, if an individual 4,853 dollars and couples 6,529 dollars. They should have total monthly-unearned income up to 1,343 dollars for individuals and 1,795 dollars for couples. The owned by the beneficiary total resources up to 24,000 dollars for individual and 26,000 dollars for couples.
The healthier MS waiver is for those who are not entitled to Medicare. They must be determined disabled under Social Security Administration rules and be of age 65 and above. Their gross monthly income is less than 1,343 dollars for individuals and 1,795 dollars for couples. Their total countable resources should be less than 4,000 dollars for individuals and 6,000 dollars for couples.
California on the other hand provide almost similar services but with some variations. The Supplementary Security Income caters for all who qualify for full med-cal coverage. The beneficiaries are 65 years or older, blind or disabled. Their countable monthly income should not exceed 889.40 dollars for individuals or 1,496.20 dollars for a couple. Higher income levels apply for individuals who are visually impaired.
The other program is Aged and Disabled Federal Poverty Level Program. Those who are eligible are those aged 65 and above or disabled. They must not be eligible for the Supplementary Security Income program, or may be able to get medical through the Aged and Disabled Federal Poverty Level Program. The disabled must meet social security's definition of disability even if disability is blindness. They have less than 2000 dollars in asset for individuals and 3000 dollars for couples. The monthly countable income is less than 1121 dollars for individuals and 1638 dollars for couples.
California also has another program known as Medi-cal with share of cost. The monthly limits for this program is higher than the limits to qualify for SSI or the A&DFPL program, but one meets the asset level requirements with a share of cost.
Finally, there is the 250% California Working Disabled program. These residents of the state are working, disabled and have an income too high to qualify for free med-cal. The beneficiaries pay a small monthly premium based on their income. They should meet the medical requirements of social security's definition of disability. They are not required to meet the agency's income and work requirements. Their assets are less than 2000 dollars for individuals and 3000 dollars for couples. Their countable income is less than 250% Federal Poverty level.
Mississippi and California states response to the option of expanding the Medicaid benefits proposed by Healthcare Reform
Mississippi State rejected the expansion even though it is one of the sickest and poorest states in America. Most people are uninsured with one out of seven people uninsured. The state claimed that it could not afford the corresponding share of state money it will have to put up to add hundreds of thousands of people to the government health insurance program for the poor.
California on the other hand responded by passing a bill (SB1124) that would stop med-cal from trying to collect repayment for routine medical care and insurance premiums (Wagster, 2012). The department of finance opposed the bill because it would cost med-cal an estimated 30 million dollars year (Wagster, 2012). The law requires medi-cal to seek reimbursement for the cost of any care delivered to an enrollee aged 55 and above provided they did not have a surviving spouse or minor or disabled children. The law also allows heirs to obtain an exemption from the recovery if they can show it would cause them substantial hardship, such as forcing them to remain on public benefits.